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O cuidado psicológico ao médico em reprodu??o assistida: um enquadre diferenciado
Miranda, Keith Laura;Serafini, Paulo Cesar;Baracat, Edmund Chada;
Estudos de Psicologia (Campinas) , 2012, DOI: 10.1590/S0103-166X2012000100008
Abstract: health professionals have to deal with human suffering, even if they don't deal directly with interventions in the psychology area. this study was based on psychoanalysis, with the aim of understanding the aspects of human suffering which emerge with doctors in the exercise of their work with assisted human reproduction, considering the collective model concerning the difficult situations that they have to deal with in their clinics. twenty-two doctors working in hospitals and clinics in the state of s?o paulo, in both private and public facilities, volunteered to participate, ignoring sex, age and time since graduation. the drawing and storytelling thematic was used as the dialogical procedure. the interview was characterized as a special situation with the expression and communication of emotions generated in sessions related to the proposed theme. it was found that there was a need for the proposition of facilitating spaces for emotional expression, promoting the containment of human suffering and the occurrence of the transforming life reflection experiences of reality.
Novos conhecimentos sobre a flora bacteriana vaginal
Linhares, Iara Moreno;Giraldo, Paulo Cesar;Baracat, Edmund Chada;
Revista da Associa??o Médica Brasileira , 2010, DOI: 10.1590/S0104-42302010000300026
Abstract: the aim of this review is to update knowledge about the vaginal ecosystem, non-cultivation methods for bacterial identification (gene amplification), the lactobacillus species that comprise normal vaginal flora and influence of host genetics on bacterial interactions with local innate and acquired immune defenses. a medline (pubmed) search from 1997-2009 for relevant articles was performed and the most informative articles were selected. non-culture techniques (gene amplification) allow a comprehensive analysis of the vaginal ecosystem's composition. in the majority of women in the reproductive age there is a predominance of one or more species of lactobacillus: l. crispatus, l. inners and l gasseri. however, in other apparently healthy women there is a deficiency or complete absence of lactobacilli. instead, there is a substitution by other lactic acid-producing bacteria: atobium, megasphaera and/or leptotrichia species. the infectivity and/or proliferation of pathogenic bacteria in the vagina is suppressed by lactic acid production, by products of endogenous bacteria and by activation of local innate and acquired immunity. vaginal epithelial cells produce several compounds with anti-microbial activity. these cells have toll-like receptors on their membrane that recognize molecular patterns associated with pathogens. recognition leads to production of pro-inflammatory cytokines and stimulation of antigen-specific immunity. the production of igg and iga antibodies is also triggered in the endocervix and vagina in response to infection. vaginal flora composition and the immune mechanisms constitute important defenses. criteria of normal and abnormal flora have to be reviewed and genetic polymorphism can explain variations in flora composition. this new knowledge should be included in the clinical practice of gynecologists and obstetricians to improve patients care.
Fallopian tube origin of supposed ovarian high-grade serous carcinomas
Diniz, Patricia Martini;Carvalho, Jesus Paula;Baracat, Edmund Chada;Carvalho, Filomena M;
Clinics , 2011, DOI: 10.1590/S1807-59322011000100013
Abstract: introduction: serous carcinomas are the most frequent histologic type of ovarian and peritoneal cancers, and can also be detected in the endometrium and fallopian tubes. serous carcinomas are usually high-grade neoplasms when diagnosed, yet the identification of an associated precursor lesion remains challenging. pathological examination of specimens obtained from prophylactic bilateral salpingo-oophorectomies that were performed for patients harboring brca1/2 mutations suggests that high-grade serous carcinomas may arise in the fallopian tubes rather than in the ovaries. objective: to investigate the presence and extent of fallopian tube involvement in cases of serous pelvic carcinomas. methods: thirty-four cases of serous pelvic carcinoma with clinical presentations suggesting an ovarian origin were analyzed retrospectively. histologic samples of fallopian tube tissues were available for these cases and were analyzed. probable primary site, type of tubal involvement, tissues involved in the neoplasia and vascular involvement were evaluated. results: fallopian tube involvement was observed in 24/34 (70.6%) cases. in 4 (11.8%) of these cases, an intraepithelial neoplasia was present, and therefore these cases were hypothesized to be primary from fallopian tubes. for an additional 7/34 (20.6%) cases, a fallopian tube origin was considered a possible primary. conclusions: fallopian tubes can be the primary site for a subset of pelvic high-grade serous carcinomas.
Fatores biocomportamentais e as altera??es no número das células de Langerhans
Uchimura, Nelson Shozo;Ribalta, Julisa Chamorro Lascasas;Focchi, José;Baracat, Edmund Chada;Uchimura, Taqueco Teruya;
Revista Brasileira de Ginecologia e Obstetrícia , 2004, DOI: 10.1590/S0100-72032004000400004
Abstract: objective: to study the relationship of biobehavioral factors, such as age, menarche, number of gestations, and age of first sexual intercourse, with changes in langerhans'cells in women with negative hybrid capture for hpv. methods: thirty women referred due to abnormal cervical cytology or premalignant cervical lesions were studied and underwent colposcopy, guided biopsy and histopathological exams. the langerhans' cells were identified by immunohistochemical (s100+) exams. langerhans' cells visualized in brown color were counted using the software cytoviewer. the nonparametric wilcoxon rank-sum test was employed for statistical analysis. results: the number of langerhans' cells in women who had menarche after 13 years old presented statistically significant difference (173.34 cell/mm2) compared to the group whose menarche occurred before 13 (271.41 cell/mm2). the age at the first sexual intercourse was associated with the low number of langerhans' cells, 127.15 cell/mm2 and 250.14 cell/mm2, respectively, for the beginning of the sexual activity up to 17 years old and after 17 (p=0.03). previous cauterizations of the uterine cervix have been related to a lower number of langerhans' cells in the epithelium, with the average 120.30 cell/mm2 as compared to 236.06 cell/mm2 for those women who never underwent that procedure (p=0.05). other factors such as the patient's age and the number of gestations showed no statistically significant differences in the density of langerhans' cells. conclusions: the present study reports the association of biobehavioral factors with decrease in the number of langerhans' cell.
Influência do uso de anticoncepcionais hormonais orais sobre o número de células de Langerhans em mulheres com captura híbrida negativa para papilomavírus humano
Uchimura, Nelson Shozo;Ribalta, Julisa Chamorro Lascasas;Focchi, José;Baracat, Edmund Chada;Uchimura, Taqueco Teruya;
Revista Brasileira de Ginecologia e Obstetrícia , 2005, DOI: 10.1590/S0100-72032005001200004
Abstract: purpose: to study the influence of the use of oral contraceptives (oc) on the number of langerhans' cells in women without cervical infection by human papillomavirus (hpv). methods: thirty women who presented abnormal cervical cytology and colposcopy-guided biopsy with samples of uterine cervix negative for hpv were selected. the absence of hpv dna was confirmed by hybrid capture. langerhans' cells were identified by immunohistochemistry using anti-s100 antigens. the cells visualized in light microscopy were counted using the cytoviewer software. the nonparametric wilcoxon rank sum test was employed for statistical analysis. results: the average number of langerhans' cells in oc users was 320.7/mm2 and in non-users 190.7/mm2, this difference being statistically nonsignificant. in the intermediary layer of the cervical epithelium a tendency towards the increase of these cells was observed, with the averages 192.1/mm2 for oc users and 93.4/mm2 for non-users (p=0.05). conclusions: the present study reports a tendency towards the increase in the number of the langerhans' cells among oc users. this result suggests the oc may induce alterations in the number of langerhans' cells, but considering the limited number of cases, more studies should be developed for a definitive conclusion.
Efeitos da associa??o estro-androgênica em mulheres na pós-menopausa
Mameri Filho, Justino;Haidar, Mauro Abi;Soares Júnior, José Maria;Baracat, Edmund Chada;
Revista Brasileira de Ginecologia e Obstetrícia , 2005, DOI: 10.1590/S0100-72032005000300004
Abstract: purpose: to evaluate the effects of the association of estrogen and androgen on the quality of life and sexuality of women during climacterium. methods: ninety-six postmenopausal women with vasomotor symptoms and sexual dysfunction were included. the participants were randomly divided into three treatment groups with 32 pacients each: placebo, conjugated equine estrogens (cee) (0.625 mg per day) and cee (0.625 mg per day) associated with methyltestosterone (2.5 mg per day). the length of the treatment period was three months. the women health questionnaire (whq) and the modified sexuality questionnaire were applied to evaluate the quality of life and sexuality before and after the treatment. some parameters of cardiovascular risk, endometrial echo and hepatic toxicity were evaluated. anova was used for data analysis followed by the fisher test and the shapiro-wilk post hoc test. results: the improvement in whq parameters was significant in the hormonal treatment groups (cee and cee + methyltestosterone) compared to the placebo group. however, there were no differences in somatic symptoms among the three groups. the association of estrogen with androgen significantly improved sexual function (score (mean): 64 vs 67, p<0.05) and depressive humor (score (mean): 75 vs 80, p<0.05) compared to estrogen alone. this therapy also presented a large number of whq questions with a high score (p<0.05). the use of cee associated with methyltestosterone decreased the total cholesterol (212±42 and 194±43, before and after the treatment, respectively) and hdl colesterol (56±16 and 48±14, before and after the treatment, respectively), and slightly increased the endometrial echo (4.7±2.3 and 5.5±2.3, before and after the treatment, respectively). no signifcant changes in liver enzymes during the treatment period was detected. conclusions: estrogen associated with methyltestosterone resulted in significant improvement in the quality of life and sexuality of postmenopausal women. this e
Efeitos de diferentes doses de tamoxifeno sobre a prolifera??o celular do epitélio mamário
Facina, Gil;Baracat, Edmund Chada;Lima, Geraldo Rodrigues de;Gebrim, Luiz Henrique;
Revista Brasileira de Ginecologia e Obstetrícia , 2003, DOI: 10.1590/S0100-72032003000300007
Abstract: purpose: to quantitatively analyze the immunoreaction of monoclonal antibody ki-67 in the mammary epithelium adjacent to fibroadenoma of premenopausal women treated with tamoxifen, for 50 days, at doses of 5, 10 and 20 mg/day. methods: we studied, prospectively, the effects of tamoxifen administered for 50 days, at doses of 5, 10 e 20 mg/day, by the immunoreaction of the ki-67 (clone ki-s5) monoclonal antibody on mammary epithelium adjacent to fibroadenoma in premenopausal women. we studied 58 patients in a double-blind trial who were divided into four groups: group a (n=13; placebo), group b (n=16; 5 mg/day tamoxifen), group c (n=14; 10 mg/day) and group d (n=15; 20 mg/day). all patients received the medication from the first day on of the menstrual cycle and biopsy was performed on the last day of the treatment. cells stained and not stained by the immunoreagent were counted by optical microscopy (400x) with a digital image capturing system and image analysis. results: the average percentage of stained nuclei was calculated for all groups: group a was 2.0 with a standard error (se) of 0.3. in group b it was 0.7 (se=0.2); in group c it was 0.4 (se=0,2) and in group d it was 0.1 (se=0). statistical analysis showed significant reductions between the groups (p<0.001), and tukey's pairwise comparison test confirmed that there was a significant increase in the immunoreaction of the monoclonal ki-67 antibody in groups b, c and d. conclusions: tamoxifen, administered at doses of 5, 10 and 20 mg/day for 50 days, significantly reduced the immunoreaction of monoclonal ki-67 in the mammary epithelium of premenopausal patients and there was no significant difference between the groups that received 5, 10 and 20 mg/day tamoxifen.
Avalia??o dos Métodos Empregados no Programa Nacional de Combate ao Cancer do Colo Uterino do Ministério da Saúde
Roberto Neto, Alfredo;Ribalta, Julisa Chamorro Lascasas;Focchi, José;Baracat, Edmund Chada;
Revista Brasileira de Ginecologia e Obstetrícia , 2001, DOI: 10.1590/S0100-72032001000400003
Abstract: purpose: to evaluate a populational sample of the screening proposed by the national program of uterine cervical cancer control (pncc), regarding the following issues: frequency of unsatisfactory cytologic results, cytologic frequency of atypical squamous or glandular cells of undetermined significance (ascus, agcus), low- or high-grade squamous intraepithelial lesions (sil), comparing the cytologic results with anatomicopathological results of colposcopically directed biopsies. methods: through the written, broadcasting television and oral midia, women between 35 and 49 years were requested to have a preventive cytopathological test, to be collected by the authorized public health or other institutions accredited by sus. the slides were analyzed by the program-authorized laboratories and all those patients from the populational sample from the municipality of naviraí in the state of mato grosso do sul with cellular alterations were submitted to colposcopy and directed biopsy. results: the frequency of cytologic alterations of the ascus, agcus and sil types was 3.3%, an index that is close to that predicted by the pncc (4%); the percentage of samples that were unsatisfactory for evaluation was high (12.5%); among the ascus, agcus or low grade-sil patients, 27.3% presented intraepithelial lesions of a high grade in the anatomicopathological study; while patients with cytology compatible with high grade-sil, the directed biopsy revealed that 12.5% presented low-grade intraepithelial lesions. conclusions: the choice of oncological cytology as the only method for the screening in the program allowed high indexes of false-negatives (27.3%) and of false-positives (12.5%). in the screening of cervical neoplasms, colposcopy has shown to be an important and indispensable method to guide the therapeutical management to be adopted.
Fatores associados à qualidade de vida após menopausa
De Lorenzi, Dino Roberto Soares;Baracat, Edmund Chada;Saciloto, Bruno;Padilha Jr., Irineu;
Revista da Associa??o Médica Brasileira , 2006, DOI: 10.1590/S0104-42302006000500017
Abstract: objective: to assess quality of life of postmenopausal women. methods: a cross-section study of 323 women between 45 and 60 years of age attended at a university climacteric clinic from june to october 2002was carried out. quality of life was assessed by the women's health questionnaire (whq). statistical analysis was performed with student's t test and analysis of variance, followed by multiple linear regression analysis. results: this study found quality of life impaired especially in the domains related to somatic symptoms, depressed mood, and anxiety. multivariate analysis showed that lower educational level (p<0.01, frequency of sexual activity (p<0.01) and the confirmation of previous clinical co-morbidities (p=0.03) were associated to the worst scores of quality of life. on the other hand, regular physical activity was related to better quality of life (p=0.01). hormone therapy, in particular, was not related to quality of life (p=0.48). conclusion: quality of life was found not only to be influenced by biological factors, but also by psychossocial and cultural factors. middle aged women frequently attributed eventual symptoms associated to clinical co-morbidities or previous emotional difficulties to menopause, distorting their perception of this phase in their life. in this sense, the educational level contributed to a better understanding of body changes at this time, reducing anxiety levels and encouraging self-care. sexuality was also an important aspect related to quality of life in the climacterium.
Do Estrogens improve bone mass in osteoporotic women over ten years of menopause
Szejnfeld, Vera Lucia;Souen, Jorge Saad;Baracat, Edmund Chada;Atra, Edgard;Lima, Geraldo Rodrigues de;
Sao Paulo Medical Journal , 1994, DOI: 10.1590/S1516-31801994000100009
Abstract: a retrospective analysis of 24 patients with established osteoporosis and with ten or more years of menopause treated with conjugated estrogen, progesterone and calcium followed for one year has been performed. treated women received 0.625 mg/day of conjugated estrogen from day 1 to 25, 5 mg/day of medroxiprogesterone from day 13 to 25, of each cycle, plus calcium (500 - 1000 mg/day), during one year (12 cycles). as control group was used 18 age-matched that received only calcium (500 a 1000 mg/day). all patients had at least two dual-photon spine and proximal femur (neck, ward's triangle and trocanter) densities measurements performed 12 months apart. estrogen treatment was associated with increased bone mineral density at spine and trocanter. control group did not present any statistically change after one year in any site studied. we concluded that women with ten or more years of menopause and established osteoporosis treated with replacement hormonal therapy and calcium results in improvement of bone mineral density. these data support that women with ten or more years of menopause respond to estrogen replacement therapy with absolute increments in bone density similar to those seen in younger women, in the early menopause.
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