OBJECTIVE:This study assessed the associations between gender identity (transmasculine vs transfeminine) and sexuality-related variables, including marital status, sexual partners, sex work, and age at first intercourse. METHODS:We conducted a cross-sectional retrospective study at a specialized transgender clinic in São Paulo, Brazil, analyzing medical records from March 2020 to August 2023. Data were routinely collected during clinical consultations through standardized questions for individualized care. Group assignment was based on self-identified gender identity documented in medical records. Chi-square and t-tests were applied (P < 0.05). RESULTS:We evaluated 74 individuals (trans men = 49, trans women = 25). Trans women were more frequently single (76% vs 44.9%, P = 0.014). Most reported one to five partners, but trans women more frequently reported no partners (16.7%) or >15 partners (11.1%) (P = 0.043). Sex work was more common among trans women (21.7% vs 6.3%, P = 0.049). No significant difference in age at first intercourse was observed (P = 0.298). CONCLUSION:Gender identity significantly influences relationship status, sexual behavior, and sex work engagement among transgender individuals. Trans women experienced greater sexual vulnerability, reflecting social exclusion and structural transphobia. These findings underscore the need for inclusive sexual health strategies and policies reducing structural inequalities.

Objective: To evaluate the clinical and metabolic parameters of women after natural or surgical menopause. Methods: We carried out a cross-sectional study in which we analyzed 686 medical records of women after natural or surgical menopause treated at the Menopause Outpatient Clinic of the Department of Obstetrics and Gynecology of a Public Hospital in São Paulo between 2020 and 2022. Data collected from medical records were: age, age at menopause, type of menopause, body mass index (BMI), waist circumference, blood pressure, HDL, triglycerides, fasting blood glucose and medication use. An interview was carried out about the use of medications during the consultation, and it was noted when the patient confirmed the use of any of these medications. Results: Women showed no difference between ages and age at menopause differed between groups. The average BMI of participants in both groups showed that they were obese (grade I obesity) and presented an increase in the average value of abdominal circumference and a high risk for cardiovascular diseases. Conclusion: The type of menopause did not lead to changes in the clinical parameters of women after natural or surgical menopause.

Introduction: Maternal colonisation with Streptococcus agalactiae, or Group B Streptococcus (GBS), during pregnancy increases the risk of neonatal infection through vertical transmission from the mother to the foetus, either before or during labour. This study aimed to evaluate the antimicrobial activity of the Sep-Pak 80% ( SP80 ) fraction derived from Allium sativum L. and its synergistic potential with antibiotics against GBS strains. Methods: Antimicrobial activity and potential synergism were assessed via broth microdilution and disk diffusion assays. Fifty-five clinical isolates and one American type culture collection (ATCC) strain of GBS were tested with the disk diffusion method to assess the combination of the SP80 fraction with ampicillin and penicillin G. A broth microdilution assay was performed on one ATCC strain. Results: The minimum inhibitory concentrations of SP80, ampicillin, and penicillin G against Streptococcus agalactiae (ATCC 12386) were 5 mg/mL, 0.01 mu g/mL, and 0.06 mu g/mL, respectively. The combination of SP80 with antibiotics, assessed through broth microdilution, demonstrated an additive effect. Statistical analysis revealed that the mean inhibition zone for ampicillin, when combined with the SP80 fraction using the disk diffusion method, was greater than that for ampicillin alone, although the difference was not statistically significant. For penicillin G, the mean remained unchanged when it was combined with SP80. The inhibition zones of the isolated antibiotics revealed that the tested strains were more resistant to penicillin G than to ampicillin. Conclusions: The SP80 fraction exhibits antimicrobial activity against GBS. When combined with antibiotics, it has an additive effect, suggesting that this approach could be promising for combating GBS infections.

OBJECTIVE: The aim of this study was to characterize the anthropometric, lipid, and dietary profiles of postmenopausal women with metabolic syndrome attending a public health service and compare them with a group of women without metabolic syndrome. METHODS: A cross-sectional study was conducted with 60 postmenopausal women who were divided into two groups: control group and metabolic syndrome group, attending the Climacteric Outpatient Clinic at Santa Casa de S & atilde;o Paulo Hospital, Brazil, between February 2019 and December 2021. Participants were evaluated using a validated semi-quantitative food frequency questionnaire, body mass index, waist circumference, and serum laboratory tests. RESULTS: Significant differences were observed between the groups regarding body mass index and all parameters of metabolic syndrome. The nutritional profile revealed an imbalance in the number of food portions consumed, particularly in the intake of carbohydrates in the form of flour and sweets, which was higher in the metabolic syndrome group. CONCLUSION: The analysis of the three profiles of postmenopausal women revealed significant imbalances, particularly in the metabolic syndrome group, highlighting the importance of regular adjustments and evaluations during this phase of a woman's life.

OBJECTIVE:The aim of this study was to compare endometrial thickness with the use of transdermal estrogen (gel) versus oral estrogen (pills) for endometrial preparation in the frozen embryo transfer cycle and serum estrogen concentrations during the preparation cycle, side effects, and chemical and clinical pregnancy rates. METHODS:This was a prospective, randomized controlled trial of women undergoing endometrial preparation for cryopreserved blastocyst transfer. A total of 88 women were randomized, of which 82 completed the study protocol. Of this group, 44 received 6 mg/day of estradiol valerate orally (pills group) and 38 received 4.5 mg/day of estradiol hemihydrate transdermally (gel group). Endometrial thickness was measured using transvaginal ultrasound between the 7 and 10th day of the cycle. Serum estradiol concentrations were measured on the day of initiating the cycle, on control transvaginal ultrasounds, and on the day of embryo transfer. Side effects were documented at each study visit. p<0.05 were adopted as statistically significant. The groups were compared using Student's t-test for continuous variables and chi-square or Fisher's exact test for categorical variables. RESULTS:There were no significant group differences (p>0.05) in endometrial thickness, biochemical and clinical pregnancy rates, miscarriage rate, blood estradiol concentrations, duration of estradiol administration, or cycle cancellation rates. CONCLUSION:Endometrial preparation with transdermal estrogen yielded similar reproductive outcomes to oral estrogen with fewer side effects.

Abstract Objective The study aimed to evaluate the antimicrobial activity of the SP80 fraction (obtained from Allium sativum) and its synergism with the antibiotic against strains of GBS. Methods The broth microdilution and disk diffusion assays were used to determine the antimicrobial and synergistic activity of Sep-pak 80% (SP80) in combination with ampicillin and penicillin G, respectively. Results The results showed that the combination of SP80 and antibiotics respectively showed an additive effect. Conclusions The SP80 fraction has antimicrobial activity against GBS, and the association with the antibiotic has an additive effect.

Abstract Maternal colonization by Streptococcus agalactiae or Group B Streptococcus(GBS) during pregnancy increases the risk of neonatal infection due to vertical transmission from mother to fetus before or during labor. The study aimed to evaluate the antimicrobial activity of the SP80 fraction (obtained from Allium sativum) and its synergism associated with the antibiotic against strains of GBS. The broth microdilution was used to determine the antimicrobial activity of the SP80 and to establish the MIC of SP80 (2.40 mg/mL). By using, the disk diffusion method, fifty-five clinical isolates and 1 ATCC of GBS were tested against the association of the SP80 fraction with antibiotic PEN and AMP, respectively, for synergistic assessment. The results showed that the association of SP80 + PEN did not alter the response of PEN alone. In contrast, the association of SP80 + AMP caused the mean inhibition halos to increase with a p<0.001. The SP80 fraction has antimicrobial activity against GBS, and the association with the antibiotic AMP showed a synergistic effect, which did not occur when in association with PEN.

OBJECTIVE: The aim of this study was to compare the distribution of fat tissue in non-obese women with polycystic ovary syndrome and those without the syndrome using dual-energy radiological densitometry.METHODS: This was a case-control study in which we enrolled women aged 14-39 years with polycystic ovary syndrome according to the Rotterdam criteria with a body mass index between 18.5 and 30 kg/m2. The control group comprised women with the same profi le, but without polycystic ovary syndrome. Patients were treated at the Endocrinological Gynecology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Irmandade da Santa Casa de Misericordia de Sao Paulo between 2019 and 2022. Anthropometric measurements were taken and the assessment of body composition was performed using dual-energy radiological densitometry.RESULTS: The sample comprised 57 women: 37 in the polycystic ovary syndrome group and 20 in the control group. The mean age of the polycystic ovary syndrome group was 24.9 years (+/- 6.9) with a mean body mass index of 60.8 kg/m2 (+/- 8.5), and for the control group, it was 24.2 years (+/- 6.9) with a mean body mass index of 58 kg/m2 (+/- 8.4). Body composition was evaluated using dual-energy radiological densitometry and showed a higher value of trunk fat in the polycystic ovary syndrome group (44.1%, +/- 9.0) compared to the control group (35.2%, +/- 11.4), which was statistically significant (p=0.002).CONCLUSION: Our study showed that non-obese polycystic ovary syndrome patients have a higher concentration of abdominal fat, which is a risk factor for increased cardiovascular risk and insulin resistance.

Background: The objective was to compare the use of micronized vaginal progesterone 800 mg daily and oral dydrogesterone 40 mg daily in the endometrial preparation for frozen-thawed embryo transfer (FET). Methods: Prospective randomized study with women undergoing FET along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally received 40 mg/day dydrogesterone (DYD group, n = 36) or 800 mg/day micronized vaginal progesterone (MVP group, n = 37) after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation. Biochemical pregnancy, clinical pregnancy and live birth rates were the secondary outcome. Results: The reproductive outcomes in FET cycles were similar, with pregnancy and Live birth rates in the didrogesterone and MVP treatment groups being respectively: Biochemistry (38.9%/37.8%; p = 0.189 [95% confidence interval (CI) = –23.4–21.2]), Clinical (33.3%/35.1%; p = 0.192 [95% CI = –20.0–23.6]); 12 Weeks Pregnancy (33.3%/32.4%; p = 0.196 [95% CI = –22.4–20.6]); Live birth (33.3%/32.4%; p = 0.196 [95% CI = –22.4–20.6]). Conclusions: 40 mg/day dydrogesterone and 800 mg/day MVP revealed similar reproductive results in FET cycles. The use of oral dydrogesterone is a reasonable option, may be more accepted by patients in terms of ease of use and lower cost. Clinical Trial Registration: U1111-1247-1845.

OBJECTIVE:This study aimed to evaluate the prevalence of ovarian hyperstimulation syndrome (OHSS) and associated risk factors in patients undergoing fertilization cycles at risk of OHSS (≥15 antral follicles or ≥15 oocytes aspirated) and submitted to cryopreservation of all embryos in the Human Reproduction Service of the Pérola Byington Hospital (Referral Center for Women's Health) in São Paulo, SP, Brazil. METHODS:This cross-sectional, institutional, descriptive study of secondary data from patients' charts enrolled in the Assisted Reproduction Service of the Pérola Byington Hospital at risk of OHSS after controlled ovarian stimulation and submitted to cryopreservation of all embryos was conducted between January 2015 and September 2017. RESULTS:OHSS occurred in 47.5% of cycles, all with mild severity, and there were no moderate or severe cases of OHSS. CONCLUSION:The cryopreservation of all embryos is associated with a reduction in moderate and severe forms of OHSS. Risk factors for OHSS should be evaluated prior to initiation of treatment, with less intense stimulation protocols accordingly.

This study focused on the unbalanced relationships that can arise in current public–private partnership (PPP) risk management frameworks, especially in developing countries’ water sectors. Different stakeholders’ perceptions of risk management were examined by analyzing 15 interviews in Portugal and Mozambique. The hybrid method included semantic, descriptive statistic, content, and narrative analyses. To achieve the research objectives, the semi-structured interview transcripts were processed using quantitative and qualitative techniques to collate relevant actors’ opinions of risk management in PPP water projects. Five risk categories were identified. The interviewed experts ranked the financial risk category as the most crucial, followed by infrastructure, commercial, technical and operational, and context risks. However, when the transcripts were evaluated from a risk factor perspective, the context risk category unexpectedly jumped to first place. Twenty-five high-impact risk factors were isolated in the semi-structured interview contents. The top five most critical risk factors were political interference, no performance measurement baselines, an unfavorable private investment climate, nonpayment of bills, and water assets uncertain condition. The results comprise a fresh contribution to the existing knowledge about experts’ perceptions of PPP contract risks, including that prior research and specialists categorize financial risks as the most important. The findings further reveal that experts consider managing context risks to be the key factor in PPPs success in developing countries, as well as highlighting the need to explore these risks more fully in emerging economies’ water sectors. In addition, a complete risk management cycle is proposed based on the interviewed professionals’ opinions, in which risk assessment and risk treatment or mitigation measures are dealt with simultaneously.

OBJECTIVE:The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer.METHODS:This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound.RESULTS:The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196).CONCLUSIONS:The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Maternal colonization by Group B Streptococcus during pregnancy increases the risk of neonatal infection due to vertical transmission from mother to fetus before or during labor. The aims of this study were to evaluate the antimicrobial activity of SP80 (obtained from RGE) and its synergism associated with the antibiotic against strains of Streptococcus agalactiae . Biomonitoring of SP80 disclosed antimicrobial activity only in fractions F18, F19, F20 and F42. The broth microdilution was used to determine the antimicrobial activity of SP80 and fractions from SP80 and to establish the MIC of SP80 (2.40 mg/mL). By using the disk diffusion method, fifty-five clinical isolates of S. agalactiae and 1 ATCC were tested against the association of SP80 with antibiotic penicillin G and ampicillin, respectively, for synergistic assessment. The association of SP80 with penicillin G showed that the mean of the inhibition halos decreased, but it was not significant, with p<0.07 . In contrast, the association of SP80 with ampicillin caused the mean inhibition halos to increase with a p<0.001 , a significant result. SP80 has antimicrobial activity against S. agalactiae Gram-positive bacteria, and the association with the antibiotic ampicillin showed a synergistic effect, which did not occur when in association with penicillin G.

To assess the effects of Cimicifuga racemosa (L.) Nutt on climacteric symptoms and sexual function in women receiving tamoxifen after breast cancer treatment. A prospective study of women treated at the Mastology Outpatient Clinic of the Department of Obstetrics and Gynecology of the Santa Casa de Sao Paulo School of Medical Science of the hospital was conducted between 2018 and 2021. Patients diagnosed with breast cancer that underwent surgical, radiotherapy and chemotherapy treatment more than one year prior, receiving tamoxifen, exhibited climacteric symptoms and were sexually active were selected. Total of 34 women were recruited and during outpatient visits completed sociodemographic questionnaire, Blatt-Kupperman Index (KI) and Female Sexual Function Index (FSFI). The group showed improvements in climacteric symptoms (p<.001) and sexual function (p=.011) after the 6-month follow-up. Cimicifuga racemosa (L.) Nutt promoted improvements in climacteric symptoms and sexual function in women surgically treated for breast cancer. Clinical Trials.gov ID: NCT02467686.Impact StatementWhat is already known on this subject? The medications used for the treatment of breast cancer can lead to important complaints of vasomotor manifestations with a negative impact on the success of their treatment, and cases have been described until their interruption. Cimicifuga racemosa (L.) Nutt. is described in several works as a therapy to alleviate these symptoms. Numerous works in the literature present climatic symptoms and sexual function with a selective approach to the themes.What do the results of this study add? Our study evaluated a group of women who were treated for breast cancer after menopause taking into account the following aspects: climacteric symptoms and sexual function. When we reviewed the literature, we did not find, so far, work similar to ours.What are the implications of these findings for clinical practice and/or further research? In clinical practice, assessing vasomotor symptoms and sexual response of breast cancer patients can contribute towards improving the lives of this patient group. Prescribing Cimicifuga racemosa (L.) Nutt in cases with climacteric complaints and poor sexual response can relieve distress and promote better health and life status for these women. Although the present investigation has generated important data on female breast cancer survivors, there are limitations regarding the number of participants. We recommend further clinical research with expansion of the sample studied and the results presented.

Invasive disease due to group B streptococcal (GBS) infection results in a wide spectrum of clinical disease in neonates. Maternal colonization by GBS is the primary risk factor for disease.

Public-private partnerships (PPPs) offer possible solutions for governments seeking to achieve better value for money and fund the investments needed to provide infrastructure and manage public services. Water-sector projects demand extensive, up-front and sunk investments, and inefficiency levels are often significant. This study conducted a systematic review of previous research on water sector PPP projects. The research design is innovative in that it relied on a hybrid methodology combining systematic quantitative, semantic network and narrative analyses. The literature review protocol applied found 122 relevant studies published in top journals. Five key topics within water-related PPP studies were identified: risk management, PPP contractual arrangements, financing and tariffs, infrastructure, and governance. The most important topic is risk management, within which individual scholars’ contributions were tracked. However, a consensus has not been reached about the best risk matrix for improving PPP contracts in the water sector.

This research sought to determine how public–private partnership (PPP) arrangements can more efficiently address risk management issues using the example of Mozambique as a case study. Analyses of 15 interviews in this country were conducted using the Gioia methodology. The results indicate that integrating key risk indicators into PPP contracts can improve risk management. These measures have been widely used in company risk management. The indicators can serve as monitoring, reviewing and supervising tools, allowing the integration of external factors into PPP contracts at the right time, which is hard to predict when the contracts are signed. Key risk indicators can capture megatrends, track risk evolution and develop future scenarios throughout the entire lifecycle of contracts, preventing conflicts between partners, contract renegotiations or early contract terminations by facilitating an improved understanding of contracts' current realities. The findings suggest that these measures should be applied by PPP units. The proposed approach encourages originality and empirical research-based improvements of PPP risk management frameworks and provides guidelines for future studies.

OBJECTIVE:This study aimed to identify the morbidities and medications used by nurses practicing in São Paulo, Brazil, during the climacteric period to raise awareness and contribute to future preventive health measures in this population.METHODS:A descriptive, cross-sectional study of 218 nurses aged 46-65 years based on data collected between January 2018 and July 2019 using a self-administered questionnaire was conducted.RESULTS:Respondents had a mean age of 53.9±5.1 years, mean weight of 71.3±13.6 kg, mean waist circumference of 91.6±14.5 cm, and mean body mass index of 27.8±4.9 kg/m2. Notably, 70.5% did not menstruate, had a mean age at last menstruation of 47.5±6.2 years and mean total score (Menopause Rating Scale) of 10.8±8.1, and reported the following morbidities: dyslipidemia (35.5%), subarachnoid hemorrhage (31.0%), rheumatologic diseases (14.8%), coronary heart disease (10.3%), diabetes (10.2%), malignant tumors (5.5%), deep venous thrombosis (3.2%), stroke (2.8%), and pulmonary embolism (0.5%). Medications used are antihypertensive agents (28.7%), antidyslipidemic agents (20.6%), antidiabetic agents (10.2%), antidepressants (9.6%), and anxiolytic agents (8.9%).CONCLUSIONS:The most prevalent climacteric symptoms were somatic and psychological, most notably physical and mental exhaustion and muscle and joint issues. The most common morbidities were anxiety, dyslipidemia, arterial hypertension, depression, arthrosis, arthritis and rheumatologic diseases, osteoporosis, diabetes mellitus, and coronary heart disease. The most frequently used medications were antihypertensive agents, antidyslipidemic agents (statins), antidiabetic agents, antidepressants, and calcium supplements. The study results furnish information on the health of practicing nurses during the climacteric period to inform preventive measures aimed at the main risk factors for morbidities to which nurses are exposed during this period.