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Introdução: As pessoas transexuais encontram uma série de dificuldades no atendimento médico, tanto na rede privada como na pública no Brasil. Objetivo: Demonstrar aos profissionais da área da saúde a realidade vivida pelas pessoas transexuais, quando necessitam de atendimento médico no Brasil, visando aprimorar os conhecimentos sobre o atendimento a este grupo populacional. Métodos: Coleta de dados realizada em fevereiro de 2020 com buscas nas bases eletrônicas: PubMed, Scielo, Lilacs e Google Scholar. Utilizou-se os descritores em associação: transgender; medical care; transexual; cross-sex hormone therapy, no período entre 2000 a 2020. Resultados: Encontramos 720 publicações com as palavras-chave transgender persons e medical care, 30 com as palavras-chave transgender, medical care e cross-sex hormone therapy, sendo escassos os estudos feitos no Brasil. Conclusão:Para que ocorra uma melhora no atendimento à saúde das pessoas transexuais é necessário que sejam inseridas disciplinas específicas sobre este tema na grade curricular dos cursos técnicos, de graduação e de pós-graduação da área da saúde.

Background Clinical presentation of celiac disease (CD) in terms of gender have demonstrated differences between symptoms among women and men. This study evaluated the differences in the clinical presentation of CD among Brazilian men and women at the time of diagnosis. Material and Methods We investigated data on symptoms and clinical signs of 240 patients (80 [33.3%] men and 160 [66.6%] women) aged >18 years who were diagnosed with CD during 2000–2017. The overall mean age at diagnosis was 38.3 ± 13.28 years, with the mean age being 38.1 ± 14.48 years for men and 38.4 ± 12.68 years for women (p = 0.16). Details regarding other previously diagnosed autoimmune diseases were enquired with the patient. All data were collected at the time of diagnosis of CD. Results Symptoms such as anxiety/depression (OR = 7.9), lack of appetite (OR = 3.5), flatulence (OR = 1.9), malaise (OR = 2.5), nausea (OR = 3.1), and vomiting (OR = 6.5) were more frequent in females than in males. Only steatorrhea was more frequent in men (OR = 2.6). Clinical signs such as anemia (OR = 2.8), short stature (OR >20), and weight loss (OR = 2.4) were also more frequent in women. Other findings such as diarrhea, abdominal distension or pain, and anorexia did not reveal differences in terms of gender. Regarding concomitant autoimmune diseases, dermatitis herpetiformis was more frequent in men (OR = 2.6), and thyroiditis was more frequent in women (OR = 10.5). Conclusion Our study has demonstrated that men and women with CD presented differences in clinical presentation at the time of diagnosis. Women exhibited more gastrointestinal symptoms and clinical signs than men.

OBJECTIVE To study a sample of Brazilian lesbian, bisexual, and heterosexual women concerning their gynecologic history and their experience with gynecologic care. METHODS An internet-based survey for women aged 18 years or older was conducted to gather epidemiologic data on sexual habits, primary gynecologic diseases, and patient-gynecologist relationships. RESULTS The survey was answered by 1201 women, with 571 reporting being heterosexual, 272 lesbian, and 358 bisexual. The lesbian/bisexual (LB) group contained fewer Caucasian individuals, used more public health resources, and had more individuals consuming tobacco, alcohol, and recreational drugs. No significant differences were found in the number of individuals with diabetes mellitus, obesity, hypertension, and sexually transmitted diseases. Depression was more common in the LB group. Endometriosis and vaginismus were more common in bisexual women, whereas polycystic ovary syndrome was more frequent in lesbians. Questions on the patient-gynecologist relationship revealed that most LB women felt uncomfortable and dissatisfied with the treatment received. CONCLUSION The LB group had different epidemiologic characteristics from the heterosexual group. Differences in morbid antecedents were found only in endometriosis, vaginismus, and polycystic ovary syndrome. Most LB Brazilian women are dissatisfied with treatment received from gynecologists.

Introdução: As dificuldades e diferenças no atendimento ginecológico são uma realidade encontrada pelas pacientes lésbicas e bissexuais quando comparadas às heterossexuais. Há uma necessidade de se entender o perfil dessas pacientes para um atendimento mais adequado. Objetivo: O objetivo do trabalho é avaliar o perfil sociodemográfico das mulheres lésbicas e bissexuais para que, com maior entendimento sobre essa população, o atendimento ginecológico passe a ser mais adequado. Material e método: Realizou-se um estudo transversal analítico. As participantes responderam de forma voluntária e anônima a um questionário adaptado em formato Google Forms, disponível on-line e divulgado pelas redes sociais e mídias virtuais, para mulheres maiores de 18 anos de todas as orientações sexuais, de setembro a dezembro de 2020. Os dados foram planilhados e analisados com o auxílio do programa Graph Pad Prism 5.0 e os valores p foram considerados significativos após a correção de Bonferroni. Resultados e conclusão: Responderam à pesquisa 751 pacientes heterossexuais, 272 lésbicas e 358 bissexuais. A maioria das participantes é de etnia caucasiana e tem ensino superior completo/incompleto. As pacientes lésbicas e bissexuais usam mais o sistema público de saúde, têm menores rendas salariais, fazem mais uso de tabaco e drogas ilícitas que as heterossexuais. Não houve diferença significativa na prática de atividade física entre os três grupos. A menor taxa de desemprego entre os três grupos é a das lésbicas. Não houve diferença significativa no índice de massa corporal entre os três grupos. Concluímos que essas mulheres possuem um perfil sociodemográfico diferente das heterossexuais, é necessário mais atenção às particularidades, ofertando um atendimento médico, especialmente ginecológico, mais embasado nas suas reais necessidades.

Objectives: Transgender individuals submitted to hormone or surgical treatment may have alterations in their bone metabolism as these elements are important players in bone remodeling. We aimed to study bone mineral density (BMD) and body composition in transwomen undergoing cross-sex hormonal treatment (CSHT) from Brazil for over 3 years, comparing them with female and male controls. Methods: 93 individuals (31 transwomen, 31 females and 31 males paired for age and body mass index) were studied for bone mass, and body composition by densitometry (by DXA). Epidemiological and clinical data were collected through direct questioning. Results: Low bone mass (T score ≤2) was found in 12.9% of transwomen; in 3.2% of females and 3.3% of males. Transwomen individuals had lower spine Z score (0.26 ± 1.42 vs 0.50 ± 1.19) and femur Z score (−0.41 ± 0.95 vs 0.29 ± 1.04) than females. They had lower total femur Z score than males (−0.41 ± 0.95 vs 0.20 ± 0.83). Lean mass values correlated positively with total femur BMD (ρ = 0.40; 95% confidence interval = 0.009–0.68; p = 0.04) and BMD in femoral neck (ρ = 0.48; 95% confidence interval = 0.11–0.74; p = 0.01) but neither the type of therapy received nor the time that they were used, impacted bone mass. Conclusion: Low BMD is found frequently in transwomen and it is correlated with lean body mass. Advances in knowledge: There are few studies of the effects of hormone therapy on the bones and muscles of transwomen. This study demonstrated that significant changes occur, and that the population studied needs greater care in musculoskeletal health.

Hypovitaminosis D is a global health problem that affects all age groups. Pregnant women are considered a high-risk group and the condition has potentially associated maternal and fetal complications. The goal of the present review is to analyze the magnitude and consequences of hypovitaminosis D in pregnant women and the safety of vitamin D supplementation. Prevalence of hypovitaminosis D during pregnancy is very high, even in sunny countries. Maternal vitamin D deficiency has been associated with increased risk of specific hypertensive disease of pregnancy, bacterial vaginosis, prematurity, gestational diabetes mellitus, osteomalacia, and muscle weakness. It has also been linked to prematurity, low birth weight, and fetal infectious complications. Due to potential maternal and fetal complications, it is extremely important to achieve adequate vitamin D levels prior to pregnancy. During pregnancy, it would be prudent to monitor serum vitamin D levels and implement preventive measures to reduce maternal and fetal morbidity. No consensus exists in the medical literature regarding vitamin D supplementation in pregnant women., A hipovitaminose D é um problema de saúde universal que atinge todas faixas etárias. As gestantes constituem um grupo de alto risco, com possíveis complicações materno-fetais. Esta revisão visa avaliar a magnitude e consequências da hipovitaminose D na gestação e a segurança da suplementação de vitamina D. Os resultados obtidos sugerem que a prevalência de hipovitaminose D na gestação é muito elevada, mesmo em países com elevada disponibilidade de sol. Potenciais complicações maternas da hipovitaminose D incluem aumento do risco de doença hipertensiva específica da gravidez, diabetes gestacional, vaginose bacteriana, osteomalacia e fraqueza muscular. A condição associa-se ainda a prematuridade, baixo peso ao nascimento e complicações infecciosas no feto. Devido às potenciais complicações materno-fetais associadas à hipovitaminose D, é extremamente importante atingir níveis adequados de vitamina D na fase pré-gestacional. Durante a gestação, seria prudente monitorizar os níveis séricos de vitamina D e adotar medidas preventivas para reduzir a morbilidade materno-fetal. Não há consenso na literatura médica sobre suplementação de vitamina D durante a gestação.

OBJECTIVE To study the prevalence and the clinical and demographic associations of hypovitaminosis D in pregnant women from southern Brazil. METHODS In this cross-sectional study, pregnant women attending prenatal care at two university clinics in Curitiba, Brazil, were investigated for clinical and demographic data and for serum levels of vitamin D, calcium, and parathyroid hormone. Data were collected during summer (January 26 to March 4, 2016) or winter (July 28 to August 31, 2016). RESULTS The study included 520 women, with 264 studied in winter and 256 in summer. The median vitamin D level was 53.41 nmol/L; 227 (43.7%) women had vitamin D deficiency (