NILSON ROBERTO DE MELO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina - Docente
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject EVALUATION OF BRAZILIAN GYNECOLOGISTS' KNOWLEDGE ABOUT OSTEOPOROSIS THERAPY IN CLINICAL PRACTICE(2012) STEINER, M. L.; POMPEI, L. D. M.; MELO, N. R. de; FERNANDES, C. E.Aims: To evaluate Brazilian gynecologists’ knowledge about osteoporosis therapy. Methods: Invitations have been sent by email to 11,164 gynecologists registered in the Hormogin mailing to answer a structured questionnaire on the Internet. Results: Of the 11,164 invitations sent messages, 503 failed. There were 1237 responses to the questionnaire, and 977 met the inclusion criteria. The distribution of responses by regions of the country was similar to the distribution of gynecologists, according to the Febrasgo. The average age of those included was 45.2±10.9 years and median 45. The time since graduation was 20.2±10.7 years, median 20. Of the 946 (96.8 %) gynecologists who investigate osteoporosis, 820 (86.7 %) treat this disease and the remaining refer to another medical colleague. Those who treat osteoporosis are younger than those who do not (44.8 vs. 10.8±48.1 ±10.9, respectively, p=00.001) and have less time since graduation (19.9±10.6 vs. 22.8±10.8, p=00.004). Physicians without academic ties responded more frequently than those with university ties (87.8 % vs. 80.6 %, p=00.023). Only 45 (4.8 %) correctly answered all questions about the drugs used for osteoporosis, however, 760 (80.3 %) answered at least one correct treatment and none wrong. There were no significant differences in responses between doctors without ties to university services and those of the academic environment. Those who answered none wrong treatment were younger than those who choose at least one incorrect treatment (43.7±9.3 vs. 45.7±11.3 years, respectively, p=00.032) also had fewer years since graduation (18.8±9.3 vs. 20.7±11.0 years, respectively, p=00.032). The association of calcium and vitamin D was considere deffective for the treatment of osteoporosis for 50.3 % of respondents, while 67.3 % considered hormone replacement therapy effective. Sodium alendronate was the most often mentioned osteoporosis drug therapy (95.0 %), followed by risedronate sodium (79.4 %) and hormone replacement therapy (68 %). There were no differences in prescriptive habits among physicians with no links to university services and those of the academic environment. Conclusion: The vast majority of Brazilian gynecologist treats osteoporosis. Although most known effective treatments and prescribing them, there are still gaps in knowledge about the effectiveness of some therapeutic modalities.- Combined oral contraceptives: update recommendations of the Latin American contraceptive association(2023) PALACIOS, Santiago; AYALA, Gabriela; GONZALEZ, Gemarilis; BADILLA-APUY, Can L.; MARCHENA, Jeannette; MARTINEZ, Katia; MOSTAJO, Desiree; VERNAZA, Maria S.; PARADAS, Alejandro; HERNANDEZ, Luis; VASQUEZ-AWAD, David; CELIS-GONZALEZ, Cuauhtemoc; MELO, Nilson Roberto deBackground: In recent years, new combined oral contraceptives (COCs) have become available, representing an advance in terms of individualization and compliance by users.Objective: To provide recommendations regarding COCs: formulations, use, efficacy, benefits and safety.Method: For these recommendations, we have used the modified Delphi methodology and carried out a systematic review of studies found in the literature and reviews performed in humans, published in English and Spanish in Pubmed, Medline and advanced medicine and computer networks until the year 2021, using the combination of terms: 'oral contraceptives', 'estroprogestins' and 'combined oral contraceptives'.Results: Regarding the estrogen component, initially switching from mestranol (the pro-drug of ethinylestradiol) to ethinylestradiol (EE) and then reducing the EE dose helped reduce side effects and associated adverse events. Natural estradiol and estradiol valerate are already available and represent a valid alternative to EE. The use of more potent 19-nortestosterone-derived progestins, in order to lower the dose and then the appearance of non-androgenic progestins with different endocrine and metabolic characteristics, has made it possible to individualize the prescription of COC according to the profile of each woman.Conclusion: Advances in the provision of new COCs have improved the risk/benefit ratio by increasing benefits and reducing risks. Currently, the challenge is to tailor contraceptives to individual needs in terms of safety, efficacy, and protection of female reproductive health.
- Impact of standardized information provided by gynecologists on women's choice of combined hormonal contraception(2013) MACHADO, Rogerio Bonassi; POMPEI, Luciano Melo; GIRIBELA, Aricia; MELO, Nilson Roberto deThis prospective interventional study was designed to determine the impact of providing standardized information on different methods of combined hormonal contraception on women's selection of which method to use. A total of 952 Brazilian gynecologists were randomly selected. Each gynecologist recruited 15 consecutive patients for whom combined hormonal contraception was indicated. Each patient was asked which contraceptive method she would prefer (pill, patch, vaginal ring or injectable) before and after receiving a standardized explanation on each of these methods provided by her doctor. A total of 9507 women were included in the study. Prior to counseling, 66.5% of the women stated that they would prefer the pill, 17.9% the injectable, 8.9% the patch and 6.7% the vaginal ring. After counseling, 53.7% of the women stated that they would prefer the pill, 16.3% the injectable, 14% the patch and 16% the ring. In conclusion, the combined pill remains the most popular contraceptive method among Brazilian women; however, after receiving information on the various contraceptive methods available, the proportion of women choosing the vaginal ring or patch increased, while preference for the combined pill decreased.
- Effects of a combined oral contraceptive containing 20 mcg of ethinylestradiol and 3mg of drospirenone on the blood pressure, renin-angiotensin-aldosterone system, insulin resistance, and androgenic profile of healthy young women(2015) GIRIBELA, Cassiana Rosa Galvao; CONSOLIM-COLOMBO, Fernanda Marciano; NISENBAUM, Marcelo Gil; MORAES, Tercio Lemos de; GIRIBELA, Aricia Helena Galvao; BARACAT, Edmund Chada; MELO, Nilson Roberto deCombined oral contraceptives (COCs) may increase the risk for cardiovascular disease depending on the ethynyl estradiol (EE) dose and the androgenicity of the progestogens. Our objective was to evaluate the impact of a COC containing 20mcg EE+3mg drospirenone on blood pressure (BP), renin-angiotensin-aldosterone system, insulin resistance, and androgenic profile of healthy young women. Eighty-one healthy young women aged 301 years (case group, n=49, received COC; control group, n=32, used no COC) were assessed twice, before and after the 6-month study. Statistical analysis employed the paired t-tests and expressed the data in mean and standard deviation. Results were as follows: no changes in BP or in BMI; a significant increase in aldosterone, plasma renin activity, triglycerides, and total cholesterol levels, but a non-significant increase in HDL and no significant changes in LDL levels (these parameters remained within normal ranges); a significant increase in the HOMA-IR index and a significant decrease in dehydroepiandrosterone sulfate (SDHEA), androstenedione, total testosterone, and free testosterone levels; no significant variations in the control group parameters. An oral contraceptive combination of a low EE dose and an anti-androgenic progestogen does not negatively influence the risk factors for a cardiovascular disease.
- Vitamin D supplementation: position Statement of the Iberoamerican Society of Osteoporosis and Mineral Metabolism (SIBOMM)(2021) PALACIOS, Santiago; CERDAS, Sonia; SILVA, Ramiro Da; PARADAS, Alejandro; VARGAS, Jorge; MOSTAJO, Desiree; TSEROTAS, Konstantinos; DANCKERS, Luis; MORENO, Mario; NAVAS, Maria; MUNOZ-LOUIS, Roberto; MAIDA, Tatiana; ROSERO, Oscar; RUEDA, Camilo; VASQUEZ, David; MELO, Luciano; CORDOBA, Santiago; RASEC-MORALES, Luis; MELO, Nilson Roberto deBackground Vitamin D (VD) deficiency is a global pandemic that affects more than a third of the population worldwide. The population of Latin America and the Caribbean exceeds 620 million inhabitants with diverse ethnic origins and different latitudes and altitudes, which make comparisons and generalizations difficult. Aim and method We sought to establish an expert consensus regarding the recommendations for VD supplementation in Latin America by means of the Delphi methodology. Results The prophylactic dosage of VD in the general population should be individualized according to age, race, body weight, sun exposure of an individual, altitude, and dietary and exercise habits, without ruling out existing chronic diseases. Conclusion The importance of VD has been widely documented and its deficiency is a pandemic. Many individuals have difficulty meeting daily VD requirements through food and the sun. The population of Latin America and the Caribbean has diverse ethnics, cultures, in addition to living in different latitudes and altitudes. Therefore, it is important to make a position on VD supplementation, given the different characteristics, ages and serum levels of 25(OH)D.
- ISGE statement on oral emergency contraception(2014) GLASIER, Anna; GEMZELL-DANIELSSON, Kristina; BOUCHARD, Philippe; GENAZZANI, Andrea R.; AL-AZZAWI, Farook; BERGA, Sarah; BIRKHAEUSER, Martin; BRINCAT, Mark; MELO, Nilson R. De; FOIDART, Jean Michel; KENEMANS, Peter; LUNENFELD, Bruno; MARUO, Takeshi; MILEWICZ, Andrzej; NAFTOLIN, Frederick; NG, Ernest H. Y.; SCHINDLER, Adolf; SIMON, Carlos; SIMONCINI, Tommaso; SIMPSON, Evan; SISELES, Nestor; SMETNIK, Vera; TARLATZIS, Basil; SCHOULTZ, Bo vonUnintended pregnancy is an important public health problem worldwide. Unwanted pregnancies may end in induced abortion (legal or illegal, safe or unsafe) or in childbirth. In many parts of the world both can be life threatening. Even where both are safe, abortion is distressing for all concerned while unwanted births often lead to poor health and social outcomes for both the mother and her child.
- Attitudes, knowledge and prescribing habits of Brazilian gynecologists regarding extended-cycle oral contraceptives(2013) POMPEI, Luciano Melo; FERNANDES, Cesar Eduardo; STEINER, Marcelo Luis; STRUFALDI, Rodolfo; MELO, Nilson Roberto deExtended-cycle and continuous use combined oral contraceptives (COC) have been widely investigated; however, gynecologists' prescribing habits are largely unknown. This study evaluated the opinions and prescribing habits of Brazilian gynecologists regarding extended/continuous COC. Gynecologists caring for reproductive-age women and used to prescribing COC were recruited to an online survey. Overall, 1097 physicians were included. Of these, 93.0% stated that patients requested extended/continuous COC, with 93.9% of the physicians having already prescribed these regimens at least once. Only 67 physicians reported never having prescribed extended/continuous COC. The most common reasons for prescribing extended/continuous COC were ""dysmenorrhea"", ""endometriosis"" and ""convenience of menstrual suppression"". Physicians reported prescribing extended/continuous regimens for 20.7 +/- 17.2% of their patients with an indication for COC, postgraduate degree holders being more likely to prescribe extended/continuous regimens than physicians without postgraduate degree (23.6 +/- 19.1% versus 20.0 +/- 16.7%; p = 0.014). In conclusion, the vast majority of gynecologists prescribe extended/continuous COC. Women often request information from their doctors on the subject. ""Convenience of menstrual suppression"" is a common reason given for prescribing extended/continuous COC. According to the physicians, the great majority of extended/continuous COC users are satisfied or very satisfied with the regimen prescribed.