Background: We followed polycystic ovary syndrome (PCOS) women with metabolic syndrome (MS) over a six-year treatment period and evaluated the influence of PCOS phenotypes on MS and on the risk for type 2 diabetes mellitus (T2DM). Methods: This was an observational study of 457 PCOS women, whose demographic, clinical, hormonal, and metabolic data underwent analysis. The PCOS women were divided into four groups per NIH recommendations. Results: After a follow-up of a mean of six years (1–20 years), 310 patients were selected to assess the development of T2DM and MS. The clinical and biochemical parameters, along with the Rotterdam phenotypes, were evaluated. Data were analyzed using Student’s t- and the Pearson chi-square tests for data variation and group proportions, respectively. Additionally, multivariate analysis was applied to evaluate the effect of PCOS phenotypes on the risk for MS and T2DM. Patients of the four PCOS phenotypes did not differ in age, body mass index, total testosterone, insulin resistance, and dyslipidemia, but phenotype A patients showed the highest risk for T2DM. A decrease in androgen levels was not followed by an improved metabolic profile; instead, there was a significant increase in the number of T2DM cases. Conclusion: Phenotype A women are at the highest risk for type 2 diabetes mellitus.

BACKGROUND: The pre-transplant period is complex and includes lots of procedures. The severity of liver disease predisposes to a high number of hospitalizations and high costs procedures. Economic evaluation studies are important tools to handle costs on the waiting list for liver transplantation. OBJECTIVE: The objective of the present study was to evaluate the total cost of the patient on the waiting list for liver transplantation and the main resources related to higher costs. METHODS: A cost study in a cohort of 482 patients registered on waiting list for liver transplantation was carried out. In 24 months follow-up, we evaluated all costs of materials, medicines, consultations, procedures, hospital admissions, laboratorial tests and image exams, hemocomponents replacements, and nutrition. The total amount of each resource or component used was aggregated and multiplied by the unitary cost, and thus individual cost for each patient was obtained. RESULTS: The total expenditure of the 482 patients was US$ 6,064,986.51. Outpatient and impatient costs correspond to 32.4% of total cost (US$ 1,965,045.52) and 67.6% (US$ 4,099,940.99) respectively. Main cost drivers in outpatient were: medicines (44.31%), laboratorial tests and image exams (31.68%). Main cost drivers regarding hospitalizations were: medicines (35.20%), bed use in ward and ICU (26.38%) and laboratorial tests (13.72%). Patients with MELD score between 25-30 were the most expensive on the waiting list (US$ 16,686.74 ± 16,105.02) and the less expensive were those with MELD below 17 (US$ 5,703.22 ± 9,318.68). CONCLUSION: Total costs on the waiting list for liver transplantation increased according to the patient’s severity. Individually, hospitalizations, hemocomponents reposition and hepatocellular carcinoma treatment were the main cost drivers to the patient on the waiting list. The longer the waiting time, the higher the total cost on list, causing greater impact on health systems.

Background: The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. Methods: The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. Results: The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. Conclusions: Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.

Studying the dietary habits and symptoms of postmenopausal women during situations such as the COVID-19 pandemic is important to mitigate long-term post-pandemic health problems. We compared the menopausal symptoms and food consumption in postmenopausal women before and during the COVID-19 pandemic. A longitudinal survey was conducted on postmenopausal Brazilian women between 2018 and 2021. The Kupperman–Blatt Menopausal Index, Women’s Health Questionnaire, and 24 h food recall were used. Of 274 women, 78 (28.5%) participated in the study during the COVID-19 pandemic. The intensity of the symptoms was lower during the pandemic than during the previous period (p < 0.05). Energy and processed food consumption were lower during the pandemic than before (p = 0.003 and p = 0.003, respectively). Milk and plain yogurt consumption were also lower (p = 0.043), while the consumption of sugar-sweetened beverages and sweet foods was higher (p = 0.007 and p = 0.001, respectively) during the pandemic. There was also a decrease in the consumption of proteins and lipids (p = 0.001 and p = 0.004, respectively). In conclusion, we found that postmenopausal women consumed sweet foods and sugar-sweetened beverages in higher quantities and had a lower consumption of milk and plain yogurt and processed foods during the pandemic than during the pre-pandemic period. Furthermore, decreases in energy and macronutrient consumption were observed.

Stress, unhealthy lifestyle, and sleep disturbance worsen cognitive function in mood disorders, prompting a rise in the development of integrative health approaches. The recent investigations in the gut–brain axis field highlight the strong interplay among microbiota, inflammation, and mental health. Thus, this study aimed to investigate a new nutraceutical formulation comprising prebiotics, minerals, and silymarin’s impact on microbiota, inflammation, mood, and sleep quality. The study evaluated the LL1 + silymarin capsule supplementation over 180 days in overweight adults. We analyzed the fecal gut microbiota using partial 16S rRNA sequences, measured cytokine expression via CBA, collected anthropometric data, quality of life, and sleep questionnaire responses, and obtained plasma samples for metabolic and hormonal analysis at baseline (T0) and 180 days (T180) post-supplementation. Our findings revealed significant reshaping in gut microbiota composition at the phylum, genus, and species levels, especially in the butyrate-producer bacteria post-supplementation. These changes in gut microbiota were linked to enhancements in sleep quality, mood perception, cytokine expression, and anthropometric measures which microbiota-derived short-chain fatty acids might enhance. The supplementation tested in this study seems to be able to improve microbiota composition, reflecting anthropometrics and inflammation, as well as sleep quality and mood improvement.

Background: Polycystic ovary syndrome (PCOS), a prevalent endocrine disorder characterized by menstrual irregularities and hyperandrogenic manifestations, has been increasingly associated with psychological distress and impaired self-image. However, results regarding sexual function (SF) in PCOS women are still controversial, and their interpretation is complicated by the use of different SF assessment tools across studies. Aim: To evaluate female sexual dysfunction in PCOS women diagnosed through modified Rotterdam criteria by conducting specific meta-analyses for each validated SF questionnaire and assess the influence of overweight/obesity (OW/O) on these outcomes. Methods: A Systematic Review (PRISMA) of 8 databases was performed until March 2024. Meta-analysis employed STATA software, employing a random-effects model to compare groups via Hedges’ g and standardized mean difference (SMD). Heterogeneity (I2 statistic; Q test) and publication bias (funnel plots; Egger’s test) were assessed. Outcomes: The influence of PCOS and OW/O on SF. Results: A total of 6171 articles were initially screened, and 40/6171 studies were included in this systematic review. Meta-analyses were performed solely for the Female Sexual Function Index (FSFI) score as it was the only SF assessment tool widely used across published studies. Pooled meta-analysis results showed that PCOS women had significantly lower FSFI scores in all fields than controls: total FSFI: -0.4 (95% CI -0.45; -0.36, I2 = 94.3%); desire: -0.22 (95% CI -0.26; -0.17, I2 = 90.8%); arousal: -0.3 (95% CI -0.34; -0.25, I2 = 94.1%); lubrication: -0.31 (95% CI -0.36; -0.26, I2 = 93%); orgasm: -0.27 (95% CI -0.32; -0.22 I2 = 89.2%); satisfaction: -0.23 (95% CI -0.28; -0.18, I2 = 81.5%); pain: -0.3 (95% CI -0.35; -0.25, I2 = 91.1%). OW/O PCOS women scored with higher lubrication scores than OW/O controls (SMD = 0.3 95% CI [0.03;0.58], P = .02, I2 = 0%). Clinical Translation: These findings emphasize the importance of incorporating SF assessments into PCOS follow-up protocols and multidisciplinary care. Strengths and Limitations: Strengths include a large cohort, analysis of an OW/O subgroup, and robust quality assessment using the Newcastle–Ottawa Scale. The main limitation was the lack of published studies using SF-assessment tools other than the FSFI, which precluded meta-analyses for other questionnaires. Conclusion: While PCOS women experience significantly impaired SF than controls, those with OW/O and PCOS may have comparable or even enhanced SF in certain domains, particularly lubrication, suggesting that the interplay between obesity and SF in PCOS women may not always be negative. By integrating routine screening with a multidisciplinary approach, we can more effectively address the sexual health challenges faced by PCOS women, ultimately empowering them to achieve optimal health and overall well-being.