The relationship between HIV status and clinical manifestations of urogenital infections in women during pregnancy: a scoping review / A relação entre o status de HIV e as manifestações clínicas das infecções urogenitais em mulheres durante o período gravídico: uma revisão de escopo

Introduction: Maternal and child health are essential to public health, especially during pregnancy, where urogenital infections can affect mothers and fetuses. Sexually transmitted infections (STIs) increase obstetric risks and have complex connections with the human immunodeficiency virus ­ HIV. In Brazil, pregnant women with HIV are a growing concern, requiring focus and appropriate interventions. Objective: This study aimed to examine the clinical and epidemiological characteristics of urogenital infections in pregnant women with and without HIV and to assess whether there are notable differences between these groups. Methods: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses ­ Extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidelines. Databases such as Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Scientific Electronic Library Online (SciELO) were explored using relevant terms. Inclusion/exclusion criteria selected nine studies for analysis. A Population, Intervention, Comparison, Outcome, and Study Design (PICOS) approach directed the search. Results: Pregnant women with HIV had a high prevalence of STIs, including Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and bacterial vaginosis. HIV infection appears to influence the risk and severity of urogenital infections. Pregnancy increases the risk of STIs, regardless of HIV status. Male partners may also influence the presence of STIs in pregnant women, especially those with HIV. Conclusion: This study highlights the association between HIV status and urogenital infections in pregnant women, indicating the need for appropriate screening and care. Prevention and treatment of STIs in pregnant women are essential for maternal and child health, regardless of HIV status. An in-depth understanding of these issues can improve public policies, clinical practices, and preventive interventions that target the overall health of these vulnerable populations.Keywords: HIV. Signs and symptoms. Female urogenital diseases and pregnancy complications. Pregnant women. Sexually transmitted infections

Introdução: A saúde materna e infantil é essencial na saúde pública, especialmente durante a gravidez, quando infecções urogenitais podem afetar mães e fetos. Infecções sexualmente transmissíveis (IST) aumentam riscos obstétricos e têm conexões complexas com o vírus da imunodeficiência humana (HIV). No Brasil, gestantes com HIV são uma preocupação crescente, requerendo foco e intervenções adequadas. Objetivo: Este estudo teve como objetivo examinar as características clínicas e epidemiológicas das infecções urogenitais em mulheres grávidas com e sem HIV, avaliando se há diferenças notáveis entre esses grupos. Métodos: Uma revisão de escopo foi conduzida, seguindo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews(PRISMA-ScR) e Joanna Briggs Institute. Bases de dados como Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), and Scientific Electronic Library Online (SciELO) foram exploradas com termos relevantes. Os critérios de inclusão/exclusão selecionaram nove estudos para análise. Uma abordagem do tipo População, Intervenção, Comparação, Desfecho e Desenho do Estudo (PICOS) direcionou a pesquisa. Resultados: Mulheres grávidas com HIV apresentaram alta prevalência de IST, incluindo Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis e vaginose bacteriana. A infecção por HIV parece influenciar o risco e a gravidade das infecções urogenitais. A gravidez aumentou o risco de IST, independentemente do status de HIV. Os parceiros masculinos também podem influenciar a presença de IST em mulheres grávidas, especialmente aquelas com HIV. Conclusão: A associação entre o status de HIV e as infecções urogenitais em mulheres grávidas indica a necessidade de rastreamento e cuidado adequado. A prevenção e o tratamento de IST em gestantes são essenciais para a saúde materno-infantil, independentemente do status de HIV

Applicability of vaginal energy-based devices in urogynecology: evidence and controversy

SUMMARY OBJECTIVE: This study aimed to analyze the evidence and controversies about the use of vaginal energy-based devices (laser and radiofrequency) for treatment of genitourinary syndrome of menopause, recurrent urinary tract infection, urinary incontinence, and genital prolapse through a literature review. METHODS: A search of literature databases (PubMed, Medline) was performed for publications in December 2022. Keywords included genitourinary syndrome of menopause, vaginal laxity, vaginal/vulvovaginal atrophy, urinary tract infection, urgency incontinence, frequency, urgency, stress urinary incontinence, genital prolapses AND energy-based devices, AND vaginal laser, AND vaginal radiofrequency, AND CO2 laser, AND Er:YAG laser. Publications in English from the last 7 years were reviewed and selected by the authors. RESULTS: The literature regarding vaginal energy-based devices in the treatment of urogynecological conditions is primarily limited to prospective case series with small numbers and short-term follow-up. Most of these studies showed favorable results, improvement of symptoms with low risk, or no mention of serious adverse events. Consensus statement documents from major medical societies suggest caution in recommending these therapies in clinical practice until more relevant data from well-designed studies become available. CONCLUSION: The potential of the vaginal laser and radiofrequency as a therapeutic arsenal for the evaluated urogynecological conditions is great, but qualified research must be done to prove their efficacy and long-term safety, define application protocols, and recommend the use of these technologies in clinical practice.

Prevalência, conhecimento e fatores associados à incontinência urinária em mulheres estudantes de um curso de Fisioterapia / Prevalencia, conocimientos y factores asociados a la incontinencia urinaria en mujeres estudiantes de Fisioterapia / Prevalence, knowledge, and factors associated with urinary incontinence in female students of a physical therapy undergraduate course

RESUMO O objetivo deste estudo foi avaliar a prevalência, o conhecimento e os fatores associados à incontinência urinária (IU) em mulheres estudantes de um curso de fisioterapia, bem como sua qualidade de vida. Foi aplicada uma ficha de avaliação, o International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) e um questionário de conhecimento sobre a musculatura do assoalho pélvico (MAP) e a ocorrência de IU, baseado em estudo tipo conhecimento, atitude e prática (CAP). Das 248 estudantes do curso, 170 (69%) participaram do estudo. Pela ficha de avaliação, 111 (65%) relataram perda urinária. De acordo com o ICIQ-SF, 63 participantes (37%) são incontinentes, sendo que 41 (65%) dessas apresentam IU de esforço, apresentando pequena perda e com frequência de uma vez na semana ou menos, com baixo impacto na sua qualidade de vida. A maioria das participantes que relataram ter dor na relação sexual (59%) e alguns sintomas uroginecológicos e intestinais, como esforço ao urinar (92%), jato interrompido (75%), incômodo na região vaginal (73%), constipação (53%), esforço ao defecar (53%) e esvaziamento intestinal incompleto (70%), apresentou queixa de IU. Todas as que usam protetor (100%) e procuraram atendimento médico (100%) eram incontinentes. O uso de anticoncepcional foi maior em mulheres sem perda urinária (84%). O conhecimento sobre a MAP e a IU foi adquirido gradualmente com o avançar do curso. Esse resultado sugere que as mulheres que não cursam Fisioterapia não têm domínio do assunto, sendo necessário disseminar o conhecimento sobre a IU e a atuação da fisioterapia.

RESUMEN El objetivo de este estudio fue evaluar la prevalencia, el conocimiento y los factores asociados a la incontinencia urinaria (IU) en mujeres estudiantes de Fisioterapia, así como su calidad de vida. Se aplicó un formulario de evaluación, el International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) y un cuestionario de conocimiento sobre la musculatura del suelo pélvico (MSP) y la ocurrencia de IU, basado en un estudio de conocimiento, actitud y práctica (CAP). De las 248 estudiantes del curso, 170 (69%) participaron en el estudio. Según el formulario de evaluación, 111 (65%) reportaron pérdida urinaria. Conforme el ICIQ-SF, 63 participantes (37%) son incontinentes, y 41 (65%) de ellas tienen IU de esfuerzo, presentando una pequeña pérdida y con frecuencia de una vez a la semana o menos, con bajo impacto en su calidad de vida. La mayoría de las participantes que informaron sentir dolor en las relaciones sexuales (59%) y algunos síntomas uroginecológicos e intestinales, como esfuerzo al orinar (92%), chorro interrumpido (75%), molestias en la región vaginal (73%), estreñimiento (53%), esfuerzo al defecar (53%) y vaciamiento intestinal incompleto (70%), se quejó de IU. Las participantes que usan protectores (100%) y buscan atención médica (100%) eran incontinentes. El uso de anticonceptivos fue mayor en las mujeres sin pérdida urinaria (84%). El conocimiento sobre la MSP e IU se adquirió de manera gradual a medida que avanzaba el curso. Este resultado apunta que las mujeres que no estudian Fisioterapia no tienen dominio del tema y es necesario difundir conocimientos sobre la IU y la actuación de la fisioterapia.

ABSTRACT This study aimed to evaluate the prevalence, knowledge, factors associated with urinary incontinence (UI), and quality of life in female students enrolled in a physical therapy undergraduate course. Students had to answer a form we developed, the International Questionnaire on Incontinence Consultation - Short Form (ICIQ-SF), and a knowledge questionnaire on pelvic floor musculature (PFM) and the occurrence of UI, based on a previous knowledge, attitude, and practice (KAP) study. Out of 248 students, 170 (69%) participated in our study. According to our evaluation form, 111 women (65%) reported urinary loss at some point in their lives. According to ICIQ-SF criteria, 63 (37%) women were incontinent, 41 (65%) suffered from strain urinary incontinence, showing small urinary losses once per week or less, which slightly impacted their quality of life. Most women who have pain during sexual intercourse (59%) and some urogynecological and intestinal symptom, such as straining (92%), intermittent urination (75%), nausea (73%), constipation (53%), excessive effort (53%), and incomplete outlet (70%) also suffered from UI. All women who used pads (100%) and sought medical care (100%) were incontinent. The use of contraceptive was higher among women without UI (84%). Participants built their knowledge on PFM and UI as the course progressed. These results suggest that women who attend undergraduate courses outside physical therapy have limited knowledge about the subject. We find it necessary to spread knowledge about UI and the importance of physical therapy to prevent and treat UI.

Presencia de COVID-19 en mujeres gestantes y pacientes neonatos / Presence of COVID-19 in pregnant women and neonatal patients

Objetivo: Analizar la presencia de covid-19 en mujeres gestantes y pacientes neonatos. Método: Se basó en una revisión sistemática. Resultados: Se seleccionaron 15 articulos que evidenciaban información directa con el objetivo planteado. Conclusión: Se determinó que el contagio desde una madre positiva COVID-19, es poco probable que se transmita desde la fecundación hasta los 3 meses de gestación, y en el caso de que posteriormente a este lapso llegase a contagiarse la madre no provocará amenazas de perdida gestacional, sin embargo, se han presentado una minoría de casos en los cuales aumenta el riego de una labor de parto prematura. Las pacientes gestantes y sus hijos que sean diagnosticados con coronavirus serán atendidos de la misma manera que pacientes comunes ya que el virus no es más fuerte ni menos invasivo.

Objective: To analyze the presence of covid-19 in pregnant women and neonatal patients. Method: It was based on a systematic review. Results: 15 articles were selected which showed direct information with the proposed objective. Conclusion: It was determined that infection from a COVID-19 positive mother is unlikely to be transmitted from fertilization to 3 months of gestation, and in the event that the mother becomes infected after this period it will not cause threats of gestational loss, however, there have been a minority of cases in which the risk of premature labor increases. Pregnant patients and their children who are diagnosed with coronavirus will be cared for in the same way as ordinary patients since the virus is not stronger or less invasive.

Actualización de la infección por Chlamydia trachomatis en mujeres / Update of Chlamydia trachomatis infection in women

La infección por Chlamydia trachomatis es la infección de transmisión sexual bacteriana más frecuente en el mundo. En este artículo se revisa la prevalencia reportada en Chile, cuadro clínico, diagnóstico, tratamiento, prevención y complicaciones a largo plazo en mujeres.

Chlamydia trachomatis infection is known to be the most common sexually transmitted bacterial infection world-wide. This article reviews the prevalence reported in the Chilean population, as well as the clinical manifestations, diagnosis, treatment, prevention and complications in women

Proceso de enfermería a embarazada con infección de vías urinarias y amenaza de aborto / A Nursing Process for a Pregnant Woman with Urinary Tract Infection and Threatened Miscarriage

Introducción: La infección de vías urinarias es recurrente en el embarazo y generadora de complicaciones. Objetivo: Presentar un plan de cuidados enfermero a una mujer con diagnóstico infección de vías urinarias y amenaza de aborto Métodos: Caso clínico de paciente admitida en unidad de Ginecología y Obstetricia del Hospital General de Teziutlán, Puebla, México, durante 2019. Siguiendo la lógica del proceso de enfermería, la valoración se fundamentó en los patrones funcionales de salud de Marjory Gordon. Fueron utilizadas las terminologías normalizadas de enfermería: Diagnósticos (NANDA.int). Resultados (NOC) e Intervenciones (NIC). Resultados: Se identificaron cuatro diagnósticos de enfermería: deterioro de la eliminación urinaria, gestión ineficaz de la propia salud, disposición para mejorar la nutrición y riesgo de alteración de la díada materno/fetal, este último diagnóstico principal. Además, un Resultado NOC (Conocimiento: Control de Infección), cuatro indicadores y la escala de nunca a siempre demostrado; cuatro Intervenciones NIC, con 19 actividades. La evaluación transitó desde 12 (puntuación inicial) a 19 (puntuación final), de 20 como puntuación diana. Conclusión: La integración de las taxonomías NANDA, NIC, NOC y los patrones funcionales de salud de Marjory Gordon permitió diseñar el plan de cuidado de la embarazada, fueron articulados diagnósticos, resultados e intervenciones de enfermería que favorecieron la relación enfermera-paciente-contexto sociocultural, para llevar el cuidado hasta una concepción sistémica que permita el seguimiento y control de la embarazada(AU)

Introduction: Urinary tract infection is recurrent in pregnancy and causes complications. Objective: To present a nursing care plan provided to a woman with a diagnosis of urinary tract infection and threatened miscarriage. Methods: Clinical case of a patient admitted to the gynecology and obstetrics unit of General Hospital of Teziutlán (Puebla, Mexico) during 2019. Following the logic of the nursing process, the assessment was based on Marjory Gordon's functional health patterns. The standard nursing terminologies were used: diagnostics (NANDA-I), outcomes (NOC) and interventions (NIC). Results: Four nursing diagnoses were identified: deterioration of urinary elimination, ineffective self-health management, willingness to improve nutrition, and risk for alterations in maternal-fetal dyad, the latter being the main diagnosis. In addition, a NOC outcome (knowledge: infection control), four indicators and the never-to-always scale upon demonstration, as well as four NIC interventions, with nineteen activities, were obtained. Evaluation ranged from twelve (initial score) to nineteen (final score), with twenty as target score. Conclusion: The integration of the NANDA, NIC and NOC taxonomies together with the Marjory Gordon's functional health patterns allowed the design of the pregnant woman's care plan, with an articulation between nursing diagnoses, outcomes and interventions, which favored the nurse-patient-sociocultural context relationship, up to considering care based on a systemic conception that allows monitoring and control of the pregnant woman(AU)

Evaluation of the fibulin 5 gene polymorphism as a factor related to the occurrence of pelvic organ prolapse

SUMMARY OBJECTIVE Pelvic organ prolapse (POP) is a very frequent situation in our population that may lead to a significant decrease in patients' quality of life. Currently, we are looking for predictive factors for the development of POPs; thus, this study seeks to evaluate whether the Fibulin 5 polymorphism (FBLN5) is associated with the occurrence of POP. METHODS This is a cohort study with postmenopausal women who were divided into groups by POP stage: POP stages 0 and I (control group) and POP stages III and IV (case group). Subsequently, analyses of genetic polymorphisms of FBLN5 were performed using the Restriction Fragment Length Polymorphism (RFLP) technique. RESULTS A total of 292 women were included in the study. Pregnancy, parity and vaginal delivery in the patients, as well as in data described in the literature, were related to the occurrence of POP in the univariate analysis. However, after binary logistic regression, home birth and age remained independent risk factors for POP. We found no association between the FBLN5 polymorphism and the occurrence of POP (p = 0.371). CONCLUSION There was no association between the FBLN5 polymorphism and the occurrence of POP in Brazilian women.

RESUMO OBJETIVOS O prolapso de órgãos pélvicos (POP) é uma situação muito frequente em nossa população que pode levar a uma diminuição significativa da qualidade de vida dos pacientes. Atualmente, buscam-se fatores preditivos para o desenvolvimento de POPs e, assim, este estudo correlaciona um polimorfismo de Fibulina 5 (FBLN5) com a ocorrência da doença. MÉTODOS Estudo de coorte com mulheres na pós-menopausa, divididas por grupos pelos estádios 0 e I do POP (grupo controle) e POP III e IV (grupo caso). Posteriormente, análises do polimorfismo genético de FBLN5 foram realizadas utilizando a técnica de Polimorfismo de Comprimento de Fragmentos de Restrição (RFLP). RESULTADOS Um total de 292 mulheres foi incluído no estudo. Gestação, paridade e parto vaginal, como bem descritos na literatura, foram relacionados à ocorrência de POPs na análise univariada. No entanto, após a regressão logística binária, o parto domiciliar e a idade permaneceram como fatores de risco independentes para os POPs. Não encontramos associação deste polimorfismo FBLN5 com a ocorrência de POP (p=0,371). CONCLUSÃO Não houve associação deste polimorfismo FBLN5 com a ocorrência de POPs em mulheres brasileiras.

The application of sacral neuromodulation in the treatment of female neurogenic lower urinary tract dysfunction / 中国医师杂志

Trauma,iatrogenic injury,and neurological disorders can lead to neurogenic lower urinary tract dysfunction (NLUTD).However,there are some special causes in women,including radical hysterectomy,mid-urethral suspension,pelvic organ prolapse repair,Fowler syndrome,interstitial cystitis etc.Traditional behavioral therapy,drug treatment and surgeries may work less well in patients with NLUTD and may even lead to progression and deterioration of the diseases.A review of current literatures revealed that there is an increasing evidence on the application of sacral neuromodulation (SNM) in the treatment of NLUTD in female.This review will provide a summary of the known mechanisms of female NLUTD and the effectiveness of SNM.

Correlation between pelvic floor pain and pelvic floor injury in female patients with lower urinary tract disease / 中国医师杂志

Objective To investigate the relationship between pelvic floor pain and pelvic floor injury in female patients with lower urinary tract disease.Methods Transvaginal and rectal pelvic floor acupressure was used to perform pelvic floor pain point examination in women with lower urinary tract disease.The number of tender points and the pain point of tenderness were recorded.R~ults The positive rate of pelvic pain points was 61.5％ (3 507 checkpoints,2 156 checkpoints had tenderness);there was a difference in the degree of pain caused by pain points in different regions (H =159.144,P ＜0.01).There was no difference in pain level between the P3 area,P4 and P5 areas and P2 (adjust P =1),and the pain points of the other areas were statistically different from the pain level (adjust P ＜ 0.01).Conclusions The density of tender points and degree of pain in pain points in female pelvic floor are related to the pelvic floor injury.It is of clinical significance to evaluate the degree of pelvic floor injury by taking the pelvic floor pain point.

Application of sacral neuromodulation in lower urinary tract diseases related to pelvic floor dysfunction / 中国医师杂志

Pelvic floor dysfunction associated with lower urinary tract diseases,is a common disease in women.Sacral neuromodulation is a safe and effective new technique with small trauma,which has significant advantages for patients with refractory pelvic floor dysfunction-related lower urinary tract diseases and has good clinical application prospects.

The study of correlation between female urination abnormality and pelvic floor injury / 中国医师杂志

Objective To study the correlation between female urination abnormalities and pelvic floor injury.Methods A total of 193 adult women with urination abnormalities from January 2015 to January 2017 were selected from Foshan Maternal and Child Hospital of Guangdong Province,including 84 cases of lower urinary tract symptoms (LUTS),71 cases of overactive bladder (OAB) and 38 cases of stress urinary incontinence (SUI).All patients aged 38-82 years (mean 51 ± 3.74) were enrolled according to their clinical symptoms.100 adult female patients without obvious symptoms such as abnormal urination were selected as the control group.Pelvic floor pain points were examined and scored in both groups.Results In the 193 cases,the number of pain points in LUTS,OAB and SUI were 1 093,983 and 415,respectively,a total of 2 491.The total pain scores of pain points were 7 163,6 480 and 2 583,with a total of 16 226 points.There were 100 cases in the control group with 527 pain points,and the total pain points were 1 377 points.According to the pelvic floor injury formula,the injury scores of the inspection group and the control group were calculated to be 3.59 vs 0.24 respectively,with statistically significant difference (P ＜ 0.01).The pelvic floor injury scores of LUTS group,OAB group and SUI group were 3.67,4.18 and 2.46 respectively,with statistically significant difference (P ＜ 0.01).Conclusions Overall,female urination abnormalities are significantly associated with pelvic floor injury,which are consistent with clinical observation.

Research progress of bladder urethral dysfunction associated with pelvic floor injury in women / 中国医师杂志

Female pelvic floor dysfunction is caused by pelvic floor dysfunction due to pelvic,pelvic organs and lumbosacral tissue lessions,deformities,tumors,trauma,surgery,pregnancy and dystocia.It is called bladder-urethral dysfunction associated with pelvic floor injury.Early diagnosis and targeted treatment of bladder-urethral dysfunction are the key to prevent upper urinary tract damage and obtain good curative effect.Nervous system and urodynamic monitoring are prerequisites for accurate diagnosis and reasonable treatment.

Clinical features, socio-demographic profile and ultrasound findings in women with endometriosis symptoms / Características clínicas, perfil sociodemográfico e achados ecográficos em mulheres com sintomas de endometriose

AIMS: To describe clinical and socio-demographic features, as well as transvaginal ultrasound results, of women with endometriosis symptoms. METHODS: A prospective cross-sectional study included patients who had at least one of the following symptoms: dyspareunia, dysmenorrhea, chronic pelvic pain, infertility, and urinary or bowel cyclic symptoms. The sample comprised women treated in a private gynecology clinic located in a small city in southern Brazil, from March to November 2016. All the participants, after signed an informed consent, were subjected to clinical anamnesis, transvaginal ultrasound with bowel preparation, and examination for the CA-125 antigen serum level. Association between two qualitative variables was assessed through Pearson's Chi-Square or Fisher's exact tests. Mean values of quantitative variables were compared through the two-tailed Student's t-test for independent samples. Significance level was set as p<0.05. RESULTS: A total of 85 women, aged 18-49 years, participated in the study. Most were married (75.3%), with children (51.8%), showed no family history of endometriosis (89.4%), had no knowledge about endometriosis (77.6%) and completed high school (43.5%). Ultrasound findings suggested endometriosis in 25 (29.4%) women. Dysmenorrhea was the most prevalent symptom (88.2%), followed by dyspareunia (61.2%). In comparison to those without ultrasound signs, the patients whose ultrasound findings suggested endometriosis had an older age (37.16±6.83 years vs. 30.37±6.80 years, p<0.001) and a longer duration of symptoms (9.06±6.49 years vs. 5.27±4.79 years, p=0.004). In addition, they presented higher mean serum CA-125 antigen levels (50.07±54.05 U/mL vs. 17.71±14.09 U/mL, p=0.011). Endometriosiscompatible lesions were mainly found in the ovaries (60%) and in the rectosigmoid region (52%). The disease was confirmed in the nine cases that were subjected to videolaparoscopy. CONCLUSIONS: Transvaginal ultrasound confirmed endometriosis in about one third of symptomatic patients, who were older, had symptoms for a longer time, and had higher serum CA-125 antigen levels in comparison to those without endometriosis diagnosis based on transvaginal ultrasound. Ovaries and rectosigmoid region were the sites with the highest frequency of ultrasound signs of endometriosis.

OBJETIVOS: Descrever características clínicas e sociodemográficas, bem como resultados de ultrassonografia transvaginal, de mulheres com sintomas de endometriose. MÉTODOS: Um estudo transversal prospectivo incluiu pacientes que apresentaram pelo menos um dos seguintes sintomas: dispareunia, dismenorreia, dor pélvica crônica, infertilidade e sintomas urinários ou intestinais cíclicos. A amostra foi composta por mulheres atendidas em clínica privada de ginecologia, localizada em uma pequena cidade do sul do Brasil, de março a novembro de 2016. Todas as participantes, após assinatura do termo de consentimento livre e esclarecido, foram submetidas a anamnese clínica, ultrassonografia transvaginal com preparo intestinal e análise do nível sérico do antígeno CA-125. A associação entre duas variáveis qualitativas foi avaliada pelos testes Qui-Quadrado de Pearson ou Exato de Fisher. Os valores médios das variáveis quantitativas foram comparados através do teste t de Student bicaudal para amostras independentes. O nível de significância foi estabelecido como p<0,05. RESULTADOS: Um total de 85 mulheres, com idade entre 18 e 49 anos, participou do estudo. A maioria era casada (75,3%), com filhos (51,8%), não apresentava história familiar de endometriose (89,4%), não tinha conhecimento sobre endometriose (77,6%) e tinha ensino médio completo (43,5%). Achados ultrassonográficos sugeriram endometriose em 25 (29,4%) mulheres. A dismenorreia foi o sintoma mais prevalente (88,2%), seguida pela dispareunia (61,2%). Em comparação com aquelas sem sinais ultrassonográficos, as pacientes cujos achados ultrassonográficos sugeriram endometriose tinham idade mais avançada (37,16±6,83 anos vs. 30,37±6,8 anos, p<0,001) e maior duração dos sintomas (9,06±6,49 anos vs. 5,27±4,79 anos, p=0,004). Além disso, apresentaram níveis séricos de antígeno CA-125 mais elevados (50,07±54,05 U/mL vs. 17,71±14,09 U/mL, p=0,011). Lesões compatíveis com endometriose foram encontradas principalmente nos ovários (60%) e na região retossigmoide (52%). A doença foi confirmada nos nove casos que foram submetidos a videolaparoscopia. CONCLUSÕES: A ultrassonografia transvaginal confirmou a endometriose em cerca de um terço das pacientes sintomáticas, que eram mais velhas, apresentavam sintomas por mais tempo e tinham níveis mais altos de antígeno CA-125 sérico, em comparação àquelas sem diagnóstico de endometriose com base na ultrassonografia transvaginal. Ovários e região retossigmoide foram os locais com maior frequência de sinais ultrassonográficos de endometriose.

Prevalência de vulvovaginites na gestação e sua associação com complicações perinatais / Prevalence of vulvovaginitis in pregnancy and their relationshio to perinatal complications

Introdução: Vulvovaginite é o processo infeccioso do trato geniturinário inferior feminino, podendo gerar complicações perinatais como trabalho de parto prematuro, rotura prematura de membranas e corioamnionite. Objetivo: Avaliar a prevalência de vulvovaginites na gestação e definir sua associação com fatores sociodemográficos e complicações perinatais. Métodos: Estudo transversal, com análise de 216 prontuários das pacientes que realizaram o pré-natal em ambulatório-escola de julho/2010 até fevereiro/2012. Os dados foram analisados pelo programa SPSS 16.0. O teste qui-quadrado testou a homogeneidade de proporções. Foram calculadas as razõoes de prevalência e seus respectivos intervalos de confiança, com nível de significância de p < 0,05. Resultados: A prevalência de vulvovaginites na gestação foi de 38,9%. A idade maior ou igual a 30 anos esteve menos associada (p = 0,003) ao desenvolvimento de vulvovaginites [RP 0,24 (IC95% 0,07-0,68)]. O aparecimento de vulvovaginites na gestação aumentou em quase quatro vezes [RP 3,80 (1,29-12,63)] a probabilidade de ocorrência de rotura prematura de membranas (p = 0,007). As vulvovaginites não se mostraram associadas ao trabalho de parto prematuro e/ou corioamnionite. Conclusões: A prevalência de vulvovaginites na gestação foi de 38,9%. Pacientes com 30 anos ou mais apresentaram menos probabilidade de desenvolverem vulvovaginites, porém a patologia aumentou em quase quatros vezes a probabilidade de ocorrência de rotura prematura de membranas.

Background: Vulvovaginitis is the infectious process of the female lower genitourinary tract, which can lead to perinatal complications such as preterm labor, premature rupture of membranes and chorioamnionitis. Objective: To evaluate the prevalence of vulvovaginitis in gestation and to define its association with sociodemographic factors and perinatal complications. Methods: Cross-sectional study with analysis of 216 medical records of patients who performed prenatal care in an outpatient clinic from July / 2010 to February / 2012. The data were analyzed by the SPSS 16.0 program. The chi-square test tested the homogeneity of proportions. The prevalence ratios and their respective confidence intervals were calculated, with a significance level of p < 0.05. Results: The prevalence of vulvovaginitis in pregnancy was 38.9%. Age greater than or equal to 30 years was less associated (p = 0.003) with the development of vulvovaginitis [RP 0.24 (CI95% 0.07-0.68)]. The occurrence of vulvovaginitis during pregnancy increased the probability of premature rupture of membranes (p = 0.007) by almost four times [RP 3.80 (CI95%1.29-12.63)]. Vulvovaginitis was not associated with preterm labor and/or chorioamnionitis. Conclusions: The prevalence of vulvovaginitis in pregnancy was 38.9%. Patients 30 years of age or older were less likely to develop vulvovaginitis, but the condition increased by almost four-fold the likelihood of premature rupture of membranes.

New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency / Nova opção terapêutica na síndrome geniturinária da menopausa: estudo piloto utilizando radiofrequência fracionada microablativa

ABSTRACT Objective: To evaluate the clinical response of patients with symptoms of genitourinary syndrome of menopause after application of microablative fractional radiofrequency in the vagina and vaginal introitus. Methods: Fourteen patients with symptoms of genitourinary syndrome of menopause underwent three applications of microablative fractional radiofrequency with a 30-day interval, using the Wavetronic 6000HF-FRAXX device and a fractional vaginal electrode. The questionnaires World Health Organization Quality of Life (for quality of life evaluation), Female Sexual Function Index and Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (for sexual function and satisfaction evaluation) were administered before and after the applications (30 to 60 days after the last procedure), in addition to the satisfaction questionnaire after procedure. Results: There was an increase in almost all dimensions on average in quality of life, with statistical significance only in the health domain. There was a significant improvement in the sexual domains in almost all dimensions. All patients stopped using lubricant during intercourse after treatment. In the satisfaction questionnaire after treatment, we observed that the vast majority felt cured or much better (29% and 64%, respectively, total of 92.6%) and were very satisfied or satisfied (43 and 57%, respectively, total of 100%). The only patient who reported little improvement had an 18-year postmenopausal history and was treatment naïve. Conclusion: Microablative fractional radiofrequency was effective in treating symptoms of vaginal dryness and dyspareunia, and eliminated the use of vaginal lubricant during the period observed. Since this is a pilot study with a small number of patients, further studies are required to corroborate our findings and evaluate the long-term effects of microablative fractional radiofrequency on the vaginal tissue.

RESUMO Objetivo: Avaliar resposta clínica de pacientes com sintomas da síndrome geniturinária da menopausa após aplicação de radiofrequência fracionada microablativa na vagina e no introito vaginal. Métodos: Quatorze pacientes com sintomas de síndrome geniturinária da menopausa foram submetidas a três aplicações de radiofrequência fracionada microablativa com intervalo de 30 dias, utilizando aparelho Wavetronic 6000HF-FRAXX e eletrodo vaginal fracionado. Foram aplicados os questionários World Health Organization Quality of Life (para avaliar qualidade de vida), Female Sexual Function Index e Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (para verificar função sexual e satisfação) antes e depois das aplicações (30 a 60 dias após último procedimento), além do questionário de satisfação após procedimento. Resultados: Na qualidade de vida, houve aumento na média em geral, com significância estatística apenas no quesito saúde. No domínio sexual, houve melhora significativa em quase todas as dimensões. Todas as pacientes cessaram o uso de lubrificante na relação sexual após o tratamento. No questionário de satisfação após tratamento, a maioria se sentiu curada ou muito melhor (29 e 64%, respectivamente; total de 92,6%) e estava muito satisfeita ou satisfeita (43 e 57%, respectivamente; total de 100%). A única paciente que relatou pouca melhora tinha história de 18 anos de pós-menopausa e era virgem de tratamento. Conclusão: Radiofrequência fracionada microablativa foi efetiva em tratar sintomas de ressecamento vaginal e dispareunia, e eliminou o uso de lubrificante vaginal durante o período observado. Por se tratar de estudo piloto com pequena quantidade de pacientes, mais estudos são necessários para corroborar estes achados e avaliar os efeitos a longo prazo da radiofrequência fracionada microablativa no tecido vaginal.

Zoon vulvitis

Abstract Zoon vulvitis or vulvitis chronica plasmacellularis is a rare, chronic benign inflammation of the vulvar mucosa, diagnosed histologically, with variable therapeutic responses. It is important to be diagnosed because it mimics the presentation of other genital conditions, such as lichen planus and squamous cell carcinoma, which require specific treatment. We report a case of a female patient with three asymptomatic shallow ulcers on the labia minora. Laboratory tests ruled out infectious diseases and the biopsy was consistent with Zoon Vulvitis.

Genitourinary problems in the elderly in geriatric hospitals

Population analyses and demographic data have clearly documented the rapid growth of the aging population in recent years. Although the population over 65 currently accounts for approximately 13.2% of the total population in Korea, it is estimated that this number will reach at least 40% by 2060. Aging is associated with a general decline in almost every physiological function of biological systems, including the lower urinary tract. Aging is also known to put individuals at a high risk for urinary tract infections. Geriatric hospitals in Korea have undergone a large expansion in terms of the number of beds and institutions. Many elderly patients in geriatric hospitals suffer from various genitourinary disorders. In particular, voiding dysfunction and urinary tract infections are prevalent comorbidities of other chronic geriatric diseases in patients in geriatric hospitals. Careful monitoring and management can help to reduce those genitourinary problems in elderly patients in geriatric hospitals.

Aderência ao seguimento no cuidado ao recém-nascido exposto à sífilis e características associadas à interrupção do acompanhamento / Adherence to the follow-up of the newborn exposed to syphilis and factors associated with loss to follow-up

RESUMO: Introdução: Todo recém-nascido exposto à sífilis na gestação deve ter acompanhamento ambulatorial. A interrupção do seguimento põe em risco todos aqueles que não recebem tratamento ao nascer. Objetivo: Descrever as características clínicas e epidemiológicas dos recém-nascidos expostos à sífilis, assim como gestacionais e sociodemográficas de suas mães e investigar os fatores associados com a descontinuidade do seguimento. Métodos: Trata-se de um estudo observacional, descritivo, analítico e retrospectivo dos prontuários de 254 crianças expostas à sífilis, atendidas no Ambulatório de Infecções Congênitas do Hospital de Clínicas da Universidade Federal do Paraná, entre 2000 e 2010. Os recém-nascidos foram classificados por referência ao seu acompanhamento ou não. Os dados foram ajustados a um modelo de regressão logística binária, no sentido de identificar os fatores associados à descontinuidade do tratamento. Resultados: As características estatisticamente associadas à interrupção do seguimento na análise multivariada foram: mães com idade acima de 30 anos, paridade de três ou mais filhos e a ausência de coinfecções pelo HIV e/ou hepatites virais. Conclusão: Tais achados demonstram a necessidade de identificar essas famílias e estabelecer estratégias que incentivem a formação de vínculos. Recomenda-se que os critérios de tratamento dos recém-nascidos tenham maior rigor, visto que a maior parte deles não faz o seguimento adequado.

ABSTRACT: Introduction: All newborns exposed to syphilis in pregnancy must have outpatient follow-up. The interruption of this follow-up especially threatens those children who were not treated at birth. Objective: To describe the clinical, epidemiological, and sociodemographic characteristics of pregnant women with syphilis and their newborns, and to investigate the factors associated with the discontinuation of the follow-up. Methods: This is an observational, descriptive, analytical, and retrospective study of medical records of 254 children exposed to syphilis, who were assisted at the Congenital Infectious Clinic of the university hospital of the Universidade Federal do Paraná, between 2000 and 2010. The newborns were classified by reference according to their follow-up. Data were analyzed by means of the binary logistic regression model in order to identify the factors associated to drop out. Results: The factors associated to the interruption of the follow-up were maternal age over 30 years, mothers with 3 or more children, and the absence of cross-infections by HIV and/or viral hepatitis. Conclusion: Such findings demonstrate the need to identify these families and implement strategies to promote the establishment of bonds. A greater rigor to indicate the treatment of the disease at birth is recommended, as most of them do not properly follow up.

Correção laparoscópica de fístula vesicovaginal: relato de caso / Laparoscopic repair of vesicovaginal fistula: a case report

Apesar de constituírem complicação incomum, as fístulas vesicovaginais apresentam expressivo impacto na qualidade de vida dos pacientes. As abordagens minimamente invasivas têm ganhado mais espaço no tratamento de doenças geniturinárias. Ainda são poucos os relatos do acesso laparoscópico para correção das fístulas vesicovaginais. Relata-se aqui um caso de fístula pós-histerectomia tratada totalmente de forma laparoscópica com ótimo resultado. As vantagens do acesso laparoscópico, assim como alguns detalhes técnicos, são discutidos...

Despite being an uncommon complication, vesicovaginal fistulas have significant impact on patient quality of life. Minimally invasive approaches have gained more space in the treatment of genitourinary diseases. There are few reports on laparoscopic approaches for correction of vesicovaginal fistulas. This is a case report of a post-hysterectomy fistulatreated exclusively through laparoscopy with excellent results. The advantages of the laparoscopic approach, as well as some technical details, are discussed...

Climaterio: oleadas de calor y otrossíntomas en indígenas Zenúes colombianas / Climacteric hot flashes and other symptoms in Colombian Zenúes indigenous / Climatério: ondas de calor e outros sintomas em indígenas colombianas Zenúes

Introducción: las oleadas de calor (OC) son un importante indicio con prevalencia diferente según etnias, del estado menopáusico. El objetivo de nuestra investigación fue evaluar la frecuencia y severidad de OC, y estimar en mujeres sintomáticas el riesgo de otros síntomas menopáusicos concomitantes. Método: estudio transversal como parte del proyecto CAVIMEC (Calidad de Vida en la Menopausia y Etnias Colombianas), realizado con la escala ‘MenopauseRating Scale’ en indígenas colombianas Zenúes, resguardo de San Andrés deSotavento, (Córdoba, Colombia), con edades entre 40 y 59 años. El análisis de los resultados se realizó en Epi-Info. 3.5.1 (Centers for Disease Control and Prevention, Atlanta, EEUU; 2008).Resultados: 596 (86.0%) de las 693 involucradas presentaron OC y solo el 1% mostró manifestación severa. Las mujeres sintomáticas tenían 51.2±5.7 años; escolaridad 4.6±4.6 años; 88.4% con pareja 98,2% con hijos, y 14.9% usaban terapia hormonal. 4.5% premenopáusicas, 12.6% perimenopáusicas y 62.9%posmenopáusicas. La prevalencia de OC moderada + severa, se incrementó con los cambios en el estado menopáusico. Fueron factores de riesgo la baja escolaridad y una edad mayor a 45 años. Sequedad vaginal, problemas vesicales y sexuales tuvieron elevado OR para presentarse concomitantemente en un modelo ajustado. Conclusión: fue elevada la presencia de OC en Zenúes, pero baja la presencia de síntomas severos. Los síntomas urogenitales tuvieron importante presencia concomitante.

Introduction: hot flashes (HF) are an important clue with different prevalence by ethnicity, menopausal status. The aim of our research was to evaluate the frequency and severity of HF, and estimate the risk of symptomatic women other menopausal symptoms attendant.Method: cross-sectional study as part of the CAVIMEC (Quality of Life Menopause and Colombian Ethnic groups), performed with the scale 'Menopause Rating Scale' in Colombian Zenues indigenous shelter of San Andrés de Sotavento, (Cordoba, Colombia), aged between 40 and 59 years. The analysis of the results was performed using Epi-info. 3.5.1 (Centers for Disease Control and Prevention, Atlanta, USA, 2008).Results: 596 (86.0%) of the 693 involved had HF and only 1% had severe manifestation. Symptomatic women were 51.2 ± 5.7 years, education 4.6 ± 4.6 years, 88.4% with 98.2% couples with Children, and 14.9% used hormone therapy. 4.5% premenopausal, 12.6% perimenopausal and postmenopausal 62.9%.HF prevalence moderate + severe increased with changes in the menopausal state. Risk factors were low education and age older than 45 years. Vaginal dryness, bladder and sexual problems were presented concomitantly elevated HFor an adjusted model.Conclusion: the presence of HF was elevated in Zenues but low presence of severe symptoms. Urogenital symptoms had concomitant significant presence.

Introdução: as ondas de calor (OC) são um indicio importante, que variam segundo etnias, do estado menopáusico. O objetivo de nossa pesquisa foi avaliar a frequência e severidade das OC, e estimar em mulheres sintomáticas o risco de outros sintomas menopáusicos concomitantes.Método: estudo transversal como parte do projeto CAVIMEC (Qualidade de Vida na Menopausa e Etnias Colombianas), realizado con a escala Menopause Rating Scale' em indígenas colombianas Zenúes, resguardo de San Andrés de Sotavento, (Córdoba, Colômbia), com idades entre 40 e 59 anos. A análise dos resultados foi feita em Epi-Info. 3.5.1 (Centers for Disease Control and Prevention, Atlanta, EEUU; 2008).Resultados: 596 (86.0%) das 693 envolvidas apresentaram OC e só 1% apresentou manifestação severa. As mulheres sintomáticas tinham 51.2±5.7 anos; escolaridade 4.6±4.6 anos; 88.4% com companheiro, 98,2% com filhos, e 14.9% usavam terapia hormonal. 4.5% premenopáusicas, 12.6% perimenopáusicas e 62.9% posmenopáusicas.A prevalencia de OC moderada mais severa, se incrementou com as mudanças no estado menopaúsico. Foram fatores de risco a baixa escolaridade e uma idade superior a 45 anos. Secura vaginal, problemas vesicais e sexuais liberam elevado OR presentes concomitantemente em um modelo ajustado.Conclusão: foi elevada a presença de OC en Zenúes, mas baixos os síntomas severos. Os síntomas urogenitais tiveram importante presença concomitante.