Manejo intraparto del tabique vaginal longitudinal / Intrapartum management of a longitudinal vaginal septum

RESUMEN El tabique vaginal congénito longitudinal (TVCL) es un defecto que puede asociarse a dispareunia o distocia durante el parto. Se presenta el caso de una mujer secundigesta nulípara de 20 años en quien se identificó un TVCL durante trabajo de parto. En el tacto vaginal se palpó una estructura elástica de aproximadamente 2 cm por detrás del introito vaginal. Durante la segunda etapa del trabajo de parto, se realizó una sección medial del tabique permitiendo el nacimiento de un producto vivo. En conclusión, un examen físico exhaustivo es suficiente para evidenciar la presencia de un tabique vaginal; sin embargo, existe la probabilidad de un diagnóstico intraparto de TVCL donde la formación médica ginecológica es necesaria para minimizar los riesgos asociados al parto.

ABSTRACT The longitudinal congenital vaginal septum (LCVS) is a defect that can be associated with dyspareunia or dystocia during childbirth. We present a case of a 20 year old woman in whom a LCVS was identified during labor. In the pelvic examination, an elastic structure was felt about 2 cm behind the vaginal intro. During the second stage of labor, a medial section of the septum was made allowing the birth of a live female product. In conclusion, a thorough physical examination is enough to show the presence of a vaginal septum. However, there is a probability of an intrapartum diagnosis of LCVS therefore gynecological medical training is necessary to minimize the risks associated with childbirth.

Comportamiento de la infección vaginal en gestantes, Consejo Popular William Soler, 2017-2018 / Behavior of vaginal infection in pregnant women, William Soler People's Council, 2017-2018 / Comportamento da infecção vaginal em mulheres grávidas, William Soler People's Council, 2017-2018

RESUMEN Introducción: la infección vaginal es una enfermedad con gran incidencia, constituye una de las complicaciones más frecuentes asociadas a la gestación, se trata de una infección común del tracto genital inferior en las mujeres que de no ser tratada oportunamente puede traer consecuencia para la salud de la madre y su producto. Objetivos: caracterizar el comportamiento de la infección vaginal en las gestantes del consejo popular William Soler de 2017-2018. Método: se realizó un estudio descriptivo transversal sobre el comportamiento de la infección vaginal en embarazadas del consejo William Soler del Policlínico 13 de Marzo, en el período 2017 - 2018. El universo estuvo constituido por 203 gestantes diagnosticadas con sepsis vaginal y la muestra representativa por 127. Los datos se recolectaron mediante un cuestionario y fueron procesados a través de una base de datos creada en Excel utilizando el paquetes estadístico profesional SPSS 22.0 para Windows, se utilizó el método del conteo simple, se reflejaron los datos en números absolutos y porcentaje. Resultados: la infección vaginal predominó en las gestantes de nivel secundario y pre-universitarias, fundamentalmente en las menores de 19 años, seguidas de las de 20-25 años de edad, el agentes causales más frecuentes fue la monilia, predominó en un 61,4% una adecuada técnica de aseo, el mayor número de diagnósticos fue en el primer y tercer trimestre y las complicaciones surgidas fueron pocas entre ellas la sepsis neonatal con 8,6%, sepsis puerperal 7,8%. Conclusiones: la infección vaginal en el embarazo es más frecuente en menores de 25 años con nivel secundario y pre-universitario. La causa más frecuente es la moniliasis, predominó la técnica adecuada de aseo, el diagnóstico de infección vaginal es más frecuente en el I y III trimestre del embarazo. Se produjeron pocas complicaciones con predominio de la sepsis neonatal y puerperal.

ABSTRACT Introduction: vaginal infection is a disease with a high incidence, it is ONE of the most frequent complications associated with pregnancy, it is a common infection of the lower genital tract in women that, if not treated in a timely manner, can have consequences for the health of the mother and her product. Objectives: to characterize the behavior of vaginal infection in pregnant women of the William Soler popular council of 2017-2018. Method: a descriptive cross-sectional study was carried out on the behavior of vaginal infection in pregnant women of the William Soler Council of the Polyclinic March 13, in the period 2017 - 2018. The universe consisted of 203 pregnant women diagnosed with vaginal sepsis and the representative sample by 127. The data was collected through a questionnaire and processed through a database created in Excel using the professional statistical packages SPSS 22.0 for Windows, the simple counting method was used, the data were reflected in absolute numbers and percentage. Results: the vaginal infection prevailed in the pregnant women of secondary and pre-university level, fundamentally in the minors of 19 years, followed of those of 20-25 years of age, the most frequent causative agents was the monilia, prevailed in a 61, 4% an adequate cleaning technique, the highest number of diagnoses was in the first and third trimester and the complications arisen were few among them neonatal sepsis with 8.6%, puerperal sepsis 7.8%. Conclusions: vaginal infection in pregnancy is more frequent in children under 25 with secondary and pre-university level. The most frequent cause is moniliasis, the proper cleaning technique prevailed, the diagnosis of vaginal infection is more frequent in the I and III trimester of pregnancy. There were few complications with predominance of neonatal and puerperal sepsis.

RESUMO Introdução: a infecção vaginal é uma doença de alta incidência, é uma das complicações mais frequentes associadas à gravidez, é uma infecção comum do trato genital inferior em mulheres que, se não tratada em tempo hábil, pode ter consequências para a saúde da A mãe e seu produto. Objetivos: caracterizar o comportamento da infecção vaginal em gestantes do conselho popular William Soler de 2017-2018. Método: foi realizado um estudo descritivo transversal sobre o comportamento da infecção vaginal em gestantes do Conselho William Soler da Policlínica de 13 de março de 2017 a 2018. O universo foi composto por 203 gestantes com diagnóstico de sepse vaginal e a amostra representativa de 127. Os dados foram coletados por meio de um questionário e processados ​​por meio de um banco de dados criado em Excel, utilizando os pacotes estatísticos profissionais SPSS 22.0 for Windows, foi utilizado o método de contagem simples, os dados foram refletidos em números absolutos e percentuais. Resultados: a infecção vaginal predominou nas gestantes de nível secundário e pré-universitário, fundamentalmente nos menores de 19 anos, seguidas das de 20 a 25 anos, o agente causador mais frequente foi a monília, com 61, 4% como técnica de limpeza adequada, o maior número de diagnósticos ocorreu no primeiro e terceiro trimestre e as complicações surgidas foram poucas, entre elas sepse neonatal com 8,6%, sepse puerperal 7,8%. Conclusões: a infecção vaginal na gravidez é mais frequente em menores de 25 anos, com ensino médio e pré-universitário. A causa mais frequente é a monilíase, prevaleceu a técnica de limpeza adequada, o diagnóstico de infecção vaginal é mais frequente no trimestre I e III da gravidez. Houve poucas complicações com predominância de sepse neonatal e puerperal.

Safety and efficacy of Vecchietti vaginoplasty in vaginal agenesis: cohort study. Medellín, Colombia 2007-2012 / Segurança e eficácia da vaginoplastia de Vecchietti na agenesia vaginal: coorte de 2007 a 2012 / Seguridad y eficacia de la vaginoplastia de vecchietti en agenesia vaginal: estudio de cohorte, en medellín, colombia, 2007 a 2012

RESUMEN Objetivo: describir la técnica de vaginoplastia de Vecchietti (TVV) en pacientes diagnosticadas con agenesia vaginal secundaria y hacer una aproxima- ción a la seguridad y eficacia de esta técnica. Materiales y métodos: cohorte histórica de pacientes con agenesia vaginal secundaria al síndrome de Mayer-Rokitansky-Kuster-Hauser y al síndrome de insensibilidad androgénica, a quienes se les realizó vaginoplastia por técnica de Vecchietti en el Hospital Universitario San Vicente Fundación, institución de referencia, de alta complejidad, en el periodo 2007 a 2012. Se excluyeron quienes tenían una vagina funcional para relaciones coitales. Muestreo consecutivo. Se midieron variables socio- demográficas, clínicas, de seguridad y de eficacia. Se utilizó estadística descriptiva. Resultados: el principal motivo de consulta fue la amenorrea primaria (69,2 %). Las malformaciones asociadas fueron agenesia renal derecha (15,4 %) y malformaciones esqueléticas (15,4 %). Se presentó una perforación intraoperatoria de la vejiga y tres complicaciones menores (23,1 %) en el posoperatorio. En el 84,6 % de ellas se obtuvo una vagina funcional a un año de seguimiento. Conclusiones: la TVV es una técnica quirúrgica simple que ha permitido obtener resultados funcionales satisfactorios con complicaciones menores. Se requieren estudios con grupo control para tener una mejor evaluación de la eficacia de las diferentes técnicas de construcción de la neovagina.

ABSTRACT Objective: To describe the Vecchietti vaginoplasty technique (VVT) in patients diagnosed with sec- ondary vaginal agenesis and to analyze the safety and efficacy of this technique. Materials and methods: Historical cohort of patients with vaginal agenesis secondary to Mayer- Rokitansky-Kuster-Hauser and androgen insensitivity syndromes, subjected to vaginoplasty using the Vecchietti technique at San Vicente Fundación University Hospital, a high complexity referral institution located in the city of Medellín, during the time period between 2007 and 2012. Patients with functional a vagina for intercourse were excluded. Sampling was consecutive. Sociodemographic, clinical, safety and efficacy variables were measured. Descriptive statistics were used. Results: The main complaint was primary amenorrhea (69.2%). Associated malformations included right renal agenesis (15.4%) and skeletal malformations (15.4%). There was one intra-operative bladder perforation and, postoperatively, there were three (23.1%) minor complications. At 1-year follow-up, a functional vagina had been obtained in 84.6% of cases. Conclusion: Vecchietti vaginoplasty is a simple surgical technique resulting in satisfactory functional outcomes with only minor complications. Further studies with control groups are required in order to better assess the efficacy of the various techniques used for neovagina creation.

RESUMO Objetivo: descrever a técnica da vaginoplastia de Vecchietti (TVV) em pacientes diagnosticadas com agenesia vaginal secundária e fazer uma abordagem a respeito da segurança e eficácia desta técnica. Materiais e métodos: coorte histórica de pacientes com agenesia vaginal secundária à síndrome de Mayer-Rokitansky-Kuster-Hauser e à síndrome de insensibilidade androgênica, que foram submetidas a uma vaginoplastia pela técnica de Vecchietti no Hospital Universitário San Vicente Fundación, estabelecimento de referência, de alta complexidade, no período 2007-2012. Foram excluídas aquelas pacientes que tinham uma vagina funcional para relações coitais. Amostragem consecutiva. Foram mensuradas diversas variáveis sociodemográficas, clínicas, de segurança e de eficácia, utilizando o método de estatística descritiva. Resultados: o principal motivo de consulta foi a amenorreia primária (69,2%). As malformações correlatas foram agenesia renal direita (15,4%) e malformações esqueléticas (15,4%). Verificouse uma perfuração intraoperatória da bexiga e três complicações menores (23,1%) no pós-operatório. Em 84,6% delas conseguiu se uma vagina funcional durante o primeiro ano de acompanhamento. Conclusão: a TVV é uma técnica cirúrgica simples que permitiu obter resultados funcionais satisfatórios com complicações menores. É preciso levantar estudos com grupo-controle para fazer uma melhor avaliação da eficácia das diferentes técnicas de construção da neovagina.

Vaginal tubulo-squamous polyp: a clinicopathological analysis of four cases / 中华病理学杂志

Objective@#To investigate clinicopathological characteristics of vaginal tubulo-squamous polyp (TSP).@*Methods@#Clinical and pathological data of 4 cases of vaginal TSP diagnosed at Women′s Hospital, School of Medicine, Zhejiang University from 2007 to 2018 were analyzed by hematoxylin-eosin and EnVision two-step immunohistochemical staining technique.@*Results@#The age of the 4 patients ranged from 62 to 71 years, with a mean of 66 years. Histologically, the polyps consisted of an admixture of squamous epithelium and tubules within a fibrous stroma. Immunohistochemically, the cells lining the tubules showed positive staining of prostatic acid phosphatase (PSAP) and/or prostate-specific antigen (PSA) in all 4 cases. Available follow-up in 3 patients for 4 to 6 months (mean of 5.3 months) showed no tumor recurrence.@*Conclusion@#TSP is an under-recognized benign vaginal polypoid disease that may develop from paraurethral Skene glands.

Value of MRI in diagnosis of oblique vaginal septum syndrome / 中华全科医师杂志

Objective To assess the application of MRI in diagnosis of oblique vaginal septum syndrome (OVSS).Methods Clinical and imaging data of 41 patients with OVSS confirmed by surgery from March 2011 to November 2016 were retrospectively analyzed.Results The average age of patients was 20.5 year (10-46 years).The primary clinical symptoms were menorrhalgia (16 cases) and menorrhagia (13 cases).There were 12 cases of type Ⅰ,23 cases of type Ⅱ,5 cases of type Ⅲ and 1 case of type Ⅳamong 41 cases of OVSS.The resections for OVSS were performed in 35 cases.Forty two cases were diagnosed as OVSS by MRI scan,and 41 were confirmed by surgery,the accuracy of MRI diagnosis was 97.6％ (41/42).MRI showed uterus didelphys,hydrocolpos or hematocolpos with varying degrees,and revealed ipsilateral renal agenesis in all 41 cases.Conclusion MRI scan can accurately diagnose oblique vaginal septum syndrome and provide comprehensive information for clinical treatment.

Rejuvenation Using Platelet-rich Plasma and Lipofilling for Vaginal Atrophy and Lichen Sclerosus

Vaginal atrophy is a common condition among peri- and post-menopausal women. Symptoms of vaginal dryness, pruritus, irritation, loss of subcutaneous fat, sparse pubic hair and dyspareunia occur due to decreased estrogen level. Estrogen-based treatments are effective. But many patients are reluctant to be treated due to health concerns. As alternatives, we explored the efficacy of platelet-rich plasma (PRP) and lipofilling. A 67-year-old female patient with vaginal atrophy was referred to our department. Treatment using estrogen cream had failed to improve patient's symptoms. Diminished volume and aged look of genitalia were also major concerns. We treated her using lipofilling mixed with PRP. A total of 40 cc of autologous fat mixed with PRP was transferred to labia majora. Lipofilling with PRP relieved the clinical symptoms. Missing fullness and tone was corrected and the augmented volume was well maintained. White patchy lesions of lichen sclerosus on labia minora also improved. Lipofilling with PRP relieved symptoms, restored contour of the labia majora and achieved remission of lichen sclerosus on labia minora. As vulvar lesions were repaired and the aged appearance of genitalia was rejuvenated, both functional and cosmetic outcomes were satisfactory. Lipofilling with PRP can be effective for vaginal atrophy and lichen sclerosus.

Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article

Bacterial vaginosis (BV) and complicated vulvovaginal candidiasis (VVC) are frequently occurring vaginal infections in postmenopausal women, caused by an imbalance in vaginal microflora. Postmenopausal women suffer from decreased ovarian hormones estrogen and progesterone. A normal, healthy vaginal microflora mainly comprises Lactobacillus species (spp.), which act beneficially as a bacterial barrier in the vagina, interfering with uropathogens. During premenopausal period, estrogen promotes vaginal colonization by lactobacilli that metabolizing glycogen and producing lactic acid, and maintains intravaginal health by lowering the intravaginal pH level. A lower vaginal pH inhibits uropathogen growth, preventing vaginal infections. Decreased estrogen secretion in postmenopausal women depletes lactobacilli and increases intravaginal pH, resulting in increased vaginal colonization by harmful microorganisms (e.g., Enterobacter, Escherichia coli, Candida, and Gardnerella). Probiotics positively effects on vaginal microflora composition by promoting the proliferation of beneficial microorganisms, alters the intravaginal microbiota composition, prevents vaginal infections in postmenopausal. Probiotics also reduce the symptoms of vaginal infections (e.g., vaginal discharge, odor, etc.), and are thus helpful for the treatment and prevention of BV and VVC. In this review article, we provide information on the intravaginal mechanism of postmenopausal vaginal infections, and describes the effectiveness of probiotics in the treatment and prevention of BV and VVC.

Sentinel lymph node mapping with indocyanine green in vaginal cancer / 부인종양

OBJECTIVE: Sentinel lymph node (SLN) mapping is being adapted to gynecologic cancer. Higher SLN mapping rates were reported with indocyanine green (ICG) compared to other dyes. The aim of this film is to share our experience of SLN mapping with ICG in vaginal cancer. METHODS: A 40 year-old woman was diagnosed with squamous cell vaginal cancer. About 1.5 cm-sized tumor was located on the posterior vaginal fornix. Preoperatively she was assumed to be stage I vaginal cancer. Beginning of surgery, we performed SLN mapping by ICG injection into 3- and 9-o'clock positions of the vaginal tumor. Concentrated in 1.25 mg/mL, 1 mL of ICG solution was injected into deep stroma and another 1 mL submucosally in both sides. Bilateral SLN identification and lymphadenectomy were done. Afterward, laparoscopic Type C1 Querleu-Morrow radical hysterectomy with vaginectomy was done. A fluorescence endoscope produced by KARL STORZ (Tuttlingen, Germany) was used for ICG detection. RESULTS: To our knowledge, this is the first film report performing SLN mapping with ICG in vaginal cancer. The mapping was successful and we were able to recognize SLN of vaginal cancer. SLNs were located in the bilateral obturator fossa. According to the pathologic diagnosis, the mass size was 15 mm and invasion depth was 1 mm. Subvaginal tissue involvement and pelvic wall extension were absent. Resection margin of the vagina was free from carcinoma. No lymph node metastasis was reported including the bilateral SLNs. CONCLUSION: For vaginal cancer, SLN mapping can be applied by injecting ICG into the bilateral sides of the vaginal tumor.

Fatores associados à variação no comprimento e diâmetro vaginal após radioterapia pélvica para câncer do colo uterino / Factors associated with changes in vaginal length and diameter after pelvic radiotherapy for cervical cancer

Introdução: o câncer do colo uterino é o quarto tipo de câncer mais comum entre as mulheres. O tratamento pode incluir a radioterapia e um dos eventos adversos é a estenose vaginal. Objetivos: avaliar a incidência de estenose vaginal através de medidas objetivas e uma escala subjetiva, e identificar os fatores associados à ocorrência desse evento adverso após a radioterapia pélvica. Métodos: estudo longitudinal descritivo realizado de janeiro/2013 a novembro/2015 com 139 mulheres portadoras de neoplasia maligna do colo uterino, estádio I-IIIB, com idades entre 18-75 anos que haviam sido convidadas a participar de um ensaio clínico randomizado para avaliar diversos tratamentos para estenose vaginal após radioterapia. O desfecho foi a estenose vaginal, avaliada através da escala de estenose vaginal Common Terminology Criteria for Adverse Events version 3.0 (CTCAEv3.0) e da diferença entre as medidas do comprimento e do diâmetro da vagina logo após o término da radioterapia. As variáveis independentes foram as características da neoplasia, dados clínicos e sociodemográficos. A análise bivariada foi realizada usando os testes do qui-quadrado, Kruskal-Wallis e Mann-Whitney. A análise multivariada foi realizada através da regressão de Poisson e do modelo linear generalizado. Resultados: a média de idade foi de 47,2 (± 13,4) anos e 40,3% das mulheres estavam na pós-menopausa. Metade delas apresentava câncer do colo do útero estadio IIIB (50,4%). Pela escala CTCAEv3.0, 42 mulheres (30,2%) não apresentaram estenose, 96 mulheres (69,1%) apresentaram estenose grau 1 e uma mulher (0,7%) apresentou estenose grau 2 logo após a radioterapia. Com relação às alterações das medidas vaginais, a variação média de diâmetro foi -0,6 (± 1,7) mm e a variação média do comprimento foi -0,6 (± 1,3) cm. Quinze mulheres apresentaram redução do diâmetro vaginal, sendo que em 93,5% delas a redução foi de 0,5 cm e em 1 mulher a redução foi de 1 cm. Com relação ao comprimento vaginal, 65,7% apresentaram diminuição da medida, sendo que dessas, 62% tiveram diminuição de 0,5-1 cm; 32% tiveram diminuição de 1,5-2,5 cm e 6% tiveram diminuição de 3-4 cm. Por outro lado, 11 mulheres (8%) tiveram aumento do comprimento vaginal, sendo que dessas, 36,3% tiveram aumento de 0,5-1 cm; 36,3% tiveram aumento de 1,5-2,5 cm; 18,3% tiveram aumento de 3-4 cm e 9,1% tiveram aumento de 5 cm. Na análise multivariada, mulheres com invasão vaginal apresentaram menos estenose vaginal pela escala CTCAEv3.0 (coeficiente:-0,51;p<0,01). Quanto à variação do diâmetro, mulheres com estadiamento clínico IIIA/IIIB apresentaram redução da medida mais frequentemente (coeficiente:+1,44;p=0,02). Quanto à variação do comprimento, mulheres que realizaram teleterapia/braquiterapia apresentaram maior redução da medida (coeficiente:-1,17;p<0,01) e mulheres portadoras de diabetes (coeficiente:+1,16; p<0,01) e com invasão vaginal pelo tumor (coeficiente:+0,73;p<0,01) apresentaram aumento da medida. Conclusões: a maioria das mulheres apresentou estenose leve, com redução discreta do comprimento do canal vaginal. Estadiamento clínico avançado e realizar uma associação de braquiterapia e teleterapia se associaram a uma maior frequência de estenose. Mulheres com neoplasias do colo que invadem a vagina apresentam aumento das medidas do comprimento vaginal logo após a radioterapia devido à redução do volume tumoral. (AU)

Introduction: cervical cancer is the fourth most common cancer among women. Treatment may include radiation therapy and one of the adverse events is vaginal stenosis. Objectives: to evaluate the incidence of vaginal stenosis using objective measures and a subjective scale, and to identify factors associated with the occurrence of this adverse event after pelvic radiotherapy for cancer of the cervix. Methods: a longitudinal descriptive study conducted from Jan/2013 to Nov/2015 with 139 women suffering from malignant cervical cancer, stage I-IIIB, aged 18-75 years who had been invited to participate in a randomized clinical trial to evaluate various treatments for vaginal stenosis after radiotherapy. The main outcome was vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAEv3.0) and through changes in vaginal diameter and length after the end of radiotherapy. Independent variables were the characteristics of the neoplasm, clinical and sociodemographic data. Bivariate analysis was carried out using chi-squared test, Kruskal-Wallis and Mann-Whitney's test. Multiple analysis was carried out using Poisson regression and a generalized linear model. Results: The mean age was 47.2 (± 13.4) years and 40.3% of women were postmenopausal. Half of them had cervical cancer stage IIIB (50.4%). By CTCAEv3.0 scale, 42 women (30.2%) showed no stenosis, 96 women (69.1%) had grade 1 stenosis and one woman (0.7%) had grade 2 stenosis after radiotherapy. Regarding changes in vaginal measures the average change in diameter was 0.6 (± 1.7) mm and the average length variation was -0.6 (± 1.3) cm. Fifteen women had reduced vaginal diameter, and in 93.5% of them the reduction was 0.5 cm and in one woman the reduction was 1 cm. Regarding vaginal length, 65.7% showed a decrease in extent, and of these, 62% had decreased 0.5-1 cm; 32% had decreased 1.5-2.5 cm and 6% had a reduction of 3-4 cm. On the other hand, 11 women (8%) had an increase in vaginal length, and of these, 36.3% had an increase of 0.5-1 cm; 36.3% had an increase of 1.5-2.5 cm; 18.3% had an increase of 3-4 cm and 9.1% had an increase of 5 cm. In multivariate analysis, women with tumoral invasion of the vaginal walls had fewer vaginal stenosis by CTCAEv3.0 scale (coefficient: -0.51, p <0.01). As to changes in diameter, women with clinical stage IIIA/IIIB had reductions in this measure more frequently (coefficient: +1.44; p=0.02). As to changes in vaginal length, women who underwent teletherapy/brachytherapy showed greater reduction in this measure (coefficient: -1.17; p <0.01) and women with diabetes (coefficient: +1.16; p <0.01) and tumoral invasion of the vaginal walls (coefficient: +0.73; p <0.01) had increases in this measure more frequently. Conclusion: most women had mild stenosis, with a slight reduction of the length of the vagina. Advanced clinical stage and performing a combination of brachytherapy and teletherapy were associated with a higher frequency of stenosis. Women with cervical cancer which invades the vaginal walls have increases in vaginal length after radiotherapy due to reduction in tumoral volume.(AU)

Streptococcus spp. en el embarazo, patología y avances en su detección temprana / Streptococcus spp. in pregnancy, pathology and advances in early detection

El Streptococcus spp ha adquirido mucha importancia a nivel mundial debido a la gran patogenicidad de sus diferentes especies. Una de ellas es el Streptococcus del Grupo B que comúnmente se encuentra a nivel vaginal en mujeres embarazadas, lo que puede ocasionar una contaminación al recién nacido en el momento del parto. Solo un pequeño porcentaje de estos neonatos desarrollan la infección y pueden llegar a presentar sepsis, meningitis, neumonía neonatal, entre otras complicaciones, así como secuelas neurológicas permanentes, retraso en el crecimiento y muerte. Debido a esto, se han implementado estrategias preventivas, en las que se incluyen pruebas de tamizaje para su detección temprana y evitar el riesgo de infección. En las últimas décadas se ha incrementado el uso de técnicas moleculares para su diagnóstico precoz y tratamiento temprano, de manera de disminuir la morbimortalidad atribuida al Streptococcus del Grupo B.

Streptococcus spp has acquired great importance due to the high pathogenicity of its different species around the world. The Group B Streptococcus is commonly found in the vaginal area of pregnant women, which at delivery may lead to contamination of the newborn. Only some of these infants develop the infection and may present sepsis, meningitis, neonatal pneumonia, among other complications, including permanent neurological sequelae, delayed growth and death. Preventive strategies include screening and early detection to avoid the risk of infection. In recent decades the use of molecular techniques for early diagnosis and treatment has increased that would decrease morbidity and mortality attributed to Group B Streptococcus.

Prevalencia de actinomicosis vaginal y su asociación con el uso del dispositivo intrauterino en tres instituciones de salud de Antioquia, 20131 / Prevalence of vaginal Actinomycosis and its association with the use of the intrauterine device in three health institutions in Antioquia, 2013

Introducción: la actinomicosis vaginal presenta una elevada ocurrencia y graves implicaciones clínicas en jóvenes y usuarias del dispositivo intrauterino, tales como cuadros febriles con pérdida de peso, dolor abdominal, sangrado genital o leucorrea e incluso endometritis. Objetivo: analizar la prevalencia de Actinomyces spp. según el uso del dispositivo intrauterino, régimen de afiliación en salud, zona de residencia y presencia de coinfecciones vaginales en tres instituciones prestadoras de servicios de salud de Antioquia. Métodos: estudio transversal en una población de 3 870 mujeres atendidas en tres instituciones de salud y sus respectivas citologías. Los análisis se realizaron a través de proporciones con sus intervalos de confianza, chi cuadrado, prueba Z, razones de prevalencia y regresión logística binaria para identificar posibles variables de confusión. Resultados: 44,4 % no usaba métodos de planificación, 5,9 % usaban DIU, 32,2 % presentó coinfecciones por vaginosis bacteriana, candidiasis o tricomoniasis. La prevalencia de actinomicosis vaginal fue de 3,9 %, que, además, presentó asociación con la institución de salud, el grupo etario, el método de planificación y la presencia de coinfecciones. Las mayores prevalencias se encontraron en las mujeres con edad entre 20-44 años (4,9 %), usuarias del dispositivo intrauterino (36,6 %) y con coinfecciones vaginales (5,5 %). Conclusión: la elevada prevalencia de actinomicosis en las usuarias del dispositivo intrauterino evidencia que este grupo presenta el mayor riesgo para el desarrollo de esta infección en las tres instituciones de salud; esta información resulta útil para orientar posteriores acciones sanitarias e investigativas.

Background: Vaginal actinomycosis presents a high occurrence in young and users of intrauterine device, such as febrile illness with weight loss, abdominal pain, genital bleeding or leucorrhea and endometritis. Objectives: To analyze the prevalence of Actinomyces spp. and its association with intrauterine device use, health affiliation scheme, area of residence and presence of vaginal coinfections in three institutions providing health services of Antioquia. Methods: Cross-sectional study in a population of 3 870 smears of women attended three institutions providing health services. Analyses were performed by proportions with confidence intervals, chi square, test Z, prevalence ratios and binary logistic regression for identify confounder. Results: 44.4 % do not use planning methods, 5.9 % used intrauterine device, 32.2 % had coinfections with bacterial vaginosis, candidiasis or trichomoniasis. The prevalence of vaginal actinomycosis was 3.9 %, this presented association with institutions providing health services, the age group, the planning method and the presence of co-infections; the highest prevalence was found in women aged 20-44 years with 4.9 %, intrauterine device users 36.6 % and with vaginal coinfections 5.5 %. Conclusion: The high prevalence of actinomycosis in intrauterine device users shows that this group present the major risk for the infection in the three institutions providing health services Medellin; this information is useful to guide subsequent health and investigative actions.

Estrategia de atención al síndrome de flujo vaginal en gestantes. Sancti Spíritus / Strategy care in pregnant vaginal discharge syndrome. Sancti Spíritus

Fundamento: las infecciones de trasmisión sexual constituyen un problema de salud en todo el mundo, sin embargo en la provincia se carece de información sobre bases científicas de los resultados de la aplicación de la estrategia para la atención del síndrome de flujo vaginal en la Atención Primaria de Salud. Objetivo: describir los resultados de la aplicación de la estrategia para la atención del síndrome de flujo vaginal a partir de la información aportada por especialistas de 16 consultorios médicos de familia en tres municipios espirituanos. Metodología: se realizó investigación descriptiva, transversal que incluyó los 16 especialistas de Medicina General Integral de igual número de consultorios tipo 1 de municipios priorizados para las infecciones de trasmisión sexual, a quienes se le aplicó una encuesta, los resultados se presentaron en tablas utilizando frecuencias absolutas y relativas. Resultados: más de la mitad de las gestantes atendidas padecían el síndrome de flujo vaginal y a todas le estudiaron sus parejas sexuales, los médicos conocen la existencia del flujograma; en Sancti Spíritus y Fomento los facultativos dominan mejor el contenido del stock de medicamentos para su tratamiento; carecen de información sobre la entrega gratuita del módulo de medicamentos destinado a esta problemática y la totalidad conoce la conducta a seguir ante una gestante con flujo vaginal. Conclusiones: la estrategia para el manejo del síndrome de flujo vaginal en gestantes no es aplicada adecuadamente en los municipios estudiados, por el desconocimiento de la disponibilidad de medicamentos eficaces y gratuitos en el área de salud para el tratamiento de la gestante y su pareja.

Background: sexually transmitted infections are a health problem worldwide, but in the province there is a lack of information on scientific basis of the results of the implementation of the strategy for the care of vaginal discharge syndrome in Primary Health Care. Objective: to describe the results of the implementation of the strategy for the care of vaginal discharge from the information provided by specialists from 16 family doctor offices in three municipalities of Sancti Spíritus. Methodology: descriptive, cross investigation was used that included 16 specialists in Comprehensive General Medicine with equal number of Type 1 doctor offices of prioritized municipalities for sexually transmitted infections, to whom a survey was applied, the results were presented in tables using absolute and relative frequencies. Results: more than half of the cared pregnant women suffered vaginal discharge syndrome and their sexual partners were studied as well, doctors are aware of the flowchart; physicians dominate the content of the stock of medicines for treatment better in Sancti Spiritus and Fomento; they are lack of information about the free drug delivery module devoted to this condition and all of them know the medical procedures to follow in the presence of a woman with vaginal discharge. Conclusions: the strategy for the management of vaginal discharge syndrome in pregnant women is not properly implemented in the municipalities studied, due to the lack of availability of effective and free drugs in the healthcare area for the treatment of pregnant women and their partners.

Septate uterus with cervical duplication and longitudinal vaginal septum: [review] / Útero septado com duplicidade cervical e septo vaginal longitudinal: [revisão]

We present the case of a 19-year-old nulligravida woman with severe dysmenorrhea since menarche; she was found to have a longitudinal vaginal septum, cervical duplication and two endometrial cavities, separated by a complete septum. Diagnosis and management of this unusual Müllerian anomaly are discussed in the context of a literature review.

No presente artigo, relata-se o caso de uma mulher de 19 anos com queixa de dismenorreia intensa desde a menarca. Diagnosticou-se a presença de septo longitudinal vaginal, duplicidade cervical e duas cavidades endometriais, separadas por um septo completo. O diagnóstico e o manejo desta rara malformação Mülleriana são discutidos junto a uma revisão bibliográfica.

Frequência de leveduras em fluido vaginal de mulheres com e sem suspeita clínica de candidíase vulvovaginal / Frequency of yeasts in vaginal fluid of women with and without clinical suspicion of vulvovaginal candidiasis

OBJETIVO: estudar a candidíase vulvovaginal em mulheres com e sem suspeita clínica a partir de fluido vaginal, identificando frequência de Candida spp. e associando a fatores de risco intrínsecos e extrínsecos. MÉTODOS: foram coletadas 286 amostras de pacientes atendidas em clínicas e postos de saúde entre Agosto de 2005 e Agosto de 2007. Foram 121 mulheres com suspeita e 165 sem suspeita clínica. Com zaragatoas estéreis, as amostras foram coletadas, transportadas ao laboratório em solução fisiológica 0,85 por cento, semeadas em CHROMagar Candida e em meio ágar Sabouraud 4 por cento com cloranfenicol. Foram realizados os procedimentos clássicos para identificação: macro e micromorfologia, zimograma e auxanograma. Os dados obtidos foram analisados através de testes de frequência e tabelas de contingência (χ2). RESULTADOS: Um total de 47,9 por cento das mulheres com suspeita clínica obteve confirmação de candidíase pelos exames laboratoriais. Das pacientes sem suspeita clínica (Grupo Controle), 78,2 por cento foram negativas para candidíase vulvovaginal pelos testes laboratoriais. Candida albicans foi a espécie prevalente com 74,5 por cento dos casos. Foram encontradas diferenças significativas para os casos positivos, de acordo com as pacientes das duas cidades avaliadas (p<0,05). O vestuário foi um aspecto diferencial encontrado entre as duas populações estudadas. CONCLUSÕES: a presença de fatores predisponentes não define, seguramente, a candidíase vulvovaginal. A localização geográfica tem mostrado ser um fator relevante na distribuição dos eventos. O tipo de vestuário pode ser uma das razões. O cultivo de amostras do conteúdo vaginal, seguida de identificação do micro-organismo, é importante.

PURPOSE: to study vulvovaginal candidiasis from the vaginal fluid of women with and without clinical suspicion, identifying the frequency of Candida spp., and associating it with intrinsic and extrinsic risk factors. METHODS: a total of 286 samples from patients attended in private practices and public health units from August 2005 to August 2007 were collected, being 121 women under clinical suspicion and 165, without. The samples were collected with sterile swabs, taken to the laboratory in 0.85 percent physiological solution, and then seeded in CHROMagar Candida and in 4 percent agar Sabourad with chloramphenicol. Classical identification procedures were carried out: macro and micromorphology, zymogram and auxanogram. Data obtained were analyzed by frequency tests and contingency tables (χ2). RESULTS: a total of 47.9 percent of the women under clinical suspicion got confirmation of candidiasis by the laboratorial tests. Among the patients without clinical suspicion (Control Group), 78.2 percent were vulvovaginal candidiasis negative according to the laboratorial tests. Candida albicans was the prevalent strain in 74.5 percent of the cases. There were significant differences among the positive cases, according to the patients from the two cities evaluated (p<0.05). Clothing was one differential aspect found among the two populations studied. CONCLUSIONS: the presence of predisposing factors does not necessarily define vulvovaginal candidiasis. Geographical localization has shown to be a relevant factor in the distribution of events. The type of clothing may be one of the reasons for it. Culture of samples from the vaginal contents, followed by microorganisms' identification, can be important.