Incidência de infecção do trato urinário em unidade de terapia intensiva: implementação de um checklist assistencial / Incidence of urinary tract infection in intensive care unit: implementation of assistance checklist / Incidencia de infección del tracto urinario en una unidad de cuidados intensivos: implementación de una lista de verificación de cuidados

Objetivo: Avaliar a efetividade do checklist reconstruído por uma equipe interdisciplinar, como estratégia de redução de incidência de infecção do trato urinário e do tempo de permanência do uso do cateter vesical de demora em uma Unidade de Terapia Intensiva Adulto. Métodos: Estudo quantitativo, retrospectivo, observacional, realizado entre os meses de janeiro de 2018 a junho de 2019, em Unidade de Terapia Intensiva de um hospital universitário da Cidade de Ponta Grossa ­ Paraná. O checklist, implementado na instituição, é baseado no Centers for Disease Control and Prevention, na prevenção de infecções relacionadas a assistência à saúde. Os dados foram analisados pelo teste t-student. Resultados: Observou-se uma redução de casos novos após a implementação do checklist (p=0,0005), e nos dias de permanência com o cateter vesical de demora, que teve uma média (115,3) antes do checklist ser implementado, diminuindo para (69,6) após. Conclusão: As ações desenvolvidas pelos profissionais de saúde trazem resultados atenuantes na redução de Infecções relacionadas à assistência à saúde. (AU)

Objective: To assess the effectiveness of the checklist reconstructed by an interdisciplinary team, as a strategy to reduce the incidence of infection from urinary treatment and the time of permanence of the use of a delay bladder catheter in an Adult Intensive Care Unit. Methods: Quantitative, retrospective, observational study, carried out between the months of January 2018 to June 2019, in the Intensive Care Unit of a University Hospital of the City of Ponta Grossa - Paraná. Or checklist, implemented by the institution, based on the Centers for Disease Control and Prevention, on the prevention of infections related to health care. The given foram analyzed hair test t-student. Results: Observation of a reduction of new cases after the implementation of the checklist (p = 0.0005), and the days of permanence with a late bladder catheter, which had a mean (115.3) before the checklist was implemented, decreasing to (69.6) after. Conclusion: The actions developed by health professionals bring attenuating results in the reduction of Healthcare-Related Infections. (AU)

Objetivo: Evaluar la efectividad del checklist reconstruido por un equipo interdisciplinario, como estrategia para reducir la incidencia de infección del tracto urinario y el tiempo de estadía en el uso de catéteres urinarios permanentes en una Unidad de Cuidados Intensivos de Adultos. Métodos: Estudio observacional cuantitativo, retrospectivo, realizado entre enero de 2018 y junio de 2019, en la Unidad de Cuidados Intensivos de un hospital universitario de la ciudad de Ponta Grossa - Paraná. La lista de verificación, implementada en la institución, se basa en los Centros para el Control y la Prevención de Enfermedades, en la prevención de infecciones relacionadas con la salud. Los datos se analizaron mediante la prueba t-student. Resultados: Hubo una reducción de casos nuevos luego de la implementación de la lista de chequeo (p = 0.0005), y en los días de estadía con el catéter urinario permanente, que tuvieron un promedio (115.3) antes de la implementación de la lista de chequeo, disminuyendo a (69.6) después. Conclusión: Las acciones realizadas por los profesionales de la salud traen resultados mitigantes en la reducción de infecciones relacionadas con la atención de la salud. (AU)

Genital Human Papillomavirus Infection in women from Florianópolis - Santa Catarina, Brazil / Infecção genital pelo Papilomavírus Humano em mulheres de Florianópolis - Santa Catarina, Brasil

Introduction: Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in women. About 80% of sexually active women will have contact with this virus at some age in their lives. Most infections will be transient, but when the infection becomes persistent, associated with high oncogenic risk HPV, there may be progression to cancer, especially cervical cancer. The best way to prevent HPV infection is through the use of vaccines. Objective: To assess which are the most prevalent types of HPV in the city of Florianópolis, Brazil and if the majority of the diagnosed types are contained in the HPV vaccines currently available on the market and in the public health sector. Methods: More than 14,727 HPV tests were evaluated for the diagnosis of genital HPV infection in women from Florianópolis. The prevalence of infection was evaluated according to age of the women. HPV detection was performed using molecular biology tests, such as hybrid capture (for diagnosis of the HPV group, high or low oncogenic risk) and PCR (viral genotyping) techniques. Results: The diagnosis of HPV infection was made for women between one and 102 years of age. The highest positivity of the exams was observed in women aged 20­25 years (51% of the exams). The most prevalent age group was 31­35 years old (23.5%), and the lowest was for women aged 70 and above (0.6%). High oncogenic risk HPV was detected in 94.1% of positive samples and was the most frequent in all age groups. Mixed infection (high- and low-risk HPV) was more prevalent in the 66­70 age group (25.6%). The most frequent genotypes were non-16/18 high oncogenic risk HPV (77% of positive cases). HPV 16 was found in 17.1% of positive cases, and HPV 18 in 6.5%. Conclusion: The most prevalent types of HPV in Florianópolis in the last 6 years are non-16/18 high oncogenic risk HPV types, viral types not covered by the current HPV vaccine available in the public health sector in Brazil.

Introdução: A infecção pelo Papilomavírus Humano (HPV)é a infecção sexualmente transmissível mais frequente na mulher. Cerca de 80% das mulheres sexualmente ativas irão entrar em contato com este vírus em algum momento da sua vida. A maioria das infecções será transitória, mas quando a infecção se torna persistente, associada aos HPV de alto risco oncogênico, poderá haver a progressão para o câncer, principalmente o câncer de colo de útero. A melhor forma de prevenção da contaminação pelo HPV é através da utilização das vacinas. Objetivo: Avaliar quais são os tipos de HPV mais prevalentes na cidade de Florianópolis, Brasil, e se a maioria dos tipos diagnosticados estão contidos nas vacinas contra o HPV atualmente disponíveis no mercado e no setor público de saúde. Métodos: Foram avaliados 14.727 exames para diagnóstico da infecção genital pelo HPV em mulheres de Florianópolis, de acordo com a idade das mulheres. A detecção do HPV foi realizada através dos exames de biologia molecular pelas técnicas de captura híbrida (para diagnóstico do grupo de HPV, alto ou baixo risco oncogênico) e PCR (genotipagem viral). Resultados: Foram avaliados exames para diagnóstico da infecção de mulheres entre um e 102 anos de idade. A maior positividade dos exames foi observada em mulheres dos 20­25 anos (51% dos exames). A faixa etária de maior prevalência foi dos 31­35 anos (23,5%), e a menor, após os 70 anos (0,6%). O HPV de alto risco oncogênico foi detectado em 94,1% dos casos positivos e foi o mais frequente em todas as faixas etárias. A infecção mista (HPV de alto e baixo risco) foi mais prevalente na faixa etária dos 66­70 anos (25,6%). Os genótipos mais frequentes foram os HPV de alto risco oncogênico não 16/18 (77% dos casos positivos). O HPV 16 foi encontrado em 17,1% dos casos positivos, e o HPV 18 em 6,5%. Conclusão: Os tipos de HPV mais prevalentes em Florianópolis nos últimos 6 anos são os HPV de alto risco oncogênico não 16/18, tipos virais não cobertos pela atual vacina contra o HPV disponível no setor público de saúde do Brasil.Palavras-chave: HPV. Tipos de HPV. Câncer de colo de útero. Cobertura vacinal.

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

Repercussões da pobreza menstrual para as mulheres e pessoas que menstruam: revisão integrativa / Repercusiones de la pobreza menstrual para las mujeres y las personas que menstruan: revisión integrativa / Repercussions of period poverty for women and people who menstruate: an integrative review

Objetivos: investigar as repercussões da pobreza menstrual para as mulheres e pessoas que menstruam. Método: revisão integrativa da literatura, realizada nas bases de dados MEDLINE, Scopus, Web of Science e CINAHL. Foram incluídos artigos na íntegra, nos idiomas português, inglês e espanhol e com recorte temporal de sete anos (2017-2023) para responder a pergunta norteadora: Quais são as repercussões da pobreza menstrual na vida das mulheres e pessoas que menstruam? A inclusão dos artigos foi feita por dois revisores independentes e com consenso por um terceiro. Resultados: foram incluídos 15 artigos e observou-se três principais repercussões da pobreza menstrual: absenteísmo escolar, aumento do risco de infecções do trato genital e repercussões emocionais. Conclusão: a pobreza menstrual traz repercussões negativas para as mulheres e pessoas que menstruam, comprometendo a saúde física, mental e a esfera social, motivo pelo qual o tema precisa ser amplamente visibilizado e combatido.

Objetivos: investigar las repercusiones de la pobreza menstrual para las mujeres y las personas que menstruan. Método: revisión integrativa de la literatura, realizada en las bases de datos MEDLINE, Scopus, Web of Science y CINAHL. Se incluyeron artículos en su totalidad, en los idiomas portugués, inglés y español y con recorte temporal de siete años (2017-2023) para responder a la pregunta orientadora: ¿Cuáles son las repercusiones de la pobreza menstrual en la vida de las mujeres y personas que menstruan? La inclusión de los artículos fue hecha por dos revisores independientes y con consenso por un tercero. Resultados: se incluyeron 15 artículos y se observaron tres principales repercusiones de la pobreza menstrual: absentismo escolar, aumento del riesgo de infecciones del tracto genital y repercusiones emocionales. Consideraciones finales: la pobreza menstrual trae repercusiones negativas para las mujeres y personas que menstruan, comprometiendo la salud física, mental y la esfera social, por lo que el tema necesita ser ampliamente visibilizado y combatido.

Objective: to investigate the repercussions of period poverty for women and people who menstruate. Method: an integrative review of the literature, performed in MEDLINE, Scopus, Web of Science and CINAHL databases. The sample included complete articles, in Portuguese, English and Spanish, and with a timeframe of seven years (2017-2023) to answer the guiding question: What are the repercussions of period poverty in the lives of women and people who menstruate? The inclusion of the articles was done by two independent reviewers and with consensus by a third party. Results: 15 articles were included and three main repercussions of period poverty were observed: school absenteeism, increased risk of genital tract infections and emotional repercussions. Final considerations: period poverty brings negative repercussions for women and people who menstruate, compromising physical, mental and social health, which is why the theme needs to be widely publicized and combated.

Human Papilloma Virus, Risk Factors and Sequelae: How much do Female Adolescents in Port Harcourt Metropolis know?

Background: Human Papilloma virus (HPV) infection is the most common viral infection of the genital tract; is sexually transmitted with the highest rates observed in young women. This study assessed the level of knowledge of HPV and cervical cancer among adolescent girls in Port Harcourt metropolis, Nigeria. Methodology: A cross-sectional survey among 328 in-school female secondary school students aged 9 - 19 years, selected via multi-stage sampling. Information on socio-demographics, knowledge of HPV and cervical cancer and sexual history were collected using a self-administered, semi-structured questionnaire. Data was analyzed using SPSS version 23 and Chi square test was used to establish associations. Results: Only 38.2% and 30% had heard of cervical cancer and HPV respectively; the media being the most common source. Knowledge of transmission, risk factors, sequelae and prevention of infection was poor (75%). About 20.2% were aware of the causal association between HPV infection and cervical cancer. Some (3.1%) were sexually exposed and practiced unprotected sexual intercourse. Median age at sexual debut was 11 years. Older and private school students (15-19years) had better knowledge Conclusion: The level of knowledge of HPV, cervical cancer, their association and risk factors, among adolescent girls in Port Harcourt metropolis is poor. Some adolescents engage in sexual practices that put them at risk for HPV infection. Social media and upper primary and secondary school-based approach to HPV health promotion should be explored to provide detailed adolescent-friendly information to guide in prevention of HPV infection and cervical cancer.

Genital infection by Human Papillomavirus (HPV) in women from Santa Catarina/Brazil / Infecção genital pelo Papilomavírus Humano (HPV) em mulheres de Santa Catarina/Brasil

Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in women. About 80% of sexually active women will have contact with this virus at some point in their lives. Most infections will be transient, but when the infection becomes persistent and associated with a high oncogenic risk of Human Papillomavirus, there may be progression to cancer, especially cervical cancer. The best way to prevent Human Papillomavirus infection is through the use of vaccines, which have been available to the public in Brazil since 2014. Objective: This study aimed to assess the most prevalent types of Human Papillomavirus in the state of Santa Catarina, Brazil, and its mesoregions and if the majority of diagnosed types are contained in the Human Papillomavirus vaccines currently available on the market. Methods: A total of 20,000 Human Papillomavirus tests were evaluated for the diagnosis of genital Human Papillomavirus infection in women from the state of Santa Catarina, Brazil. The prevalence of infection was evaluated according to age and the city of origin of the exams. Human Papillomavirus detection was performed using molecular biology tests, such as hybrid capture (for diagnosis of the Human Papillomavirus group, high or low oncogenic risk) and polymerase chain reaction (viral genotyping) techniques. Results: The diagnosis of Human Papillomavirus infection was performed on women between 1 and 102 years of age. The age with the highest Human Papillomavirus positivity, as expected, was 20­25 years (45.6%) and the lowest after 70 years (7.1%). The highest Human Papillomavirus positivity of the exams was observed in the Serrana region of Santa Catarina state (58.9% of the exams). A high-oncogenic-risk Human Papillomavirus was detected in 93% of positive samples and was the most frequent in all age groups. Mixed infection (high- and low-risk Human Papillomavirus) was more prevalent in the 66­70 age group (29.3%) and in the Southern Region of Santa Catarina (26.4%). The most frequent genotypes in the state of Santa Catarina were non-16/18 high oncogenic risk Human Papillomavirus (76.9% of positive cases). Human Papillomavirus 16 was found in 17.1% of positive cases and Human Papillomavirus 18 in 6.6%. Conclusion: The most prevalent types of Human Papillomavirus in the state of Santa Catarina in the past 6 years are the non-16/18 high oncogenic risk Human Papillomavirus types, which are viral types not covered by the current Human Papillomavirus vaccines available in Brazil.

A infecção por Papilomavírus Humano é a infecção sexualmente transmissível mais frequente na mulher. Cerca de 80% das mulheres sexualmente ativas entrarão em contato com esse vírus em algum momento. A maioria das infecções será transitória, mas quando ela é persistente, associada aos Papilomavírus Humano de alto risco oncogênico, poderá progredir para câncer, principalmente de colo de útero. A melhor forma de se prevenir da contaminação pelo vírus é por meio de vacina, disponível no sistema público do Brasil desde 2014. Objetivo: Avaliar os tipos de Papilomavírus Humano mais prevalentes no estado de Santa Catarina e suas mesorregiões, e se a maioria dos tipos diagnosticados estão contidos nas vacinas contra o Papilomavírus Humano atualmente disponíveis no mercado. Métodos: Foram avaliados 20 mil exames para diagnóstico da infecção genital pelo Papilomavírus Humano em mulheres de todo o estado. A prevalência da infecção foi comparada de acordo com a idade e a procedência dos exames. A detecção do Papilomavírus Humano deu-se pelos exames de biologia molecular pelas técnicas de captura híbrida (para diagnóstico do grupo de Papilomavírus Humano, alto ou baixo riscos oncogênicos) e de PCR (genotipagem viral). Resultados: Foram avaliados exames para diagnóstico da infecção de mulheres entre um e 102 anos de idade. A faixa etária de maior positividade, como era de ser esperado, foi dos 20 aos 25 anos (45.6%) e a menor depois dos 70 anos (7.1%). A maior positividade dos exames foi observada na região Serrana do estado (58.9% dos exames). O Papilomavírus Humano de alto risco oncogênico foi detectado em 93% dos casos positivos e foi o mais frequente em todas as faixas etárias. A infecção mista (Papilomavírus Humano de alto e baixo riscos) foi mais prevalente na faixa etária dos 66 aos 70 anos (29.3%) e na região Sul Catarinense (26.4%). Os genótipos mais frequentes no estado foram os Papilomavírus Humano de alto risco oncogênico não 16/18 (76.9% dos casos positivos). O Papilomavírus Humano 16 foi encontrado em 17.1% dos casos positivos e o Papilomavírus Humano 18 em 6.6%. Conclusão:Os tipos de Papilomavírus Humano mais prevalentes no estado de Santa Catarina, nos últimos seis anos, são os Papilomavírus Humano de alto risco oncogênico não 16/18, tipos virais não cobertos pelas atuais vacinas contra o Papilomavírus Humano disponíveis no Brasil.

Chlamydia trachomatis lower genital tract infection and spontaneous preterm birth: a case-control study nested in the BRISA cohort / Infecção genital do trato genital inferior por Chlamydia trachomatis e parto pré-termo espontâneo: um estudo caso-controle aninhado na coorte BRISA

Introduction: Chlamydia trachomatis (CT) is a sexually transmitted bacterium that is highly prevalent in young patients. Chlamydial infections during the gestational period have been associated with adverse obstetric outcomes, such as spontaneous preterm birth (sPTB). However, results in the literature are inconclusive. Objective: To evaluate the association between CT infection and sPTB. Methods: This was a case-control study nested in the cohort of the prospective Brazilian Ribeirão Preto and São Luís birth cohort study. Pregnant patients were recruited in private and public health clinics in São Luís and Ribeirão Preto, Brazil. At the gestational age of 20-25 weeks, cervicovaginal fluid samples were collected for the diagnosis of CT using a polymerase chain reaction. Plasma levels of Transforming Growth Factor-α (TGF- α), Interferon-γ (IFN- γ), Interleukin-10 (IL-10), IL-13, IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, Tumor Necrosis Factor-α (TNF- α), and TNF-ß were measured using a multiplex assay. Results: Of the 561 pregnant patients evaluated, 121 had sPTB and 440 had a full-term delivery (control group). According to our results, CT infection was not associated with sPTB (odds ratio, 1.13; 95% confidence interval, 0.50­2.56); however, it was more frequent among younger patients (p=0.0078), unmarried patients (p=0.0144), and those with multiple sexual partners (p=0.0299). There were no significant differences in the immune mediators between patients with sPTB or full-term deliveries, or between patients with or without a CT infection. Conclusion: In conclusion, CT infection was not associated with sPTB in our study. However, its correlation with younger pregnant patients suggests that these patients require careful clinical management.

Chlamydia trachomatis (CT) é uma bactéria sexualmente transmissível com alta prevalência em mulheres jovens. As infecções por CT durante o período gestacional têm sido associadas com desfechos obstétricos adversos como o parto pré-termo espontâneo (PPTe). No entanto, os achados na literatura sobre essa temática ainda são inconclusivos. Objetivo: Avaliar a associação entre infecção por CT e PPTe. Métodos: Trata-se de um estudo caso-controle aninhado na coorte prospectiva de nascimentos de Ribeirão Preto e São Luís (acrônimo BRISA em inglês). As gestantes incluídas foram recrutadas com idade gestacional entre 20 e 25 semanas em serviços de saúde públicos e privados de São Luis e Ribeirão Preto, Brasil. O diagnóstico de CT foi feito por reação em cadeia da polimerase em amostras de conteúdo cervicovaginal coletadas no momento da inclusão no estudo. Também foram dosados os níveis séricos de fator transformador de crescimento-α (TGF- α), interferon-γ (IFN-γ), interleucina-10 (IL-10), IL-13, IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, fator de necrose tumoral-α (TNF-α) e TNF-ß por ensaio multiplex. Resultados: Das 561 gestantes avaliadas, 121 tiveram PPTe e 440 tiveram parto a termo (grupo controle). De acordo com nossos resultados, a infecção por CT não esteve associada ao PPTe (odds ratio 1,13; intervalo de confiança de 95%, 0,50­2,56); no entanto, ela foi mais frequente entre as gestantes mais jovens (p=0,0078), solteiras e divorciadas (p=0,0144) e aquelas com múltiplos parceiros sexuais (p=0,0299). Não houve diferença significativa quanto aos imunomediadores entre o grupo com PPTe e controle nem entre as gestantes com diagnóstico positive para CT e as que não apresentavam a infecção. Conclusão: No presente estudo, a infecção por CT não esteve associada ao PPTe, no entanto sua relação com gestantes jovens sugere que essa população requeira maiores cuidados e atenção no manejo clínico.

Human Papillomavirus infection in oral and anogenital sites: prevalence and rates of concordance / Infecção pelo Papilomavírus Humano em regiões orais e anogenitais: prevalência e taxa de concordância

Introduction: HPV infection causes cancer at several anatomical sites. However, the infection's natural history in non-cervical sites is understudied. Objective: To evaluate oral and anogenital HPV infections, correlating HPV prevalence rates and genotypes with site of infection and risk factors. Methods: In the present study, 351 samples from oral, genital, and anal sites of 117 patients were investigated by using PCR MY09/11 detection, followed by genotyping with RFLP. Results: HPV DNA prevalence was 89.7% (105/117) in genital lesions, 53.8% (63/117) in oral samples, and 58.9% (69/117) in anal samples. Regarding the risk factors associated with HPV in genital lesions, statistically significant rates for oral (p=0.039) and anal sex practices (p=0.0000012) were found. For oral samples, a relevant correlation concerning oral contraceptive use (p=0.039), tobacco smoking (p=0.036), and alcohol use (p=0.0075) were observed; whereas in anal samples, higher risk for HPV infection in patients who reported non-exclusive sexual partners (p=0.013) were found. The presence of viral DNA in all the three sites concurrently was observed in 36.8% of the cases (43/117). Among them, 18% (21/117) presented concordant HPV genotypes, diverging from the literature, and thus corroborating that there is still much to learn about HPV natural history, since different biological behaviors are expected within different populations. Differences in anatomy and physiology of the studied sites can determine different prevalence rates of infection by diverse genotypes. Conclusion: Due to the high prevalence of HPV DNA in extragenital sites, further studies are required to define aspects of HPV natural history among different human anatomical sites.

Introdução: As infecções causadas pelos papilomavírus humanos (HPV) são responsáveis pelo desenvolvimento de cânceres em diversos sítios anatômicos humanos. Entretanto, a história natural da infecção em sítios que não a cérvice uterina não é muito clara. Objetivo: Avaliar infecções orais, genitais e anais por HPV, correlacionando taxas de prevalência do vírus e seus genótipos aos sítios de infecção e a fatores de risco sócio-demográficos. Métodos: Em nosso estudo, investigamos 351 amostras coletadas dos sítios oral, genital e anal de 117 pacientes, por meio da técnica de PCR MY09/11, seguida de genotipagem por RFLP. Todos os pacientes apresentavam lesões genitais benignas. Resultados: A prevalência do HPV foi de 89,7% (105/117) nas lesões genitais, 53,8% (63/117) nas amostras orais e 58,9% (69/117) nas amostras anais. Em relação aos fatores de risco associados à infecção genital, encontramos diferenças estatísticas significativas para prática de sexo oral (p=0,039) e sexo anal (p=0,0000012). Já para as amostras orais, observamos importante correlação entre infecção e uso de contraceptivo oral (p=0,039), tabagismo (p=0,036) e uso de álcool (p=0,0075) enquanto nas amostras anais, alto risco de infecção pelo HPV foi associado a pacientes relatando parceiros sexuais não exclusivos (p=0,013). A presença do DNA viral simultaneamente nos três sítios estudados foi observada em 36,8% dos casos (43/117). Desses, 18% (21/117) apresentaram genótipos concordantes, diferindo da literatura, na qual há grande disparidade de descrições. Conclusão: Há a necessidade de novos estudos a fim de esclarecer a história natural do HPV em sítios extragenitais em diferentes populações, avaliando características anatômicas e fisiológicas com o intuito de esclarecer diferentes taxas de infecção por genótipos do HPV e diferentes processos de doença.

Identificação de infecções do trato reprodutivo em mulheres atendidas na Atenção Primária à Saúde / Identification of reproductive tract infections in assisted women in a unit of Primary Health Care

Objetivo: Identificar a frequência das infecções do trato reprodutivo em mulheres atendidas em uma unidade de atenção primária à saúde, na região da Zona da Mata de Pernambuco. Método: Trata-se de um estudo retrospectivo, documental, de corte transversal, realizado com 361 registros de mulheres na faixa etária dos 14 aos 87 anos. Para a análise, procedeu-se à distribuição das frequências absolutas representados por tabelas através do programa estatístico EpiInfo versão 7.1.5.2. Pesquisa aprovada pelo Comitê de Ética em Pesquisa, com CAAE no 54417916.2.0000.5208. Resultados: A Gardnerella vaginalis (16,62%) foi o agente microbiológico mais frequente que os demais causadores de infecções do trato reprodutivo; os microrganismos foram mais prevalentes na faixa etária de 25-34 anos. Conclusão: Sob o ponto de vista dos benefícios do cuidado à saúde da mulher, na atenção primária, incentiva-se a atuação profissional no sentido de promover ações de educação em saúde visando a conscientização de mulheres das diversas faixas etárias, sobre a relevância das ITR's.

Objective: To identify the frequency of reproductive tract infections in women treated in a primary health care unit in the Pernambuco forest zone. Method: This is a retrospective, documental, cross-sectional study, conducted with 361 records of women aged 14 to 87 years. For the analysis, the absolute frequencies represented by tables were distributed through the statistical program EpiInfo version 7.1.5.2. The research was approved by the Research Ethics Committee, with CAAE No. 54417916.2.0000.5208. Results: Gardnerella vaginalis (16.62%) was the most frequent microbiological agent from all the other causes of reproductive tract infections; microorganisms were more prevalent in the 25-34 age group. Conclusion: From the point of view of the benefits of women's health care, in primary care, professional action is encouraged to promote health education actions aimed at raising awareness of women of various age groups about the relevance of ITR's.

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)

Fatores obstétricos relevantes na adolescência: uma revisão integrativa no contexto nacional e internacional / Relevant obstetric factors in adolescence: an integrative review in the national and international context

Trata-se de uma revisão integrativa de literatura, construída a partir de publicações científicas nacionais e internacionais publicadas entre 2008 e 2018, que versassem sobre os fatores obstétricos de risco na gestação de mulheres adolescentes. Os descritores empregados nesta busca foram: "gravidez na adolescência" AND "gravidez de alto risco" AND "cuidado pré-natal". A estratégia de busca convergeu em 202 resultados e após recorte temporal investigativo resultaram 48 publicações. Realizou-se leitura criteriosa dos títulos e resumos quanto aos critérios de elegibilidade, resultando em 19 artigos na íntegra que foram analisados e discutidos. A identificação dos fatores obstétricos agravantes na gestação de adolescentes demostra que existe fragilidade no atendimento a esse grupo. Número de consultas pré-natais inadequadas, baixa escolaridade, desemprego, escassez no uso de métodos contraceptivos e preventivos, foram manifestados na demanda das adolescentes.

This is an integrative literature review, built from national and international scientific publications published between 2008 and 2018, dealing with obstetric risk factors in the pregnancy of adolescent women. The descriptors used in this search were: "Pregnancy in Adolescence" AND "Pregnancy, High-Risk" AND "Prenatal Care". The search strategy found 202 results, and after the cut in the investigative period, a total of 48 publications were selected. A careful reading of the titles and abstracts regarding the eligibility criteria was performed, resulting in 19 articles in total to be analyzed and discussed. The identification of aggravating obstetric factors in the gestation of adolescents shows that there is fragility in caring for this group. The number of inadequate prenatal consultations, low schooling level, unemployment, and the lack of use of contraceptive and preventive methods were manifested in the demand of adolescents.

Genotipos de VPH y cambios citológicos cervico-uterino en pacientes de una consulta ginecológica privada del Estado Carabobo, Venezuela. Marzo-octubre de 2017 / HPV genotypes and cervical cytological changes in patients who attended a private gynecology appointment in the state of Carabobo, March-October 2017

Resumen Introducción: La infección genital por el Virus de Papiloma Humano (VPH) se ha asociado con el cáncer cérvicouterino (CCE) al provocar la aparición de lesiones precursoras de cáncer en la zona de transformación de la unión escamo-columnar del cuello uterino. Existen más de 100 tipos de VPH, clasificados en bajo riesgo oncogénico (VPH-BR) y alto riesgo oncogénico (VPH-AR). Estudios reportan la infección por genotipos de alto riesgo en el 100% de los CCE. En Venezuela, el 67,7% de los CCE, se relacionan con el genotipo de VPH-AR 16. Objetivo: Detectar la presencia de VPH en pacientes con cambios citológicos cervicouterino. Metodología: Se incluyeron 49 pacientes que presentaban cambios citológicos, se tomaron las muestras de la región endocervical y exocervical para la detección y genotipificación del virus mediante la técnica de Multiple PCR. Resultados: Las alteraciones citológicas presentes fueron Células Escamosas Atípicas (69,4%), Células Glandulares Atípicas (4,1%), Lesión Escamosa Intraepitelial de Bajo Grado (16,3%), y Lesión Escamosa Intraepitelial de Alto Grado (10,2%). La detección molecular demostró que 16,3% presentaba VPH, 62,5% correspondían a VPH-AR, 25% a VPH-BR, 12,5% al genotipo 16 y no se detectó el genotipo 18. Se reportó un solo caso de coinfección. Conclusiones: A diferencia de otros estudios, no se encontró una relación estadísticamente significativa entre la presencia del virus y la aparición de cambios citológicos cervicouterino en esta población. No obstante, se detectaron genotipos de alto riesgo oncogénico, lo que puede traducirse en una mayor incidencia de cáncer cervicouterino a futuro.

Abstract Introduction: Genital infection by the Human Papilloma Virus (HPV) has been associated with cervical cancer (CC) since it causes the appearance of precursor cancer lesions in the transformation area of ​​the squamous-columnar junction of the cervix. There are more than 100 types of HPV that are classified as low oncogenic risk (LR-HPV) and high oncogenic risk (HR-HPV). Studies report that the infection by high-risk genotypes is present in 100% of CC. In Venezuela, 67.7% of CC is related to the HPV-16 genotype. Objective: This study seeks to detect the presence of HPV in patients with cervical cytological cell changes. Methodology : Forty-nine patients with cytological changes were studied. The endocervical and ectocervical areas were sampled to detect and genotype the virus by using the Multiplex PCR technique. Results: The cytological alterations presented were: Atypical Squamous Cells (69.4%), Atypical Glandular Cells (4.1%), Low-grade Squamous Intraepithelial Lesion (16.3%) and High-grade Squamous Intraepithelial Lesion (10.2%). Besides, the general molecular detection showed that 16.3% had HPV, 62.5% of it corresponded to HR-HPV, 25% to LR-HPV, and 12.5% ​​to genotype 16. The genotype 18 was not detected, and only one co-infection case was reported. Conclusions: Unlike other studies, a statistically significant relationship was not found between the virus presence and the appearance of cervical cytological cell changes in this population. However, genotypes with high oncogenic risk were detected, which may lead to a higher incidence of cervical cancer in the future.

Accuracy in clinical examinations for the diagnosis of vulvovaginitis by CANDIDA SPP. and IN VITRO susceptibility to the main antifungals

Vulvovaginal candidiasis (VVC) is a common infection. This work aims to determine the positive predictive value (PPV) of the clinical diagnosis of VVC and to characterize Candida species isolated from the vaginal mucosa. This cross-sectional study was conducted from February 2016 to February 2017 at the Gynecology and Obstetrics Outpatient Clinic of the Hospital das Clínicas, in Goiânia, Goiás State, Brazil. The study included samples of vaginal secretion from 55 women who complained of vaginal discharge and itching as their main symptoms. The PPV of the clinical diagnosis of VVC was estimated in comparison to the laboratory culture method. The phenotypic methods and molecular tests were performed to identify Candida spp. In vitro susceptibility of Candida spp. isolates to fluconazole, itraconazole, clotrimazole, nystatin, and amphotericin B was determined using the broth microdilution assay. Yeast growth using the enzymes protease, phospholipase, and hemolysin was carried out in media containing respectively bovine albumin, egg yolk, and sheep erythrocytes. A PPV of 61.8% (34/55) was determined. Among the 55 vulvovaginal samples collected, we identified 36 isolates in which C. albicans was the most common species. High resistance to fluconazole and low minimal inhibitory concentration (MIC) values for clotrimazole, nystatin and amphotericin B were observed. All isolates were proteinase and hemolysin producers, while seven strains were phospholipase negative. The clinical diagnosis of VVC presented a moderate PPV, which meant that cultures had to be conducted in the laboratory to confirm infection. The high resistance to fluconazole and itraconazole indicated the importance of the in vitro susceptibility test.

Occurrence of Mycoplasmaspp. and Ureaplasmaspp. in genital specimens

Mycoplasmaspp. and Ureaplasmaspp. belong tohumans'genitourinary microbiota and sometimesare associated with infections of the genitourinarytract. The aim of this study was to evaluate the occurrence of Mycoplasmaspp. and Ureaplasmaspp. in genital specimens from patients of the 15thRegional de Saúde of ParanáState, Brazil, and to correlate the results with clinical and laboratory data.A retrospective cross-sectional study was conducted,based on the analysis of results of vaginal, endocervical, urine andurethral culture for mycoplasmas from patients attended in areference laboratory, from January 2009 to December 2016. We evaluated 2,475 results of culture for mycoplasmas. A total of 50.8% patients were positive for mycoplasmas. Of these, 76.8%had positive culture exclusively for Ureaplasmaspp. and 4.7% for Mycoplasmahominis. Both microorganisms were isolated in the microbiology culture of 18.5% of patients. Among the positive culture, 81.4% had significant concentrations.Bacterialvaginosis was the most common alteration observed in association with mycoplasmas.Thehigh positivity of cultures for mycoplasmas, especially Ureaplasmaspp. found in our study, highlightthe presence of these microorganisms in many of the genital tract disorders that can be sexually transmitted and, consequently, should not be neglected.

Concepciones sobre infecciones de transmisión sexual en estudiantes universitarios de pregrado / Conceptions on sexual transmission infections in undergraduate university students

Introducción: Actualmente se ha incrementado el número de personas que contraen una Infección de Trasmisión Sexual (ITS) por el aumento en el número de parejas sexuales a lo largo de la vida y por la carencia de formación adecuada. Dado que, los principales afectados por las ITS son los jóvenes, el objetivo: de esta investigación consistió en identificar las concepciones sobre ITS en estudiantes universitarios de pregrado. Materiales y métodos: En este estudio cualitativo con enfoque exploratorio descriptivo se empleó una encuesta estructurada y auto-administrada aplicada a 74 estudiantes. Resultados: Mediante estadística descriptiva e inferencial se evidenció que hay confusiones respecto a las vías de contagio, formas de protección, claridad de términos, probabilidad de contraer una infección según el género y desarrollo de las ITS y, básicamente no existen diferencias estadísticamente significativas entre las concepciones de los estudiantes del primer y último semestre (P>0.05). Se encontró también, que los padres (47%) y profesores (41%) se constituyen como las principales fuentes de información sobre ITS a través de las cuales los estudiantes tienen su primera orientación educativa respecto al tema y, a pesar del paso por la academia, pareciera que esta no transforma en buena medida aquellos conocimientos errados de sexualidad que muchas veces se traen de casa o de la escuela. Conclusión: Se sugieren pautas y estrategias desde la Universidad que permitirán esclarecer y fortalecer las concepciones sobre las ITS en los docentes en formación en particular y, a la población universitaria en general.

Introduction: At present, the number of people getting a Sexually Transmitted Infection (STIs) has increased due to the growing number of sexual couple along life and because of the lack of the right education. Given that, the main affected by STIs are young people, the objective: of this research was to identify the conceptions of STIs in undergraduate university students. Material and Methods: In this qualitative study with a descriptive exploratory approach, a structured and self-administered survey applied to 74 students was used. Results: By means of descriptive and inferential statistics it was shown that there are confusions regarding the routes of contagion, forms of protection, clarity of terms, probability of contracting an infection according to gender and development of STIs, and basically there are no statistically significant differences between conceptions of the students of the first and last semester (P> 0.05). It was found too that the parents (47%) and teachers (41%) were constituted as the principal sources of information about STIs through the students have their first sexual orientation about this topic and, in spite their time in academy looks like it does not change in a good way those wrong knowledge of sexuality that usually are taken from home o school. Conclusion: guidelines and strategies are suggested from the University that will clarify and strengthen the conceptions of STIs in teachers in training in particular and the university population in general.

Perfil clínico de pacientes com Síndrome de Fournier em um hospital terciário / Clinical profile of patients with Fournier's Syndrome in a tertiary hospital

INTRODUÇÃO: A Síndrome de Fournier consiste em uma fasciite necrosante que afeta tecido subcutâneo e pele do períneo e genitais externos. Caracterizada como uma urgência cirúrgica, seu tratamento é baseado em três pilares: debridamento de tecidos necróticos e infectados; controle sistêmico e antibioticoterapia; e reparação dos tecidos afetados. OBJETIVO: Identificar o perfil clínico de pacientes diagnosticados com Síndrome de Fournier em um hospital de urgências. MÉTODOS: Trata-se de um estudo descritivo, retrospectivo e de abordagem quantitativa. A amostra consistiu de pacientes diagnosticados com Síndrome de Fournier acompanhados pela comissão de curativos do hospital no período de agosto de 2016 a agosto de 2017, que receberam alta ou foram a óbito. RESULTADOS: A amostra do estudo foi composta por 14 pacientes, sendo em sua totalidade pacientes do sexo masculino, entre 21 e 82 anos e idade média de 55 anos. Em 50% dos casos, foi necessário internação em Unidade de Terapia Intensiva (UTI). Quanto ao desfecho, 78,6% (11) receberam alta hospitalar e 21,4% (3) evoluíram para óbito. CONCLUSÃO: A assistência a pacientes com Síndrome de Fournier ocorre de forma despadronizada, o que ocasiona altas taxas de mortalidade. A elaboração de protocolos específicos é necessária.

INTRODUCTION: Fournier's Syndrome consists of a necrotizing fasciitis that affects subcutaneous tissue and skin of the perineum and external genitalia. Characterized as a urological urgency, its treatment is based on three pillars: debridement of necrotic and infected tissues; systemic control and antibiotic therapy; and repair of the affected tissues. OBJECTIVE: To identify the clinical profile of patients diagnosed with Fournier's Syndrome in an emergency hospital. METHODS: This is a descriptive, retrospective and quantitative study. The sample consisted of patients diagnosed with Fournier's Syndrome and attended by the hospital curative committee from August 2016 to August 2017, who were discharged or died. RESULTS: The study sample consisted of 14 medical records, all of them were male, aged between 21 and 82 years and mean age of 55 years. In 50% of the cases admittance to the Intensive Care Unit (ICU) was necessary. Regarding the outcome, 78.6% (11) were discharged from hospital and 21.4% (3) died. CONCLUSION: Assistance to patients with Fournier Syndrome is poorly standardized, resulting in high mortality rates. Development of specific protocols is necessary.

Oxigenoterapia con cánula nasal de alto flujo en lactantes con infección respiratoria baja aguda: Experiencia en hospitales de la Ciudad de Buenos Aires / High-flow nasal cannula oxygen therapy in infants with acute lower respiratory tract infection: An experience in hospitals of the City of Buenos Aires

Introducción. Durante el invierno, los lactantes con infecciones respiratorias agudas bajas (IRAB) sobrecargan los recursos sanitarios. En la Ciudad Autónoma de Buenos Aires, 35 000 niños son asistidos anualmente en hospitales; se interna el 8-10 % en unidades generales, y el 5-12 % de ellos, en unidades de terapia intensiva. En 2017, el Departamento de Salud Materno-Infantil de dicha ciudad incluyó la oxigenoterapia por cánula nasal de alto flujo (CNAF) en el protocolo IRAB en unidades generales de tres hospitales. El objetivo de este trabajo es describir los resultados y explorar potenciales factores relacionados con el fracaso terapéutico. Métodos. Estudio prospectivo descriptivo que incluyó a lactantes < 18 meses hospitalizados por IRAB en 3 hospitales (Durand, Elizalde, Gutiérrez), de junio a septiembre de 2017. Todos los niños incapaces de cumplir los objetivos terapéuticos con bajo flujo recibieron CNAF, y se consideró fracaso de soporte el ingreso a Terapia Intensiva. Resultados. De 522 pacientes hospitalizados por IRAB, el 39,7 % requirieron CNAF. No se observaron diferencias basales significativas entre pacientes con CNAF y con oxigenoterapia convencional. Solo el 8,7 % de los pacientes con CNAF presentaron fracaso. Los pacientes con éxito del soporte mostraron un descenso de la frecuencia respiratoria significativamente mayor y más sostenido en el tiempo que aquellos con fracaso (p < 0,01). No se registraron complicaciones. Conclusión. La implementación protocolizada de CNAF en unidades generales fue una medida segura. Los pacientes con fracaso del soporte mostraron una menor disminución en la frecuencia respiratoria a lo largo del tratamiento.

Introduction. During the winter, infants with acute lower respiratory tract infection (ALRTI) overburden health resources. In the Autonomous City of Buenos Aires, 35 000 children are seen at the hospitals every year; 8-10 % of them are admitted to the general hospitalization ward and 5-12 % of these, to the intensive care unit (ICU). In 2017, the Department of Maternal and Child Health of the Autonomous City of Buenos Aires included high flow nasal cannula (HNFC) oxygen therapy in the ALRTI protocol in the general ward of 3 hospitals. The objective of this study was to describe its outcomes and explore the potential factors related to therapeutic failure. Methods. Prospective, descriptive study with infants < 18 months old hospitalized due to ALRTI in 3 hospitals (Durand, Elizalde, Gutiérrez) between June and September 2017. All children unable to comply with low-flow therapeutic targets received HNFC oxygen therapy; admission to the ICU was considered a failure. Results. Out of 522 patients hospitalized due to ALRTI, 39.7% required HNFC oxygen therapy. No significant baseline differences were observed between patients receiving HNFC and conventional oxygen therapy. Failure was observed in only 8.7% of patients with HNFC oxygen therapy. The decrease in respiratory rate was significantly greater and longer in patients with support success versus those with failure (p < 0.01). No complications were recorded. Conclusion. The implementation of HNFC oxygen therapy under a protocol in the general wards was a safe measure. Patients with therapeutic failure showed a smaller reduction in respiratory rate during treatment.

¿Se puede prevenir el parto prematuro por infección bacteriana ascendente y sus resultados adversos en los hospitales públicos de Chile? / Can preterm birth be prevented from ascending bacterial infection and its adverse results in the public hospitals of Chile?

Resumen El parto prematuro (PP) es el principal contribuyente de la morbilidad/mortalidad perinatal. A pesar del conocimiento de los factores de riesgo y de la introducción de intervenciones médicas destinadas a la prevención del nacimiento prematuro, su frecuencia ha aumentado. La infección bacteriana ascendente (IBA) es la condición obstétrica más frecuente asociada al PP ocasionando un importante resultado perinatal adverso en un hospital público de Chile. Esta revisión muestra la asociación entre PP e IBA, analiza la fisiopatología y la inmunología de las infecciones vaginales en la mujer embarazada susceptible, como asimismo la aplicación en este grupo de medidas con evidencia clínica que han demostrado ser eficientes, tales como la pesquisa rutinaria y el tratamiento de las infecciones genitourinarias (IGU), el cerclaje profiláctico o terapéutico, uso de probióticos, de progesterona vaginal, control metabólico de la diabetes mellitus y del peso de la obesa. El tratamiento de las IGU, conjuntamente con el uso de intervenciones que mejoran la inmunidad vaginal en la población de riesgo, permiten predecir una reducción del PP por IBA, de sus consecuencias inmediatas y de largo plazo y costos asociados elevados, con el consiguiente beneficio de la salud pública de Chile.

Preterm birth (PB) is the main contributor to the perinatal morbidity/mortality. In spite of the knowledge of the risk factors and the introduction of medical interventions intended to prevent PB, its frequency has increased. Ascending bacterial infection (ABI) is the obstetric condition most frequently associated to PB causing an important adverse perinatal outcome in a public hospital in Chile. This review shows the association between PB and ABI, analyzes the physiopathology and immunology of vaginal infections in the susceptible pregnant woman., as well as their application in this group of effective measures demonstrated by evidence, such as routine control, treatment of genitourinary tract infections (GTI), prophylactic or therapeutic cerclage, use of probiotics, use of vaginal progesterone, metabolic control of diabetes mellitus and weight of the obese woman. Treatment GTI together with the use of medical interventions that improve the vaginal immunity in the risk population allow to predict a reduction of PB by ABI and of its immediate consequences, long term sequels and high associated costs, with the consequent benefit of the public health in Chile.