Impact of Pelvic Floor Muscle Training Isolated and Associated with Game Therapy on Mixed Urinary Incontinence: A Randomized Controlled Trial.

Objective: To verify whether pelvic floor muscle training (PFMT) associated with game therapy (GT) can potentiate improvements in PFM pressure, urinary loss, and perception of improvement in women with mixed urinary incontinence (MUI). Materials and Methods: A randomized and blinded trial was conducted with 32 women aged between 45 to 70 years presenting diagnosis of MUI. They were randomly divided into two groups: PFMT group and PFMT+GT group. Interventions occurred twice a week during 8 weeks. Primary outcome was PFM pressure, assessed by manometry, and secondary outcomes were 1-hour pad-test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and patients global impression of improvement for incontinence (PGI-I). Two-way analysis of variance and post hoc Tukey analysis were performed. Results: Initially, no significant difference between groups was found in variables of age, body mass index, educational level, marital status, gynecological and obstetric variables, life habits, and sexual activity. Besides, at baseline clinical variables also showed similar results between groups for PFM pressure, 1-hour pad-test, and ICIQ-SF. Time-group interaction did not present statistically significant differences for PFM pressure (P = 0.56), 1-hour pad-test (P = 0.75), and ICIQ-SF (P = 0.30) in intergroup analysis. All women reported being "much better or better," considering the comparison of urinary complaints in the beginning and end of treatment. Conclusion: There were no statistically significant differences between groups for PFM pressure, 1-hour pad-test, and ICIQ-SF. However, both treatments proved to be effective for MUI symptoms. Perception of improvement was highly improved, according to women's report.

Liquid-based cervical cytology and microbiological analyses in women using cooper intrauterine device and levonorgestrel-releasing intrauterine system.

OBJECTIVE: To assess the influence of the copper IUD and LNG-IUS on liquid-based cytology results (cellular atypia, reactive alterations, and microbiology). STUDY DESIGN: This cross-sectional study was performed between January 2012 and December 2017 in the Northeast of Brazil. Three study groups, the LNG-IUS group (n = 1179), copper IUD group (n = 519), and a control group of women not using contraception (n = 14,616) were compared. To facilitate this analysis, the LNG-IUS and IUD groups were further divided into less and more than two years of use. RESULTS: The mean age of the LNG-IUS and IUD groups was around 36 years and the control group was about 35 years (p = ns). The meantime between dispositive placement and examination was 19 ± 16 months for the LNG-IUS and 17 ± 15 months for the IUD. The frequency of epithelial atypia revealed upon cytological analysis did not differ between the groups. However, inflammatory infiltrates were significantly more frequent in the LNG-IUS and IUD (OR IUD = 1.32; OR LNG-IUS = 1.79) groups relative to control. Candida and cytolysis were more frequent in the LNG-IUS group (OR = 4.73 and 2.41, respectively) compared to both other groups. Bacterial vaginosis andActinomyces sp occurred more frequently in the IUD group (OR = 1.39 and 3352.55, respectively) compared to both other groups. Bacterial vaginosis was more common when using an IUD for more than two years than for less than two years (OR = 2.55). The Actinomyces morphotype was also observed at greater frequency after two years of IUD use than before (OR = 5.35). CONCLUSIONS: The LNG-IUS and copper IUD do not affect the incidence of cellular atypia but do interfere with the microbiota over time. Specifically, the copper IUD is associated with bacterial vaginosis andActinomyces sp infection while the LNG-IUS is associated with candidiasis and cytolysis.

Atypical Squamous Cells in Liquid-Based Cervical Cytology: Microbiology, Inflammatory Infiltrate, and Human Papillomavirus-DNA Testing.

OBJECTIVE: The aim of this study was to assess the correlation between atypical squamous cells (ASC) and inflammatory infiltrate and vaginal microbiota using cervical liquid-based cytological (SurePath®) and high-risk human papillomavirus (HR-HPV) tests. STUDY DESIGN: A cross-sectional study was conducted using a 6-year database from a laboratory in Fortaleza (Brazil). Files from 1,346 ASC cases were divided into subgroups and results concerning inflammation and vaginal microorganisms diagnosed by cytology were compared with HR-HPV test results. RESULTS: An absence of specific microorganisms (ASM) was the most frequent finding (ASC of undetermined significance, ASC-US = 74%; ASC - cannot exclude high-grade squamous intraepithelial lesion, ASC-H = 68%), followed by bacterial vaginosis (ASC-US = 20%; ASC- H = 25%) and Candida spp. (ASC-US = 6%; ASC-H = 5%). Leukocyte infiltrate was present in 71% of ASC-US and 85% of ASC-H (p = 0.0040), and in these specific cases HR-HPV tests were positive for 65 and 64%, respectively. A positive HR-HPV test was relatively more frequent when a specific microorganism was present, and Candida spp. was associated with HR-HPV-positive results (p = 0.0156), while an ASM was associated with negative HR-HPV results (p = 0.0370). CONCLUSION: ASC-US is associated with an absence of inflammation or vaginosis, while ASC-H smears are associated with Trichomonas vaginalis and inflammatory infiltrate. A positive HR-HPV is associated with Candida spp. in ASC cytology.

Identification of immune cells by flow cytometry in vaginal lavages from women with vulvovaginitis and normal microflora.

PROBLEM: The extent of the vaginal immune response is not fully determined. The purpose of this study was to evaluate the vaginal immune cells from women with vulvovaginitis (VV). METHOD OF STUDY: A total of 142 volunteers diagnosed with bacterial vaginosis (BV), vulvovaginal candidiasis (VC), and BV associated with VC or normal microflora were sampled to evaluate the immune cells by flow cytometry. The immune cells were obtained by vaginal lavage and labeled with fluorochrome-conjugated monoclonal antibodies to identify neutrophil granulocytes, macrophages, CD4(+) and CD8(+) T lymphocytes, B lymphocytes, and NK lymphocytes. RESULTS: Neutrophil granulocytes were present in 84.6% of samples among the leukocyte populations. Considering samples in which neutrophils were present, the mean percentage of neutrophil granulocytes was significantly higher in women with VC than BV and normal microflora and was significantly lower in women with BV than normal microflora. Macrophages and lymphocytes were present in a lower percentage of samples. The mean percentage of CD4(+) T lymphocytes in vaginal lavages was significantly higher in VC and BV compared with women with normal microflora. CONCLUSIONS: Neutrophils were the predominant leukocytes and were associated with VC and inversely with BV. CD4(+) T lymphocytes were associated with both VC and BV.

[Impact of physical activity on quality of life in middle-aged women: a population based study]. / Impacto da atividade física na qualidade de vida de mulheres de meia idade: estudo de base populacional.

PURPOSE: To evaluate the influence of physical activity on the quality of life of middle-aged women. METHODS: A population-based cross-sectional study was conducted on 370 women aged 40 to 65 years-old recruited from a population-based sample. Enrollment took place in Basic Health Units in each health district of the city (North, South, East, and West) from June to September 2011. According to the Municipal Health Department of the City, 20,801 women were assisted at the Basic Health Units during a one-year period. The sample size calculation was stratified by district and based on a 95% confidence level with a power of 80%, as well as an error estimate of 5% and it was considered proportional to the number of patients classified as having adequate quality of life (indicator >26) in the general population. Data were collected while women waited for their routine appointment at the Health Unit. WHOQOL-Bref was used to evaluate the quality of life, and menopause rating scale (MRS) was used to determine climacteric symptoms. The level of physical activity was assessed by means of the International Physical Activity Questionnaire (IPAQ). To obtain the classification of PA levels, we used three categories: sedentary, moderately active, and very active. Statistical analysis was performed using the Minitab software, version 16. RESULTS: The mean age of the subjects was 49.8 years-old (±8.1) and they were predominantly Caucasian (72.7%), married (61.6%), non-smokers (93.5%), and had High School education (47.8%). Using the WHOQOL, mean scores were found to be significantly different between the groups (low, moderate, and vigorous physical activity), classified according to the domains of quality of life (p<0.01). Concerning physical activity and climacteric symptoms, significant differences were found for all domains: psychological (p<0.01), vegetative-somatic (p<0.01), and urogenital (p<0.01). CONCLUSIONS: Physical activity improves quality of life in middle-aged women.