Transcranial direct current stimulation effects on menopausal vasomotor symptoms.

OBJECTIVE: To assess the effects of transcranial direct current stimulation (tDCS) compared with tDCS-sham on vasomotor symptoms of postmenopausal women. METHODS: Postmenopausal women (N = 30), aged between 45 and 68 years, with at least four episodes of vasomotor symptoms per day, were recruited from a specialized outpatient clinic at a tertiary hospital in the south of Brazil and through a media call after inclusion and exclusion criteria were ensured. Active and tDCS-sham were administered over the motor cortex position (anode electrode) and contralateral supraorbital region (cathode electrode) for 10 consecutive days, except weekends. The number and intensity records of hot flashes were evaluated for 7 days before and along 30 days after the intervention. The Women's Health Questionnaire and the Hamilton Depression Rating Scale were applied to assess the quality of life and the depressive symptoms, respectively. RESULTS: The frequencies of hot flashes per day happened in a similar way in both groups, with a reduction in the first 3 weeks after the intervention. There was a return in hot flash frequencies to baseline in the fourth week (week 0: 79.0 ±â€Š6.2 and 75.8 ±â€Š6.0, week 1: 61.6 ±â€Š9.6 and 57.0 ±â€Š7.8, week 2: 56.8 ±â€Š8.9 and 55.9 ±â€Š7.1, week 3: 56.8 ±â€Š8.9 and 54.2 ±â€Š7.2, week 4: 64.9 ±â€Š10.7, 70.1 ±â€Š8.9; tDCS-sham and tDCS groups, respectively). In the tDCS group, a trend towards a conversion of intensive hot flashes into mild ones was observed. CONCLUSIONS: Our results suggest that the tDCS technique showed small trends on postmenopausal vasomotor symptoms, justifying searches for more effective methods by which tDCS could reduce hot flashes.

Diagnosis and treatment of cervical cancer during pregnancy / Diagnóstico e tratamento do câncer do colo uterino durante a gestação

CONTEXT AND OBJECTIVE: One third of all cervical carcinomas occur during the reproductive period. Cervical carcinoma is the second greatest cause of death due to cancer during this phase. The estimated frequency of cervical cancer during pregnancy is one case for every 1,000 to 5,000 pregnancies. The aim here was to provide information about the difficulties in diagnosing and managing cervical neoplasia during pregnancy. MATERIALS: A systematic review of the literature was undertaken through the PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO) databases, using the following words: pregnancy, cervical cancer, diagnosis and management. RESULTS: There was a consensus in the literature regarding diagnosis of cervical carcinoma and management of preneoplastic lesions during pregnancy. However, for management of invasive carcinoma, there was great divergence regarding the gestational age taken as the limit for observation rather than immediate treatment. CONCLUSION: All patients with cytological abnormalities should undergo colposcopy, which will indicate and guide biopsy. Conization is reserved for patients with suspected invasion. High-grade lesions should be monitored during pregnancy and reevaluated after delivery. In cases of invasive carcinoma detected up to the 12th week of pregnancy, patient treatment is prioritized. Regarding diagnoses made during the second trimester, fetal pulmonary maturity can be awaited, and the use of chemotherapy to stabilize the disease until the time of delivery appears to be viable.

CONTEXTO E OBJETIVO: Um terço dos carcinomas de colo ocorrem no período reprodutivo, sendo que esta é a segunda causa de morte por câncer nessa fase. A freqüência estimada do carcinoma de colo uterino na gravidez é de um caso para cada 1.000 a 5.000 gestações. O objetivo foi informar sobre as dificuldades frente ao diagnóstico e manejo da neoplasia cervical durante a gravidez. MATERIAIS E MÉTODOS: Revisão sistemática da literatura foi realizada no PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO), usando as seguintes palavras: gestação, câncer cervical, diagnóstico e manejo. RESULTADOS: A literatura apresenta consenso quanto ao diagnóstico do carcinoma cervical e a conduta das lesões pré-neoplásicas durante a gestação. No manejo do carcinoma invasor há grande divergência quanto à idade gestacional considerada como limite para a adoção da observação em vez do tratamento imediato. CONCLUSÃO: Toda paciente com citologia alterada deve realizar colposcopia, a qual indicará e a biópsia. A conização é reservada para pacientes com suspeita de invasão. As lesões de alto grau devem ser acompanhadas durante a gestação e reavaliadas após o parto. Em casos de carcinoma invasor em gestantes com até 12 semanas o tratamento da paciente é priorizado. Nos diagnósticos ocorridos no segundo trimestre, pode-se aguardar a maturidade pulmonar fetal e o uso da quimioterapia para estabilizar a doença até o momento do parto parece ser viável.

[Evaluation of the frequency of accomplishment of the breast examination and of oncotic cervical cytology and the obstetrical ultrasound during the prenatal period. An inversion of values]. / Avaliação da frequência de realização do exame físico das mamas, da colpocitologia cervical e da ultrassonografia obstétrica durante a assistência pré-natal: uma inversão de valores.

UNLABELLED: Although ultrasound examination is a frequent procedure during pregnancy, routine use has not been effective to reduce maternal or perinatal morbidity-mortality. OBJECTIVE: Assess frequency of breast examination and of oncotic cervical cytology among prenatal exams and compare it to frequency of obstetrical ultrasound. METHODS: This was a cross-sectional evaluation conducted in the city of Rio Grande, RS, Brazil between May and July 2007. Data obtained with a structured questionnaire were entered into the Epi-Info 6.04 program and analyzed using the SPSS software. RESULTS: Among the 230 puerperae interviewed, 99.1% had undergone an ultrasound during pregnancy, while 37.5% and 33.6% had been submitted to clinical examination of the breasts and cervical cytology, respectively. It was noted that a larger number of obstetrical echographies increased the probability that a patient would be submitted to clinical examination of the breasts. On the other hand, the number of cytopathological evaluations of the uterine cervix was not influenced by the number of ultrasound examinations. CONCLUSION: Obstetrical echography was given priority and performed as a routine exam, whereas clinical examination of the breasts and cervical cytopathological examination were not, although considered obligatory during the prenatal period. These data confirm the tendency documented in literature indicating an inversion of priorities, favoring ultrasonography over breast examination and cervical pathological exams. For this reason, further studies and evaluations of health programs, also of the real impact of this inversion on the population health indices are recommended.

Microinvasive carcinoma of the uterine cervix in a 14-year-old adolescent: case report and literature review.

CONTEXT: Cancer of the uterine cervix is rare during adolescence. The reported rates are 0/100,000 adolescents aged 10 to 19 years and 1.7/100,000 women aged 20 to 24 years. However, several studies have shown increasing incidence of preneoplastic lesions at increasingly early ages. CASE REPORT: This paper reports a case of microinvasive carcinoma of the uterine cervix in a 14-year-old patient with menarche at 10 years of age and first coitus at 12 years of age. The objective of the present report was to alert gynecologists and pediatricians regarding the need for cervical carcinoma prevention among sexually active adolescents, based on educational programs that explain the purpose of colpocytological examinations and encourage their use, along with condom use and limitation of the number of sexual partners.

Microinvasive carcinoma of the uterine cervix in a 14-year-old adolescent: case report and literature review / Carcinoma microinvasor do colo uterino em paciente de 14 anos: relato de caso e revisão da literatura

CONTEXT: Cancer of the uterine cervix is rare during adolescence. The reported rates are 0/100,000 adolescents aged 10 to 19 years and 1.7/100,000 women aged 20 to 24 years. However, several studies have shown increasing incidence of preneoplastic lesions at increasingly early ages. CASE REPORT: This paper reports a case of microinvasive carcinoma of the uterine cervix in a 14-year-old patient with menarche at 10 years of age and first coitus at 12 years of age. The objective of the present report was to alert gynecologists and pediatricians regarding the need for cervical carcinoma prevention among sexually active adolescents, based on educational programs that explain the purpose of colpocytological examinations and encourage their use, along with condom use and limitation of the number of sexual partners.

CONTEXTO: O câncer do colo uterino é raro na adolescência, apresentando taxas de incidência de 0/100.000 adolescentes com idade entre 10 a 19 anos e de 1,7/100.000 mulheres com idade entre 20 e 24 anos. Entretanto, vários estudos mostram a incidência crescente das lesões pré-neoplásicas em idade cada vez menores. RELATO DE CASO: Este artigo relata um caso de carcinoma microinvasor do colo uterino em paciente de 14 anos com menarca aos 10 anos e a primeira relação aos 12 anos. Com este relato objetivamos alertar a comunidade médica, principalmente ginecologistas e pediatras, para a prevenção do carcinoma cervical entre adolescentes com vida sexual ativa. Além da realização de projetos educativos que divulguem a finalidade do exame citopatológico, o uso de preservativos e o controle do número de parceiros sexuais.

Diagnosis and treatment of cervical cancer during pregnancy.

CONTEXT AND OBJECTIVE: One third of all cervical carcinomas occur during the reproductive period. Cervical carcinoma is the second greatest cause of death due to cancer during this phase. The estimated frequency of cervical cancer during pregnancy is one case for every 1,000 to 5,000 pregnancies. The aim here was to provide information about the difficulties in diagnosing and managing cervical neoplasia during pregnancy. MATERIALS: A systematic review of the literature was undertaken through the PubMed, Cochrane, Excerpta Medica (Embase), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Electronic Library Online (SciELO) databases, using the following words: pregnancy, cervical cancer, diagnosis and management. RESULTS: There was a consensus in the literature regarding diagnosis of cervical carcinoma and management of preneoplastic lesions during pregnancy. However, for management of invasive carcinoma, there was great divergence regarding the gestational age taken as the limit for observation rather than immediate treatment. CONCLUSION: All patients with cytological abnormalities should undergo colposcopy, which will indicate and guide biopsy. Conization is reserved for patients with suspected invasion. High-grade lesions should be monitored during pregnancy and reevaluated after delivery. In cases of invasive carcinoma detected up to the 12th week of pregnancy, patient treatment is prioritized. Regarding diagnoses made during the second trimester, fetal pulmonary maturity can be awaited, and the use of chemotherapy to stabilize the disease until the time of delivery appears to be viable.

Avaliação da frequência de realização do exame físico das mamas, da colpocitologia cervical e da ultrassonografia obstétrica durante a assistência pré-natal: uma inversão de valores / Evaluation of the frequency of accomplishment of the breast examination and of oncotic cervical cytology and the obstetrical ultrasound during the prenatal period: an inversion of values

INTRODUÇÃO: Embora o exame de ultrassonografia seja um procedimento frequente na gravidez, o seu uso rotineiro não demonstrou efetividade sobre a redução da morbi-mortalidade materna ou perinatal. OBJETIVOS: Avaliar a cobertura do exame das mamas e da citologia oncótica cervical entre os exames de pré-natal, comparando-se com o número de ultrassonografias obstétricas realizadas. MÉTODOS: Constituiu-se de uma avaliação transversal, realizada na cidade de Rio Grande (RS), entre maio e julho de 2007. Os dados obtidos por meio de um questionário estruturado foram digitados no programa Epi-Info 6.04 e analisados no software SPSS. RESULTADOS: Entre as 230 puérperas entrevistadas, 99,1 por cento realizaram ultrassonografia durante a gravidez, enquanto 37,5 por cento e 33,6 por cento realizaram exame clínico das mamas ou colpocitologia cervical, respectivamente. Houve significância estatística (p-valor < 0,001) entre o local do pré-natal e o número de exames ecográficos realizados na gravidez. As pacientes que realizaram consultas por convênios ou particular foram mais submetidas a cografias. Também observou-se que o maior número de ecografias obstétricas aumentou a probabilidade da gestante ter sido submetida ao exame clínico das mamas. Por sua vez, a realização da colpocitologia não foi influenciada pelo número de ultrassonografias. CONCLUSÃO: A realização da ecografia obstétrica foi priorizada e realizada como exame rotineiro, ao passo que o exame clínico das mamas e o exame colpocitológico cervical não o foram, apesar de serem orientados como obrigatórios durante o pré-natal. Este fato demanda novos estudos e avaliações dos programas de saúde e o impacto desta inversão nos índices de saúde populacional.

Although ultrasound examination is a frequent procedure during pregnancy, routine use has not been effective to reduce maternal or perinatal morbidity-mortality. OBJECTIVE: Assess frequency of breast examination and of oncotic cervical cytology among prenatal exams and compare it to frequency of obstetrical ultrasound. METHODS: This was a cross-sectional evaluation conducted in the city of Rio Grande, RS, Brazil between May and July 2007. Data obtained with a structured questionnaire were entered into the Epi-Info 6.04 program and analyzed using the SPSS software. RESULTS: Among the 230 puerperae interviewed, 99.1 percent had undergone an ultrasound during pregnancy, while 37.5 percent and 33.6 percent had been submitted to clinical examination of the breasts and cervical cytology, respectively. It was noted that a larger number of obstetrical echographies increased the probability that a patient would be submitted to clinical examination of the breasts. On the other hand, the number of cytopathological evaluations of the uterine cervix was not influenced by the number of ultrasound examinations. CONCLUSION: Obstetrical echography was given priority and performed as a routine exam, whereas clinical examination of the breasts and cervical cytopathological examination were not, although considered obligatory during the prenatal period. These data confirm the tendency documented in literature indicating an inversion of priorities, favoring ultrasonography over breast examination and cervical pathological exams. For this reason, further studies and evaluations of health programs, also of the real impact of this inversion on the population health indices are recommended.

[Clinical breast examination during prenatal visits: analysis of coverage and associated factors in a city in the State of Rio Grande do Sul, Brazil]. / Exame clínico das mamas em consultas de pré-natal: análise da cobertura e de fatores associados em município do Rio Grande do Sul, Brasil.

The Brazilian Ministry of Health recommends that breast examination be performed along with breastfeeding orientation during the first prenatal visit. The aims of the current study were to analyze breast examination during prenatal care and describe the factors associated with insufficient coverage. A cross-sectional study was performed in Rio Grande, Rio Grande do Sul State, Brazil, from May to July 2007. Data for women who had just given birth were recorded on a standardized questionnaire. Of 445 women, 266 (59.8%) had not undergone breast examination during prenatal care. Non-white women and those with a monthly income below the minimum wage (BRL 380.00) or with prenatal care and delivery in the public health system showed the highest probability of not having a breast examination during prenatal care. The results show the low prevalence of breast examination during prenatal care and indicate serious problems related to quality of prenatal care, besides unequal access for poor women.

Exame clínico das mamas em consultas de pré-natal: análise da cobertura e de fatores associados em município do Rio Grande do Sul, Brasil / Clinical breast examination during prenatal visits: analysis of coverage and associated factors in a city in the State of Rio Grande do Sul, Brazil

O Ministério da Saúde do Brasil preconiza que seja realizado o exame clínico das mamas em conjunto com as orientações para o aleitamento materno na primeira consulta de pré-natal. O objetivo deste estudo foi avaliar a cobertura do exame clínico das mamas durante o pré-natal e descrever características associadas ao não cumprimento desta norma. Foi realizado um estudo transversal em Rio Grande, Rio Grande do Sul, Brasil, entre os meses de maio e julho de 2007. Dados relativos às puérperas foram registrados em um questionário padronizado. Dentre as 445 puérperas entrevistadas, 266 (59,8 por cento) não foram submetidas ao exame clínico das mamas no pré-natal. As mulheres não-brancas, com renda familiar per capita inferior a um salário mínimo (R$ 380,00), com parto e pré-natal realizados pelo Sistema Único de Saúde (SUS) apresentaram probabilidade maior de não terem suas mamas examinadas durante o pré-natal. Esses resultados mostram a baixa prevalência da realização do exame clínico das mamas durante o pré-natal, além disso, indicam graves problemas relacionados à qualidade do atendimento pré-natal e diferenças no acesso de mulheres pertencentes aos contingentes populacionais de menor poder aquisitivo aos cuidados preconizados.

The Brazilian Ministry of Health recommends that breast examination be performed along with breastfeeding orientation during the first prenatal visit. The aims of the current study were to analyze breast examination during prenatal care and describe the factors associated with insufficient coverage. A cross-sectional study was performed in Rio Grande, Rio Grande do Sul State, Brazil, from May to July 2007. Data for women who had just given birth were recorded on a standardized questionnaire. Of 445 women, 266 (59.8 percent) had not undergone breast examination during prenatal care. Non-white women and those with a monthly income below the minimum wage (BRL 380.00) or with prenatal care and delivery in the public health system showed the highest probability of not having a breast examination during prenatal care. The results show the low prevalence of breast examination during prenatal care and indicate serious problems related to quality of prenatal care, besides unequal access for poor women.