Long-term outcomes of concomitant cisplatin plus radiotherapy versus radiotherapy alone in patients with stage IIIB squamous cervical cancer: A randomized controlled trial.

OBJECTIVE: The present analysis determined the disease free survival (DFS) and overall survival (OS) at up to 14 years of follow-up in women who participated in our previous phase 3 randomized controlled clinical trial, in which women with stage IIIB squamous cervical cancer received either cisplatin plus RT or RT alone for treatment. The first study showed that the addition of cisplatin to RT offered a significant benefit in DFS, but not in OS. METHODS: The present analysis examined DFS and OS in 146 women from the original cohort (72 patients in the CRT arm and 74 patients in the RT-only arm) with follow-up of up to 14 years. RESULTS: Longer term follow-up showed that treatment with CRT offers a significant benefit in DFS and OS compared with treatment with RT only. Patients who received RT alone had significantly worse OS (HR, 1.88; 95% CI, 1.09-3.24) and DFS (HR, 1.82; 95% CI, 1.07-3.08) compared with patients who received CRT. The multivariate analyses also showed that the patients with baseline Karnofsky performance status (KPS) <90% showed significantly worse OS (HR, 3.11; 95% CI, 1.78-5.43), as did those with hemoglobin <10 mg/dL (HR, 4.32; 95% CI, 2.23-8.36). Patients with baseline KPS < 90% showed significantly worse DFS (HR, 2.83; 95% CI, 1.60-5.01), as did those with hemoglobin <10 mg/dL (HR, 4.16; 95% CI, 2.17-7.95). CONCLUSIONS: For stage IIIB cervical cancer, treatment with CRT offers a significant benefit in DFS and OS compared with treatment with RT only.

Symptoms, CA125 and HE4 for the preoperative prediction of ovarian malignancy in Brazilian women with ovarian masses.

BACKGROUND: This manuscript evaluates whether specific symptoms, a symptom index (SI), CA125 and HE4 can help identify women with malignant tumors in the group of women with adnexal masses previously diagnosed with ultrasound. METHODS: This was a cross-sectional study with data collection between January 2010 and January 2012. We invited 176 women with adnexal masses of suspected ovarian origin, attending the hospital of the Department of Obstetrics and Gynecology of the Unicamp School of Medicine. A control group of 150 healthy women was also enrolled. Symptoms were assessed with a questionnaire tested previously. Women with adnexal masses were interviewed before surgery to avoid recall bias. The Ward Agglomerative Method was used to define symptom clusters. Serum measurements of CA125 and HE4 were made. The Risk of Ovarian Malignancy Algorithm (ROMA) was calculated using standard formulae. RESULTS: Sixty women had ovarian cancer and 116 benign ovarian tumors. Six symptom clusters were formed and three specific symptoms (back pain, leg swelling and able to feel abdominal mass) did not agglomerate. A symptom index (SI) using clusters abdomen, pain and eating was formed. The sensitivity of the SI in discriminating women with malignant from those with benign ovarian tumors was 78.3%, with a specificity of 60.3%. Positive SI was more frequent in women with malignant than in women with benign tumors (OR 5.5; 95% CI 2.7 to 11.3). Elevated CA125 (OR 11.8; 95% CI 5.6 to 24.6) or HE4 (OR 7.6; 95% CI 3.7 to 15.6) or positive ROMA (OR 9.5; 95% CI 4.4 to 20.3) were found in women with malignant tumors compared with women with benign tumors. The AUC-ROC for CA125 was not different from that for HE4 or ROMA. The best specificity and negative predictive values were obtained using CA125 in women with negative SI. CONCLUSION: Women diagnosed with an adnexal mass could benefit from a short enquiry about presence, frequency and onset of six symptoms, and CA125 measurements. Primary care physicians can be thereby assisted in deciding as to whether or not reference the woman to often busy, congested specialized oncology centers.

Chronic periodontitis and pre-term labour in Brazilian pregnant women: an association to be analysed.

AIM: To investigate the association between chronic periodontitis (CP) and pre-maturity in a group of Brazilian pregnant women from the State of São Paulo. MATERIALS AND METHODS: One hundred and twenty-four women were investigated consecutively in a cross-sectional study, between December 2003 and May 2005. Sixty-eight women had pre-term labour (PTL) and 56 had term labour. A periodontal examination was carried out to identify the presence of CP. Statistical analysis used the Fisher's exact test or chi(2) for the discrete variables and the Mann-Whitney test for the non-parametric variables. Odds ratio (OR) was calculated with a 95% confidence interval (CI), to evaluate the relation between CP and pre-maturity. RESULTS: Periodontal indicators, such as clinical attachment loss (p<0.0001) and bleeding on probing (p=0.012), were observed more in the PTL group. The presence of CP increased the risk for PTL (OR: 4.7, 95% CI: 1.9-11.9), pre-term birth (PTB; OR: 4.9, 95% CI: 1.9-12.8) and low birth weight (<2500 g; OR: 4.2, 95% CI: 1.3-13.3). The pregnant women with PTL presented low levels of schooling (p=0.029) and the lowest number of pre-natal appointments (p=0.0001) when compared with those with term labour. CONCLUSION: CP is strongly associated with PTL, PTB and low birth weight in a group of Brazilian pregnant women. These data point to the necessity of regularly investigating CP during pregnancy.

Influência da freqüência de coitos vaginais e da prática de duchas higiênicas sobre o equilíbrio da microbiota vaginal / Influence of frequency of vaginal intercourses and the use of doushing on vaginal microbiota

OBJETIVO: verificar se alta freqüência de coitos vaginais e o uso de duchas higiênicas interferem com a microbiota vaginal. MÉTODOS: noventa e sete mulheres atendidas em centro de saúde localizado em zona de prostituição na cidade de Campinas foram avaliadas em estudo prospectivo de corte transversal. A anamnese determinou as freqüências de coitos vaginais e do uso de duchas higiênicas nas 44 profissionais do sexo e nas 53 não-profissionais do sexo estudadas. O conteúdo vaginal foi coletado com swab estéril de Dacron, da parede vaginal direita, e disposto em duas lâminas de vidro. A microbiota vaginal foi estudada em microscopia óptica com lente de imersão em esfregaço corado pela técnica de Gram. Os dados foram analisados pelo teste exato de Fisher. As mulheres profissionais e não profissionais do sexo apresentaram, respectivamente, média de idade de 24,9 (± 6,4) e 31,5 (± 9,7) anos, hábito de fumar em 52,2 e 24,5 por cento, prática do uso de lubrificantes vaginais em 56,8 e 0 por cento e prática de uso de condom em 100 e 41,5 por cento dos casos respectivamente. RESULTADOS: apenas 1,8 por cento das mulheres do grupo controle tinham sete ou mais relações sexuais por semana, em evidente contraste com as profissionais do sexo (97,7 por cento). Não houve diferenças significativas quanto à raça, escolaridade e paridade. A vaginose bacteriana e a flora vaginal anormal foram mais observadas nas profissionais do sexo do que no grupo controle (p=0,02 e 0,001) e associou-se à alta freqüência (sete ou mais vezes) de coitos vaginais semanais (p=0,04 e 0,001). O diagnóstico de vaginose citolítica foi mais freqüente nas mulheres não-profissionais do sexo (p=0,04) e com menor freqüência de relações sexuais (p=0,04). O uso de duchas higiênicas foi mais comum nas profissionais do sexo (p=0,002). Entretanto, esta prática não esteve associada aos distúrbios da microbiota vaginal e nem à presença de vulvovagintes. CONCLUSÕES: profissionais do sexo com sete ou mais relações sexuais semanais apresentaram maior freqüência de vaginose bacteriana e alterações da flora vaginal. O hábito de duchas vaginais não interferiu com o ecossistema vaginal das mulheres estudadas.

Vaginose bacteriana e trabalho de parto prematuro: uma associação não muito bem compreendida / Bacterial vaginosis and pteterm labor: an association not very well understood

A vaginose bacteriana, doença frequente acomete a gestante brasileira em aproximadamente 20 por cento dos casos e parece estar associada ao trabalho de parto prematuro, rotura prematura de membranas e baixo peso peso do recém-nascido