[Impact of chemotherapy on ovarian function and quality of life of patients with gestational trophoblastic neoplasia].

Objective: Using a questionnaire to evaluate different regimens of chemotherapy on ovarian function and quality of life of patients with gestational trophoblastic neoplasia (GTN) . Methods: At least 6 months after completion of chemotherapy, 200 patients with GTN treated in Peking Union Medical College Hospital from January 2010 to June 2017 were randomly selected to fill up the questionnaire. The questionnaire items were included the patient's menstrual cycles, sexual life, gestational issues and common health. The patients were divided into 3 groups by chemotherapy regimens: actinomycin D (Act-D) group, floxuridine+Act-D+vincristine (FAV) or floxuridine+Act-D+etoposide+vincristine (FAEV) group (FAV-FAEV group) , and etoposide+methotrexate+Act-D (EMA) /vincristine+cyclophosphamide (CO) or EMA/ etoposide+cisplatin (EP) group (EMA/CO-EMA/EP group) . Chi-square test was used with a significance level of P-value less than 0.05. Results: One hundred and seventy-three (86.5%,173/200) of the patients completed the questionnaire. Forty three point two percent (43.2%, 19/44) in the EMA/CO-EMA/EP group had a normal menstrual cycle, which were significantly lower than those of Act-D group (84.6%,22/26) and FAV-FAEV group (71.2%, 37/52; all P<0.05) . Amenorrhea rate was also significantly higher in EMA/CO-EMA/EP group (25.0%, 11/44) than in Act-D group (0) and FAV-FAEV group (17.3%, 9/52; all P<0.05) . The sexual life parameters were comparable among 3 groups. Ten out of thirty-two patients conceived after chemotherapy, 2 had miscarriages and 8 had full-term delivery of healthy babies. The common health and labor capacity were significantly decreased after chemotherapy (all P<0.05) . Conclusions: EMA/CO or EMA/EP regimen have a worse impact on ovarian function than Act-D and FAV or FAEV regimen. Gynecologic oncologist should be concerned about the ovarian function and quality of life of GTN patients.

Avoidance of gastroduodenal toxicity in patients receiving hepatic arterial 5-fluoro-2'-deoxyuridine.

Gastroduodenal inflammation and ulceration have been frequently observed in patients receiving continuous hepatic arterial infusions of 5-fluoro-2'-deoxyuridine (FUDR) for liver malignancy. Thirty-five patients with metastatic colon cancer received hepatic arterial FUDR administered with implanted infusion pumps. At surgery, particular care was taken to identify and divide those vessels arising from the hepatic arteries distal to the point of cannulation that supplied the superior border of the distal stomach and proximal duodenum. None of the patients developed signs or symptoms of gastritis or ulcer attributable to chemotherapy. We contend that gastritis and ulcer in patients receiving hepatic arterial FUDR are due to misperfusion of drug into the upper gastrointestinal tract and that these complications can be largely avoided by use of appropriate surgical techniques.

Intraperitoneal 5-fluoro-2'-deoxyuridine (FUDR) and (S)-leucovorin for disease predominantly confined to the peritoneal cavity: a pharmacokinetic and toxicity study.

Intraperitoneal (IP) administration of fluorinated pyrimidines has been evaluated for ovarian and gastrointestinal malignancies in phase I, II, and III trials. The tolerance and pharmacokinetic profile of IP 5-fluoro-2'-deoxyuridine(FUDR) alone and with (R,S)-leucovorin ((R,S)-LV) have each been evaluated in previous phase I studies. FUDR doses of 3 g per day with and without (R,S)-LV doses up to 640 mg per day given IP are well tolerated. The current phase I study was designed to determine the pharmacokinetic profiles and clinical tolerance of escalating doses of the pure biologically active S-isomer of leucovorin ((S)-LV) given IP with the same dosing schedule of FUDR. A group of 16 patients with disease confined to the abdominal cavity were treated in this study. Pharmacokinetic studies of blood and peritoneal fluid, toxicity profiles, and clinical response for the first three cycles are reported here. The toxicity profile did not significantly differ from the prior two studies. All non-hematologic toxicities, such as fatigue, nausea, vomiting, diarrhea, and abdominal discomfort were less than grade 4, and most were less than grade 3. Neutropenia and thrombocytopenia were uncommon and observed only in patients with compromised bone marrow reserve. The pharmacokinetic profiles were also congruent with the previous studies and indicate a three-log advantage for FUDR. The (S)-LV profiles in the peritoneal cavity paralleled those of FUDR. Antitumor effects or absence of progression until after cessation of therapy were documented in 11 patients. At a median follow-up of 18 months 44% of patients were alive. IP administration of 3-g of FUDR and up to 640 mg (S)-LV daily for three days was well tolerated. The tolerance and antitumor effects observed during IP FUDR and LV in these studies encourage further exploration of this regimen against ovarian and gastrointestinal malignancies. The actual role and optimal dose of LV as an enhancer of the antitumor actions of FUDR administered by this route remain unknown.

Phase I and pharmacokinetic evaluation of floxuridine/leucovorin given on the Roswell Park weekly regimen.

A phase I and pharmacokinetics study was carried out of floxuridine (FdUrd) modulated by leucovorin (LV) given on the Roswell Park regimen (LV given at 500 mg/m2 by 2-h infusion and FdUrd given by i.v. push at 1 h after the start of LV infusion, treatment being given weekly x 6). The dose-limiting toxicity was diarrhea; the MTD and recommended dose for phase II studies was 1,650 mg/m2 per week of FdUrd. The dose-response curve was steep, with 3/3 patients treated at a dose of 1,750 mg/m2 developing grade IV diarrhea. With this schedule there was no significant mucositis. Pharmacokinetic parameters showed very wide interpatient variability. Plasma decay was biphasic with a t1/2 beta of approximately 2 h. Plasma clearance was high (> 200 1 h-1). No correlation between pharmacokinetic parameters and toxicity could be identified.

A cystic biliary tumour responding to regional fluorinated pyrimidine infusion.

We describe a patient with an intrahepatic biliary hamartoma associated with transformation to undifferentiated carcinoma which responded to intrahepatic arterial floxuridine chemotherapy.

Floxuridine-containing regimens in the treatment of gestational trophoblastic tumor.

OBJECTIVE: To analyze the efficacy of floxuridine (FUDR)-containing regimens in the treatment of gestational trophoblastic tumor (GTT). STUDY DESIGN: Seventy-four patients with GTT, 47 with invasive mole and 27 with choriocarcinoma were treated with FUDR-containing regimens. Clinical staging of the disease was: 33 cases of stage I, 3 cases of stage II, 31 cases of stage IIIa, 6 cases of stage IIIb and 1 case of stage IV. RESULTS: The complete response rate of FUDR-containing regimens in the treatment of GTT was 91.9% (68 of 74 cases). Six patients, of whom 3 showed signs of drug resistance and 3 showed myelosuppression, had their regimens changed to non-FUDR-containing regimens, and all achieved a complete response. All 7 patients with advanced disease (>IIIb) achieved a complete response. The major adverse event with FUDR-containing regimens was myelosuppression and gastrointestinal toxicity: third- and fourth-degree neutropenia in 26% and thrombocytopenia in 6.2%, third-degree vomiting in 57.1% and third-degree diarrhea in 4.3%. CONCLUSION: FUDR-containing regimens are efficient for the treatment of GTT even for patients with advanced or drug-resistant disease.

[Impact of preoperative locoregional chemotherapy with fluorodeoxyuridine on the outcome of liver resection]. / Impatto della chemioterapia locoregionale preoperatoria con fluorodesossiuridina (FUDR) sulla chirurgia resettiva epatica.

The aim of the study was to evaluate the effects of preoperative intra-arterial hepatic chemotherapy (IAHC) on the outcome of liver resections for hepatic metastases from colorectal cancer. Twelve patients (IAHC group) treated by IAHC with fluorodeoxyuridine (FUdR) and subsequent liver resection and 40 patients who underwent liver resection without preliminary IAHC (non-IAHC group) were analysed comparatively in terms of age, gender, concomitant diseases, previous abdominal surgery, type of hepatic resection, use of portal clamping, and associated surgical procedures. For the purposes of the study, length of operation, intraoperative blood losses, perioperative transfusions, length of hospitalisation, complications and mortality were also recorded. The two groups were comparable (p = n.s.) for those variables affecting the perioperative course. As regards the end points of the study, no significant differences were recorded in length of operation, intraoperative blood losses, perioperative transfusions [except for more postoperative plasma transfusions in the IAHC group (16.7% vs 5.0%, p = 0.009)] and postoperative complications (9.1% vs 17.5%, p = 0.415). Postoperative mortality consisted in one patient in the IAHC group. Postoperative hospitalization was significantly longer in the non-IAHC group (median: 8 vs 10, range: 6-13 vs 5-33 days; p = 0.004). IAHC does not negatively affect the outcome of subsequent liver resection.

[Hepatic arterial infusion after hepatectomy for liver metastases of colorectal carcinoma to prevent residual hepatic recurrence].

The hepatic recurrent rate after hepatic resection of colorectal liver metastases was 60-70%. Prevention of residual hepatic recurrence will result in a markedly better prognostic outcome. Thus, 51 patients with liver metastases of colorectal carcinoma were administered 5-FU from gastroduodenal artery after hepatectomy. The results were as follows: the cumulative 5-year survival rate; hepatic arterial infusion (+): 43.4%; (-): 18.5% (p < 0.05); the residual hepatic recurrent rate, hepatic arterial infusion (+): 33.3%; (-): 58.6% (p < 0.05); The total dose of 5-FU > or = 15 g administration group got less residual hepatic recurrent rate; and proved rather effective for prevention of residual hepatic recurrence. But the 5-year survival rate in extra-hepatic recurrence (+) was 14.1% and that of (-) was 70.9% (p < 0.001). In future, it will be necessary to prevent extra-hepatic recurrence after hepatectomy.

[Pharmacological study of 5'-DFUR oral administration and the clinical responses against gastrointestinal carcinoma].

In 4 out of 5 patients given 400 mg orally 5'-DFUR before surgery, intratumor 5-FU concentration showed over 150 ng/g. The concentration of either 5-FU or 5'-DFUR in the portal and peripheral blood of these patients exceeded the limits of assay. 5-FU concentration in peripheral blood was less than 0.05 micrograms/ml. White blood cell and platelet counts in the patients given 1,600 mg/day (no administration for 2 days/week) of 5'-DFUR for one month were essentially the same with those at the time of start of the treatment. Two of three patients showed minor response following the treatment with 5'-DFUR. Thus, administration of 1,600 mg/day of 5'-DFUR may be considered as an effective treatment of fluopyrimidine against advanced cancer. For the prediction of gastrointestinal side effect, assay of the 5-FU concentration in the portal blood seemed to be useful.

[Adjuvant intra-arterial chemotherapy with gastrin receptor antagonist after hepatic resection in colorectal cancer metastasis].

The aim of this study was to determine whether chemo-endocrine therapy after the resection of liver metastasis from colorectal cancer would prevent recurrence in the remnant liver and prolong survival. Eleven colorectal cancer patients underwent hepatic resection for liver metastasis. Subsequently, they were administered Proglumide gastrin antagonist 1,200 mg/day + 5'-DFUR 800 mg/day for 2 years. In seven of them, MMC 6-10 mg and ADM 20 mg were infused intra-arterially every two weeks alternately for one year. In four of them, 5-FU 250 mg/day was infused for seven days continuously intra-arterially every two weeks for one year. Recurrence in the remnant liver occurred in four of 11 patients. All of these patients underwent repeated hepatectomy. The mean disease-free survival in the remnant liver was 37 months and the five-year survival rate was 91%. These results indicate that intra-arterial chemotherapy with gastrin receptor antagonist might be effective for adjuvant therapy in patients with resectable liver metastasis from colorectal cancer.

[Adjuvant chemo-endocrine chemotherapy with gastrin antagonist after resection of liver metastasis in colorectal cancer].

This study was designed to determine whether or not chemo-endocrine therapy after the resection of liver metastasis from colorectal cancer would prevent re-recurrence in the liver. Postoperatively, seven patients received proglumide gastrin antagonist (1,200 mg/day) +5'-DFUR (800 mg/day) orally for 2 years. MMC 6-10 mg and ADR 20 mg were infused every two weeks alternately for 1 year via catheter in the common hepatic artery. After median follow-up of 39 months, re-recurrence rate in the remnant liver after hepatic resection was 14% (1/7) for patients with chemo-endocrine therapy and 52% (24/46) for the controls. These results suggest the possibility that chemo-endocrine therapy is effective to prevent re-recurrence of liver metastasis in patients with colorectal cancer.

[Advanced breast cancer with multiple bone metastases successfully treated with combined chemoendocrine-therapy of CEF (cyclophosphamide, epirubicin, 5-fluorouracil) and 5'-DFUR (5'-deoxy-5-fluorouridine) + MPA (medroxyprogesterone acetate)--a case report].

We report the case of a 51-year-old female with stage IV advanced breast cancer accompanied by multiple bone metastases. A hard mass of about 3.0 cm in diameter was palpated just below the nipple. An excisional biopsy was performed and histological examination revealed infiltrated solid tubular adenocarcinoma. There were no estrogen or progesterone receptors in the tumor. Modified radical mastectomy was performed in October, 1998. Postoperative adjuvant therapy with 10 cycles of CEF therapy was undertaken for one year. Combined chemoendocrine therapy with 5'-DFUR and MPA was also conducted for 11 months. Bone scintigraphy showed that all bone metastatic lesions disappeared completely one year after the operation. Mild bone marrow suppression, alopecia and body weight gain were observed as side effects. It is suggested that this combination therapy may be useful for advanced breast cancer patients with multiple bone metastases.

Weekly paclitaxel in combination with doxifluridine for peritoneally disseminated gastric cancer with malignant ascites.

BACKGROUND: The efficacy of systemic chemotherapy for peritoneal dissemination of gastric cancer remains unclear. The efficacy of weekly paclitaxel in combination with doxifluridine (5'-DFUR) in gastric cancer patients with malignant ascites was evaluated. PATIENTS AND METHODS: Patients with histologically confirmed gastric cancer with ascites were eligible. The treatment consisted of paclitaxel intravenously (i.v.) administered at 80 mg/m(2) on days 1, 8 and 15 every 4 weeks, and doxifluridine administered orally at 533 mg/m(2) on days 1-5 every week. The response rate for patients with ascites was determined based on the Japanese Classification of Gastric Carcinoma. Also, the concentration of paclitaxel in the ascites was measured. RESULTS: Twenty-four patients were investigated. The response rate (RR) was 41.7%, including complete remission (CR) and partial remission (PR) in 4 and 6 patients, respectively. The concentration of paclitaxel in the ascites was maintained between 0.01 µM and 0.05 µM until 72 hours. The median overall survival (OS) was 215 days, and 1-year survival rate was 29.2%. No severe toxicity was noted. CONCLUSION: Weekly paclitaxel in combination with doxifluridine is effective for gastric cancer patients with malignant ascites with an acceptable toxicity profile.

Efeitos da sondagem nasogástrica em pacientes com acidente cerebrovascular e disfagia / Effects of nasogastric catheterization in patients with stroke and dysphagia / Efectos de la cateterización nasogástrica en pacientes con accidente cerebrovascular y disfagia

O estudo teve por objetivo analisar os efeitos da sondagem gástrica em pacientes com acidente vascular cerebral e disfagia. Revisão sistemática da literatura, realizada em seis bases de dados, com os descritores stroke e intubation, gastrointestinal. Foram encontrados 120 estudos e selecionados três ensaios clínicos. Os resultados apontaram diferentes desfechos, entre os quais: aumento do nível sérico de albumina (gastrostomia), prognóstico ruim e risco de morte (gastrostomia), aumento das falhas no tratamento devido a bloqueio, deslocamento e reinserção da sonda nasogástrica, e aumento da incidência de hemorragia gastrointestinal (sonda nasogástrica). A partir dos resultados obtidos nesta revisão sistemática, ressaltam-se as seguintes evidências: a sondagem nasogástrica deve ser adotada precocemente como um método de alimentação enteral; as falhas do tratamento são mais comuns naqueles que utilizam a sonda nasogástrica como método de alimentação; os resultados relacionados à melhora do estado funcional dos pacientes foram semelhantes, independente do método de terapia nutricional empregado.

This study aimed to analyze the effects of gastric intubation in patients with stroke and dysphagia. A systematic literature review was performed in six databases, using the keywords stroke and intubation, gastrointestinal. One hundred and twenty studies were found, from which three clinical trials were selected. The results showed different outcomes, including: increased serum albumin level (gastrostomy), poor prognosis and risk of death (gastrostomy), increased treatment failures because of blocking, displacement and reinsertion need of the nasogastric tube, and increased incidence of gastrointestinal bleeding (nasogastric tube). From the results obtained in this systematic review, we emphasize the following evidences: a nasogastric catheter should be adopted as a method of early enteral feeding; treatment failures are more common in those who use nasogastric tube-feeding; outcomes related to improved functional status of patients were similar, regardless of the method of nutritional therapy used.

El objetivo del estudio fue analizar los efectos de la intubación gástrica en pacientes con accidente cerebrovascular y disfagia. Se llevó a cabo una revisión sistemática de la literatura en seis bases de datos, utilizando-se las palabras clave accidente cerebrovascular y intubación, gastrointestinal. Entre 120 estudios identificados, fueran seleccionados tres ensayos clínicos. Los resultados mostraron diferentes desfechos, incluyendo: aumento del nivel de albúmina sérica (gastrostomía); mal pronóstico y riesgo de muerte (gastrostomía); aumento de los fracasos del tratamiento debido a obstrucción, desplazamiento y necesidad de reinserción de la sonda nasogástrica; y aumento de la incidencia de hemorragia gastrointestinal (sonda nasogástrica). A partir de los resultados obtenidos, destacamos las siguientes evidencias: se deben adoptar catéteres nasogástricas como método de alimentación enteral temprana; fracasos del tratamiento son más comunes en aquellos que utilizan la alimentación con sonda nasogástrica; los resultados relacionados con la mejora del estado funcional de los pacientes fueron similares, independientemente del método de terapia nutricional utilizado.

História da saúde da criança: conquistas, políticas e perspectivas / History of the child's health: conquers, policies and perspectives / Historia de la salud del niño: conquistas, políticas y perspectivas

Objetivou-se descrever e refletir sobre os aspectos relacionados à história social e às políticas públicas de assistência à saúde da criança no Brasil. Realizou-se breve contextualização histórica sobre as transformações no ser criança no Brasil e no mundo, apresentando-se as perspectivas referentes às políticas públicas de saúde da criança no âmbito nacional. Observou-se que a evolução histórica da participação da criança na sociedade encontra-se atrelada às mudanças nas políticas públicas de assistência, traduzida em queda da mortalidade infantil, aliada a desafios como a redução da morbimortalidade por agravos perinatais e causas evitáveis. Os avanços e conquistas na saúde da criança encontram-se em um movimento de mudança paradigmática para um modelo de construção de redes e da integralidade do cuidado. Esse contexto aponta a necessidade de formação de recursos humanos para esta área, tendo em vista à promoção e prevenção em saúde, assim como uma melhor qualidade de vida dessa população.

The aim of this study was describing and reflecting about the aspects related to the social history and public policies for the children's health assistance in Brazil. A brief historical contextualization was realized concerning changes on the way the society views the child in Brazil and around the world, also perspectives considering public policies for the children's health in the national context were presented. It was possible to identify that the historical evolution of the child participation in the society is linked to the changes in the assistance public policies, which were demonstrated in the child death decrease and associated to challenges, like the morbimortality reduction caused by perinatal injuries and avoidable causes. The advances and conquers in the child's health are evolved in a paradigmatic change movement into a model of a net formation and a comprehensiveness care. This context requires the human resources preparation for such area, based on the health promotion and prevention, as well as a better quality of life of the population.

El objetivo del estudio fue describir y reflexionar acerca de los aspectos relacionados con la historia social y las políticas públicas de asistencia de salud de niños en Brasil. Una breve contextualización acerca de las transformaciones en el modo de ser niño en Brasil y en el mundo, así como las perspectivas relacionadas a las políticas públicas de salud del niño en el contexto nacional. La evolución histórica de la participación del niño en la sociedad encuentra-se vinculada a las modificaciones de las políticas públicas de asistencia, que se mira en la reducción de la mortalidad infantil, acercada de desafíos como la reducción de la morbimortalidad por injurias perinatales y causas evitables. Los avanzos y conquistas na salud del niño se encuentran en uno movimiento de modificacion paradigmática para un modelo de construcción de redes y de la integralidad del cuidado. En este contexto se observa la necesidad de formación de recursos personales para esta área, con base en la promoción y prevención en salud y una mejor cualidad de vida de esa población.

Quality of life, clinical characteristics and treatment adherence of people living with HIV/AIDS / Qualidade de vida, características clínicas e adesão ao tratamento de pessoas vivendo com HIV/AIDS / Calidad de vida, características clínicas y adhesión al tratamiento de personas viviendo con VIH/Sida

OBJECTIVES: to assess the quality of life of people living with HIV/AIDS and verify its association with clinical characteristics and treatment adherence. METHOD: cross-sectional study conducted in a hospital in the state of Paraíba, Brazil. A questionnaire was used to collect socio-demographic and clinical data. The quality of life scale proposed by the World Health Organization and a questionnaire to measure treatment adherence were used. RESULTS: of the 314 interviewees, 190 (60.5%) were male, aged 43 years on average, 121 (38.5%) had attended up to five years of schooling, 108 (34.4%) received up to two times the minimum wage, and 112 (35.7%) were on sick leave. In regard to clinical variables, individuals with an undetectable viral load scored higher in all the domains concerning quality of life, with statistically significant differences in three domains. Regarding treatment adherence, 235 (73.8%) presented poor adherence and those who strictly adhered to treatment obtained better scores in quality of life. The results show that quality of life is better among individuals adherent to ART. Supporting people to adhere to the antiretroviral treatment should be a persistent task of healthcare workers and other people participating in the treatment, such as family members and friends. .

OBJETIVOS: avaliar a qualidade de vida das pessoas vivendo com o vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida e suas associações com características clínicas e adesão ao tratamento. MÉTODO: estudo transversal, realizado em um hospital do Estado da Paraíba. Utilizou-se questionário para caracterização sociodemográfica e clínica, escala de qualidade de vida (proposta pela Organização Mundial da Saúde) e escala de adesão ao tratamento (Questionário para Avaliação da Adesão ao Tratamento Antirretroviral). RESULTADOS: dos 314 entrevistados, 190 (60,5%) eram do sexo masculino, idade média de 43 anos, 121(38,5%) contavam com até cinco anos de estudo, 108 (34,4%) recebiam até dois salários-mínimos e 112 (35,7%) estavam afastados das atividades laborais. Quanto às variáveis clínicas, identificou-se que os indivíduos com carga viral indetectável apresentaram maiores escores em todos os domínios de qualidade de vida, com diferença estatisticamente significante em três domínios. Sobre a adesão ao tratamento, 235 (73,8%) apresentaram adesão insuficiente, os que apresentaram adesão estrita obtiveram melhores escores de qualidade de vida. Os resultados mostraram que a qualidade de vida é melhor para os aderentes ao tratamento antirretroviral. Apoiar as pessoas em tratamento para melhorar a adesão aos antirretrovirais deve ser tarefa constante dos profissionais de saúde e de outras pessoas que participam do tratamento, como familiares e amigos. .

OBJETIVOS: evaluar la calidad de vida de las personas viviendo con VIH/Sida y sus asociaciones con características clínicas y adhesión al tratamiento. MÉTODO: estudio transversal, realizado en un hospital del estado de Paraíba. Se utilizó un cuestionario para caracterización sociodemográfica y clínica, la Escala de Calidad de Vida (propuesta por la Organización Mundial de la Salud) y la Escala de Adhesión al Tratamiento (Cuestionario para Evaluación de la Adhesión al Tratamiento Antirretroviral). RESULTADOS: de los 314 entrevistados, 190 (60,5%) eran del sexo masculino, edad promedio de 43 años, 121(38,5%) contaban con hasta cinco años de estudio, 108 (34,4%) recibían hasta dos salarios mínimos y 112 (35,7%) no realizaban actividades laborales. En cuanto a las variables clínicas, se identificó que los individuos con carga viral indetectable presentaron mayores puntajes en todos los dominios de calidad de vida, con diferencia estadísticamente significativa en tres dominios. Sobre la adhesión al tratamiento, 235 (73,8%) presentaron adhesión insuficiente, los que presentaron adhesión estricta obtuvieron mejores puntajes de calidad de vida. Los resultados mostraron que la calidad de vida es mejor para los adherentes a la TARV. Apoyar a personas en tratamiento para mejorar la adhesión a los antirretrovirales debe ser una tarea constante de los profesionales de la salud y de otras personas que participan del tratamiento, como familiares y amigos. .

Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study / Incontinencia urinaria relacionada con la fuerza muscular perineal en el primer trimestre del embarazo: estudio transversal / Incontinência urinária relacionada à força muscular perineal no primeiro trimestre da gestação: estudo transversal

Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.
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Objetivo Analizar la fuerza de los músculos del suelo pélvico (FMSP), la continencia urinaria y la calidad de vida en mujeres en el primer trimestre del embarazo. Método Estudio transversal cuyo muestra incluyó 500 mujeres que comenzaron la atención prenatal en un servicio del sector de salud complementaria en Guarulhos, SP, en 2012-2013. La FMSP fue evaluada por la perineometría y las mujeres embarazadas con incontinencia urinaria (IU) respondieron al International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados Muestran que edad materna (OR=1,06 IC95% 1,02-1,11) y IU previa (OR=15,12; IC95% 8,19-27,92) son las variables que, en conjunto, mejor explican la ocurrencia de IU al inicio del embarazo. La media del escore ICIQ-SF fue 8,2 (d.p.=3,9), considerado como de impacto moderado en la calidad de vida. Conclusión Las embarazadas con más edad y con IU previa tienen chance mayor de presentar IU en el primer trimestre del embarazo. .

Objetivo Analisar a força dos músculos do assoalho pélvico (FMAP), a continência urinária e a qualidade de vida associada à incontinência urinária (IU) em mulheres no primeiro trimestre da gestação. Método Estudo transversal cuja amostra incluiu 500 gestantes que iniciaram o pré-natal em um serviço do setor de saúde suplementar, em Guarulhos, SP, em 2012-2013. A FMAP foi avaliada por meio da perineometria e as gestantes com IU responderam o International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Resultados A idade materna (OR=1,06 IC95% 1,02-1,11) e IU prévia (OR=15,12; IC95% 8,19-27,92) são as variáveis que, em conjunto, melhor explicam a ocorrência de IU no início da gestação. A média do escore do ICQ-SF foi 8,2 (d.p.=3,9), considerado como de impacto moderado na qualidade de vida. Conclusão As gestantes com mais idade e com IU prévia têm maior chance de apresentar IU no primeiro trimestre da gravidez.
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Association between perineal trauma and pain in primiparous women / Associación entre el trauma perineal y dolór em primíparas / Associação entre trauma perineal e dor em primíparas

Objective To identify the association between perineal trauma and pain in 473 primiparous women. Method Cross-sectional study in which pain was measured by the numerical pain scale (0 to 10 - 0 being no pain and 10 maximal pain). Results The prevalence and mean intensity of pain were 33.0% and 4.7 points (standard deviation = 2.0) in the numeric scale, respectively. Episiotomy represented the most frequent trauma (46.7%). The occurrence and intensity of the pain were associated with perineal trauma and postpartum time. Having perineal trauma tripled the chance of pain. Each hour elapsed following the birth reduced the chance of pain by 4.8%. Conclusion Primiparous women are subject to a high frequency of perineal trauma, with episiotomy being the most prominent. Perineal pain affects approximately one-third of primiparous women and is associated with the postpartum time and perineal traumas. .

Objetivo Identificar la asociación entre el trauma y el dolor perineal en 473 primíparas. Método Estudio transversal, en el que el dolor se midió por medio de la escala numérica del dolor (0 a 10; 0 = ningún dolor y 10 = dolor máximo). Resultados La prevalencia y el promedio de intensidad del dolor fueron 33,0% y 4,7 (Desviación Estándar = 2,0) puntos en la escala, respectivamente. La episiotomía fue el trauma más frecuente (46,7%). La ocurrencia y la intensidad del dolor se asociaron con el trauma y el tiempo del postparto. Tener trauma perineal triplica la probabilidad de tener dolor. Cada hora transcurrida después del nacimiento reduce la posibilidad de dolor en 4,8%. Conclusión Las primíparas están sujetas a altas tasas de trauma perineal, especialmente episiotomía. El dolor perineal afecta aproximadamente a un tercio de las primíparas y se asocia con el tiempo de postparto y el traumatismo perineal.

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Objetivo Identificar a associação entre trauma perineal e dor em 473 primíparas. Método Estudo transversal, no qual dor foi mensurada por meio da escala numérica de dor (0 a 10 – sendo 0 ausência de dor e 10 dor máxima). A prevalência e a média de intensidade de dor foram 33,0% e 4,7 (Desvio Padrão = 2,0) pontos na escala numérica, respectivamente. Resultados A episiotomia foi o trauma mais frequente (46,7%). A ocorrência e a intensidade da dor foram associadas ao trauma perineal e ao tempo de pós-parto. Ter trauma perineal triplicou a chance de dor. Cada hora decorrida depois do parto reduziu a chance de dor em 4,8%. Conclusão As primíparas estão sujeitas a elevada frequência de trauma perineal, sobretudo episiotomia. A dor perineal afeta, aproximadamente, um terço das primíparas e está associada ao tempo de pós-parto e aos traumas locais. .