Systematic Review of Oral Therapy for the Treatment of Symptoms of Bladder Pain Syndrome: The Brazilian Guidelines.

Interstitial cystitis (IC), including bladder pain syndrome (BPS), is a chronic and debilitating disease that mainly affects women. It is characterized by pelvic pain associated with urinary urgency, frequency, nocturia and negative urine culture, with normal cytology. In 2009, the Society for Urodynamics and Female Urology (SUFU) defined the term IC/BPS as "an unpleasant sensation (pain, pressure, and discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than 6 weeks duration, in the absence of infection or other identifiable causes." This is the definition used by the American Urological Association (AUA) in the most recent guidelines on IC/BPS. Interstitial cystitis may be sufficiently severe to have a devastating effect on the quality of life, but it may also be associated with moderate symptoms whose effects are less debilitating. Although there are several clinical trials to assess oral and intravesical therapies, the treatment for IC remains far from ideal. This systematic assessment evaluates published randomized clinical trials on oral medications used to treat symptoms of BPS. This study was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method. Two independent reviewers screened the studies to determine their inclusion or exclusion and to perform the methodological analysis. The inclusion criteria included randomized studies published between April of 1988 and April of 2016 that used oral medications to treat symptoms of BPS or IC. According to the systematic review performed, we should consider pentosan polysulfate as one of the best options of oral drugs for the treatment of BPS symptoms. However, this drug is not an available option in Brazil. Orally administered amitriptyline is an efficacious medical treatment for BPS, and it should be the first treatment offered.

Cistite intersticial (IC), incluindo a síndrome da bexiga dolorosa (SBD), é uma doença crônica e debilitante que afeta principalmente mulheres. É caracterizada por dor pélvica associada à urgência miccional, frequência urinária, noctúria e exame cultural de urina negativo, com citologia normal. A cistite intersticial pode ser suficientemente severa para ter um efeito devastador na qualidade de vida, mas também pode estar associada a sintomas moderados e menos debilitantes. Embora existam vários ensaios clínicos para avaliar terapias orais e intravesicais, o tratamento para IC permanece longe do ideal. Esta revisão sistemática avaliou ensaios clínicos randomizados publicados sobre medicamentos orais usados para tratar sintomas de SBD. Este estudo foi realizado de acordo com o método preferred reporting items for systematic reviews and meta-analyses (PRISMA). Dois revisores independentes examinaram os estudos para determinar sua inclusão ou exclusão e para realizar a análise metodológica. Os critérios de inclusão foram: ensaios clínicos randomizados publicados entre abril de 1988 e abril de 2016 que usaram medicações orais no tratamento dos sintomas da SBD ou CI. De acordo com a revisão sistemática realizada, a melhor opção de medicação oral para o tratamento dos SBD é o pentosano polissulfato sódico. No entanto, esta droga não está disponível no Brasil. A amitriptilina administrada por via oral é um tratamento eficaz para SBD e deve ser oferecida como primeira escolha.

Physical activity in climacteric women: comparison between self-reporting and pedometer.

OBJECTIVE: To compare two methods of assessing physical activity in pre-, peri- and postmenopausal women. METHODS: Cross-sectional study nested in a cohort of pre-, peri- and postmenopausal women in a city in Southern Brazil. The participants completed a questionnaire that included sociodemographic and clinical data. Physical activity was assessed using a digital pedometer and the International Physical Activity Questionnaire, short version. The participants were classified into strata of physical activity according to the instrument used. For statistical analysis, the Spearman correlation test, Kappa index, concordance coefficient and Bland-Altman plots were used. RESULTS: The concordance (k = 0110; p = 0.007) and the correlation (rho = 0.136, p = 0.02) between the International Physical Activity Questionnaire, short version, and pedometer were weak. In Bland-Altman plots, it was observed that differences deviate from zero value whether the physical activity is minimal or more intense. Comparing the two methods, the frequency of inactive women is higher when assessed by pedometer than by the International Physical Activity Questionnaire--short version, and the opposite occurs in active women. CONCLUSIONS: Agreement between the methods was weak. Although easy to use, Physical Activity Questionnaire--short version overestimates physical activity compared with assessment by pedometer.

Atividade física de mulheres no climatério: comparação entre auto-relato e pedômetro / Physical activity in climacteric women: comparison between self-reporting and pedometer

OBJETIVO Comparar dois métodos de avaliação de atividade física entre mulheres na pré, transição e pós-menopausa. MÉTODOS Estudo transversal aninhado à coorte de mulheres na pré, peri e pós-menopausa em uma cidade do sul do Brasil. As participantes responderam a um questionário com dados sociodemográficos e clínicos. A atividade física foi avaliada utilizando-se o Questionário Internacional de Atividade Física – versão curta e a contagem do número de passos com o uso de pedômetro. As participantes foram classificadas em estratos de atividade física de acordo com o instrumento utilizado. Para análise estatística foram realizados os testes de correlação de Spearman, índice de Kappa, coeficiente de concordância e análise das medidas contínuas de Bland-Altman. RESULTADOS A concordância (k = 0,110; p = 0,007) e a correlação (rho = 0,136; p = 0,02) entre o Questionário Internacional de Atividade Física – versão curta e o pedômetro foram fracas. No gráfico de Bland-Altman, observou-se que as diferenças se afastam do valor zero tanto quanto a atividade física é mínima ou mais intensa. Comparando-se os dois métodos, a frequência de mulheres inativas é maior quando avaliadas pelo pedômetro do que pelo Questionário Internacional de Atividade Física. O oposto ocorre entre as ativas. CONCLUSÕES A concordância entre os métodos foi fraca. Embora de fácil aplicação, o Questionário Internacional de Atividade Física superestima a atividade física em relação à avaliação por pedômetro. .

OBJECTIVE To compare two methods of assessing physical activity in pre-, peri- and postmenopausal women. METHODS Cross-sectional study nested in a cohort of pre-, peri- and postmenopausal women in a city in Southern Brazil. The participants completed a questionnaire that included sociodemographic and clinical data. Physical activity was assessed using a digital pedometer and the International Physical Activity Questionnaire, short version. The participants were classified into strata of physical activity according to the instrument used. For statistical analysis, the Spearman correlation test, Kappa index, concordance coefficient and Bland-Altman plots were used. RESULTS The concordance (k = 0110; p = 0.007) and the correlation (rho = 0.136, p = 0.02) between the International Physical Activity Questionnaire, short version, and pedometer were weak. In Bland-Altman plots, it was observed that differences deviate from zero value whether the physical activity is minimal or more intense. Comparing the two methods, the frequency of inactive women is higher when assessed by pedometer than by the International Physical Activity Questionnaire - short version, and the opposite occurs in active women. CONCLUSIONS Agreement between the methods was weak. Although easy to use, Physical Activity Questionnaire - short version overestimates physical activity compared with assessment by pedometer. .