Characterization of the Vaginal Microbiome in Women of Reproductive Age From 5 Regions in Brazil.

BACKGROUND: Composition of the vaginal microbiome is strongly related to a woman's reproductive health and risk of sexually transmitted infections. Ethnoracial, behavioral, and environmental factors can influence microbiome. The Brazilian population is unique in terms of miscegenation of ethnic groups and behavioral characteristics across different regions. We aimed to characterize the vaginal microbiome of women from 5 geographical regions of Brazil. METHODS: We sequenced V3-V4 regions of 16S rRNA gene in vaginal samples of 609 reproductive-aged women. We performed logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between sociodemographic and behavioral factors with Lactobacillus-depleted microbiome (community state type [CST] IV). RESULTS: Vaginal samples were grouped into 5 CST: CST I (L. crispatus predominant, 30.5%), CST II (L. gasseri predominant, 4.4%), CST III (Lactobacillus iners predominant, 36.5%), CST IV (Lactobacillus-depleted, 27.4%), and CST V (L. jensenii predominant, 1.2%). Several factors were independently associated with CST IV, such as smoking (OR, 1.80; 95% CI, 1.02-3.18), number of partners (OR, 2.11; 95% CI, 1.20-3.70), and vaginal douching (OR, 2.24; 95% CI, 1.34-3.74). A protective effect was observed for milk/dairy intake (OR, 0.47; 95% CI, 0.27-0.82) and sitz bathing (OR, 0.43; 95% CI, 0.19-0.98). CONCLUSIONS: Nearly two thirds of Brazilian women may be at an increased risk for adverse outcomes associated with a vaginal microbiota characterized by the depletion of Lactobacillus or dominance by L. iners, whose protective role has been widely questioned. Several factors related to sexual behavior and intimate hygiene were associated with CST IV.

Consequences and implications of the coronavirus disease (COVID-19) on pregnancy and newborns: A comprehensive systematic review and meta-analysis.

BACKGROUND: Pregnant patients are potentially vulnerable to COVID-19. OBJECTIVES: To clarify the clinical features of COVID-19 and analyze maternal/fetal morbidity and mortality and the obstetric and neonatal outcomes of pregnant patients. SEARCH STRATEGY: Embase, PubMed, Web of Science, CINAHAL, LILACS, Google Scholar, and Scopus. SELECTION CRITERIA: Articles published from December 2019 to February 2021. DATA COLLECTION AND ANALYSIS: The reviewers extracted relevant data from the full-text. Data synthesis was performed using the R-4.1.0 Project for Statistical Computing for Windows. The meta-analysis of the included studies was carried out using the random-effects model (DerSimonian and Laird). Heterogeneity was measured using I2 analysis. RESULTS: A total of 70 studies included 10 047 pregnant women with COVID-19, of whom 71.6% were in their third trimester. The most common symptoms were fever, cough, chest pain, dyspnea, and fatigue. Most newborns were delivered preterm (24%, 95% confidence interval [CI] 0.17-0.34, I2  = 93%) and via cesarean delivery (42%, 95% CI 0.38-0.47, I2  = 92%). There were 108 maternal mortalities (2%, 95% CI 0.01-0.03, I2  = 54%) and 50 abortions (5%, 95% CI 0.03-0.09, I2  = 73%). The neonatal outcomes included fetal distress (11%, 95% CI 0.06-0.19, I2  = 91%), birth weight (15%, 95% CI 0.10-0.21, I2  = 76%), APGAR <7 (19%, 95% CI 0.12-0.28, I2  = 43%), admission to the neonatal intensive care unit (28%, 95% CI 0.17-0.43, I2  = 90%), and fetal mortality (2%, 95% CI 0.01-0.03, I2  = 46%). CONCLUSION:  There was no evidence of severe acute respiratory syndrome coronavirus-2 in the placenta, breast milk, umbilical cord, and amniotic fluid of pregnant patients. PROSPERO registration number: CRD42020181519.

Effects of high-intensity interval training in combination with detraining on mental health in women with polycystic ovary syndrome: A randomized controlled trial.

This study aimed to investigate the effects of high-intensity interval training (HIIT) and detraining on the quality of life and mental health of 23 women with polycystic ovary syndrome (PCOS). Participants were randomly assigned to the HIIT group (n = 12) [26.0 ± 3.92] and the control group (n = 11) [26.6 ± 4.68]. HIIT sessions comprised 40-60 min, 3 days a week for 12 weeks, followed by detraining for 30 days. We assessed the quality of life using the Short Form Health Survey (SF-36) and mental health by the Depression, Anxiety, and Stress Scale (DASS-21), and we compared group changes on these variables at three time points: 1) at baseline, 2) after 12 weeks of HIIT (or no training), and 3) after 30 days of detraining (or no training). The participants were classified as overweight and had a high percentage of body fat (41.5%) and irregular menstrual cycles (amenorrhea) (66.7%). Throughout training, participants in the HIIT group reported improvements in domains of the quality of life: functional capacity (M = 80.4 ± 3.4 vs. M = 87.0 ± 3.1), physical role functioning (M = 72.5 ± 9.4 vs. M = 81.8 ± 9.7), and general health perception (M = 48.6 ± 4.6 vs. M = 69.0 ± 5.8). Regarding anxiety symptoms (M = 6.4 ± 1.6 vs. M = 3.7 ± 0.7) and depression symptoms (M = 6.7 ± 1.6 vs. M = 3.8 ± 0.9), those reduced significantly after HIIT. After a 30-day detraining period, there was an increase in the significant change in the quality of life; however, domains of mental health showed instability. In summary, the HIIT program promoted improvements in the quality of life and mental health in women with PCOS. The 30 days of detraining changed the benefits in the quality of life and stability in the changes in mental health domains.

Association between genital intraepithelial lesions and anal squamous intraepithelial lesions in HIV-negative women.

OBJECTIVE: The objective of the study was to evaluate the risk of anal squamous intraepithelial lesions (ASILs) in immunocompetent women with genital squamous intraepithelial lesions (GSILs). STUDY DESIGN: This was a cross-sectional study that included 260 immunocompetent women divided into 2 study groups: 1 group included 184 women diagnosed with GSIL by genital colposcopy and biopsy, and the other included 76 controls. All subjects were submitted to anoscopy followed by a biopsy if pertinent. RESULTS: Of 184 GSIL women, 32 (17.4%) had ASIL (P<.001). The risk of ASIL was 13.1 times greater for GSIL women when there were 3 or 4 genital sites involved. All cases of high-grade ASIL were found in women with cervical GSILs. Among risk factors, anal intercourse without a condom demonstrated an important association with ASIL (prevalence ratio adjusted for age=2.6). CONCLUSION: There seems to be a strong association between ASIL and multicentric GSIL. Another factor related to ASIL was the practice of unprotected anal intercourse.

Physical methods for the treatment of genitourinary syndrome of menopause: A systematic review.

BACKGROUND: Genitourinary syndrome of menopause (GSM) negatively affects sexual function and quality of life. Techniques like laser and radiofrequency are being used to manage GSM, particularly in women with contraindications for hormone therapy. OBJECTIVES: To verify whether the physical methods of laser and radiofrequency can be recommended as safe and effective options for the treatment of GSM/urinary urgency or incontinence in pre- and postmenopausal women. SEARCH STRATEGY: Databases were comprehensively searched using combinations of the following keywords in any language: "postmenopause"; "genitourinary syndrome of menopause"; "vaginal atrophy"; "radiofrequency"; and "laser." SELECTION CRITERIA: Full articles of case-control, cross-sectional, cohort, randomized clinical trials, and quasi-randomized or controlled clinical trials were included. DATA COLLECTION AND ANALYSIS: All authors independently evaluated the design of the studies for quality of reporting, risk of bias, and quality of evidence. MAIN RESULTS: Of the included 49 studies, 37 were on the CO2 laser, 10 on the Erbium laser, and two on radiofrequency. CONCLUSIONS: Laser and radiofrequency therapy could be promising and safe therapeutic options for GSM/urinary incontinence. However, the study findings cannot be generalized until new randomized clinical trials are performed that confirm the strength of the evidence. This review has been registered with PROSPERO: CRD42020141913.

Prevalence of high-risk HPV and atypia in liquid-based cytology of cervical and intra-anal specimens from kidney-transplanted women.

BACKGROUND: There is a high frequency of human papillomavirus (HPV)-induced lesions in cervix and anus of immunosuppressed patients. However, few studies have evaluated these lesions in kidney-transplanted women. METHODS: This cross-sectional study examined 31 kidney-transplanted women receiving immunosuppressive therapy at the General Hospital of Fortaleza in Brazil. Cervical and anal samples were collected and preserved in order to perform liquid-based cytology and a real-time polymerase chain reaction assay detecting high-risk HPV. RESULTS: The patients' ages ranged from 31 to 70 years (mean: 42.6 ± 10.4). The age of sexual debut varied from 14 to 30 years (mean: 19.7 ± 3.8). Cervical cytology was diagnosed as atypical in 25.8% of cases (atypical squamous cells of undetermined significance [ASC-US] in 2 [6.2%], atypical squamous cells, but unable to exclude a high-grade squamous intraepithelial lesion in 1 [3.1%], low-grade squamous intraepithelial lesion [LSIL] in 4 [12.4%], and squamous cell carcinoma in 1 [3.1%]). Anal cytology was atypical in 35.4% of cases (ASC-US in 1 [3.2%] and LSIL in 7 [21.7%]). The presence of cervical HPV was confirmed in 22.5% of patients, and anal HPV was found in 48.8% of the cases. The relative risk of atypical anal cytology in cases of atypical cervical cytology was 4.37 (1.35-14.20). High-risk cervical HPV did not significantly increase the risk of having atypical anal cytology. However, for HPV in the anus, this was associated with a relative risk of 10.18 (1.45-71.54). CONCLUSION: High-risk HPV and atypical cytology are very common in the cervix and anus of kidney-transplanted women. Furthermore, the presence of HPV in an anal sample correlates with an increased risk of atypical anal cytology. HPV tests could be useful tools for identifying patients who require anal cytology.

Role of breast vascular calcification in predicting cardiovascular risk.

We identified a positive association between presence of breast vascular calcification and high coronary calcium score, and thus with high cardiovascular risk.

Treatment of bacterial vaginosis before 28 weeks of pregnancy to reduce the incidence of preterm labor.

BACKGROUND: Controversy exists regarding the benefits of treating bacterial vaginosis (BV) during pregnancy to reduce the incidence of preterm labor (PTL). OBJECTIVES: To evaluate whether treatment of BV with vaginal clindamycin or oral metronidazole before 28 weeks of pregnancy reduces PTL incidence. SEARCH STRATEGY: PubMed, Scopus, Web of Science, Science Direct, CENTRAL, and SciELO databases were searched until December 30, 2017. Search terms included "bacterial vaginosis" and "preterm labor." No language restrictions were applied. SELECTION CRITERIA: Randomized clinical trials that evaluated treatment of BV with clindamycin or metronidazole to reduce PTL incidence. DATA COLLECTION AND ANALYSIS: The risk of PTL was evaluated by the odds ratio (OR) and 95% confidence interval (CI). Dichotomous data from each study were combined for meta-analysis using the Mantel-Haenszel model. MAIN RESULTS: Nine reports were included in the systematic review, with eight reports included in the meta-analysis. No reduction in the incidence of PTL was found for either metronidazole (OR 0.94, 95% CI 0.71-1.25) or clindamycin (OR 1.01, 95% CI 0.75-1.36). CONCLUSIONS: Use of oral metronidazole or vaginal clindamycin to treat BV before 28 weeks of pregnancy did not reduce the incidence of PTL. PROSPERO registration: CRD42018086173.

Assessment of mobile phone applications for care management in gynecology and obstetrics.

We identified mobile applications (apps) found on digital platforms (iTunes Store and Google Play) that addressed topics about gynecology and obstetrics.

Human papillomavirus in the oral mucosa of women with genital human papillomavirus lesions.

OBJECTIVES: Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases worldwide. We determined the frequency of HPV in the oral cavity of women with and without genital HPV lesions. MATERIAL AND METHODS: All patients were seen at the Department of Gynecology, Women's Health Center and the State University of Campinas, Sao Paulo, Brazil and submitted to a general physical and gynecological examination plus an evaluation of the oral cavity. Detailed histories investigated their sexual practices. HPV in the oral cavity was determined by polymerase chain reaction using consensus primers in 70 women presenting with histopathology-confirmed clinical HPV lesions in the genital region and 70 women negative by gynecological, colposcopic and cytological examination for clinical or subclinical HPV lesions. RESULTS: Oral HPV was detected in 29 (20.7%) of the subjects. Among the positive women, 26 (89.7%) were also positive for genital HPV as opposed to only 3 (2.7%) who were genital HPV-negative (p < 0.0001). The overall prevalence of HPV in the oral cavity of patients with and without genital HPV was 37.1 and 4.3%, respectively, (p < 0.0001). The presence of oral HPV was unrelated to the practice of fellatio (22% versus 19%). CONCLUSION: Patients with HPV genital infection have a greater frequency of HPV in their oral mucosa.

Determinants of sexual dysfunction among middle-aged women.

OBJECTIVE: To assess the determinants of sexual dysfunction among middle-aged women. METHODS: In a cross-sectional, questionnaire-based study of middle-aged women (aged 40-65 years) attending a public healthcare facility in Natal, Brazil, data on sociodemographic, clinical, and behavioral characteristics were collected between May and October 2011. The Female Sexual Function Index (FSFI), Blatt-Kupperman Menopausal Index (BKMI), International Physical Activity Questionnaire (IPAQ), and WHO quality of life questionnaire (WHOQOL-Bref) were used to collect data, which were analyzed by relative frequency and percentage of variables, followed by Pearson χ(2) test and logistic regression analysis. RESULTS: Among 370 study participants, 67% exhibited sexual dysfunction (FSFI ≤ 26.55). Women who were in the oldest age group (56-65 years) (P<0.001), were divorced or separated (P<0.001), were sedentary (P=0.006), had undergone a hysterectomy (P=0.016), had strong climacteric symptoms (P<0.001), or had low quality of life (P<0.001) had a significantly higher incidence of sexual dysfunction. Logistic regression showed that the eldest group of women (55-65 years) (95% CI, 3.4-15.7; P<0.001), with the strongest climacteric manifestations (95% CI, 3.4-15.7; P<0.001) and lowest quality of life (95% CI, 3.2-13.8; P<0.001), were most likely to develop sexual dysfunction. CONCLUSION: Sexual dysfunction was found to be substantially influenced by sociodemographic, biologic, and behavioral variables.

The effect of "breathable" panty liners on the female lower genital tract.

OBJECTIVE: To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation. METHODS: A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears. RESULTS: After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period. CONCLUSION: After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation.

Marcadores imunoistoquímicos de lesões precursoras do câncer do colo uterino associadas ao HPV: o papel da proteína de supressão tumoral p16ink4a / Immunohistochemistry markers for lesions preceding HPV-induced cervical cancer: the role of tumoral suppression p16ink4a protein

A relação entre o HPV e as lesões intra-epiteliais escamosas cervicais está bem estabelecida. O mecanismo de ação que o vírus parece utilizar para causar a transformação está associado a dois genes do HPV, E6 e E7. O gene E7 tem um papel importante induzindo alterações na célula hospedeira associadas à proteína do retinoblastoma (pRb ) e o fator de transcrição E2F. Quando o fenômeno induzido pelo E7 do HPV ocorre, há expressão da proteína p16INK4a que pode ser detectada por imunoistoquímica. Recentes trabalhos mostram a importância do uso de p16INK4a como marcador de transformação celular induzida pelo HPV e a sua utilidade clínica na prática, principalmente ajudando no diagnóstico de lesões intra-epiteliais escamosas de alto grau em biópsias. Esta revisão pretende fornecer ao leitor uma idéia atualizada de como alguns marcadores celulares podem contribuir para o diagnóstico e o prognóstico das neoplasias intra-epiteliais cervicais.

The HPV and cervical squamous intra-epithelial neoplasia relation is established. The mechanisms used by the virus which causes the transformation of the squamous intra-epithelial are associated to the E6 and E7 HPV genes The E7 gene has an important role inducing the host cell changes which are related to the retinoblastoma protein and E2F transcription factor. When the phenomenon induced by the E7 occurs, there is the expression of the p16INK4a protein which can be detected by immunohistochemistry. Recent studies have shown the importance of the use of the p16INK4a as a marker for cellular transformation induced by HPV and its clinical use in practice, mainly helping in the diagnosis of high grade squamous intra-epithelial lesions in biopsies. This revision intends to provide to the reader an update to the understanding of how cellular markers can contribute to improve the differential diagnosis of the squamous intra-epithelial neoplasia and its prognosis.

A resposta imune-celular da mucosa vaginal às vulvovaginites / The cellular immune response from vaginal mucosa in the vulvovaginitis

Nos últimos anos, após a epidemia de aids (síndrome da imunodeficiência adquirida), o estudo dos mecanismos de defesa vaginal têm se revestido de especial importância para a compreensão da fisiopatogênese das infecções genitais femininas. A resposta imune celular é talvez um dos principais mecanismos de proteção da mucosa vaginal mediante desenvolvimento de resposta imune local. Na placa basal do epitélio vaginal existem células de defesa (macrófagos, linfócitos, plasmócitos, células de Langerhans, eosinófilos e mastócitos) prontas para atuar. Os linfócitos são as principais células de defesa que migram pelos canais intercelulares, precedidos pelas células de Langerhans e pelos macrófagos para erradicar o microorganismo invasor. As células de defesa controlam o crescimento bacteriano e fúngico, mediante ativação de mecanismos de fagocitose. Havendo falha da imunidade celular, com a exposição da mucosa vaginal aos antígenos, pode ocorrer o desenvolvimento de infecções vaginais. Os autores revisam o tema enfatizando a importância da resposta imune adequada na manutenção do equilíbrio vaginal.

After the aids (acquired immunodeficiency syndrome) epidemic, the mechanisms of vaginal defense have been coated with special importance in the study of the genital feminine infections. The cellular immune response is perhaps one of the main protection mechanisms of the vaginal mucosa by means development of local immune response. There are many different defense cells (macrophages, lymphocytes, Langerhans cells, eosinophils and mastocytes) in the vaginal epithelium ready to be elicited. The lymphocytes are the main defense cells; they come from the basal plaque crossing the intercellular canals, preceded only by Langerhans cells and macrophages, in order to eradicate the invasive microorganisms. The defense cells control the bacterial and fungi growth, by means of phagocytosis activation. If the cellular immune response fails, vaginal infections can occur. The authors revise the theme emphasizing the importance of the adequate immune response in the vaginal equilibrium.

Fatores associados à infecçäo clínica e subclínica do trato genital feminino pelo papilomavírus humano / Associated factors in clinical and subclinical female papilomavirus infection

Os principais fatores que induzem as manifestaçöes clínicas e subclínicas da infecçäo pelo HPV ainda näo estäo definidos. Este estudo objetiva identificar os possíveis fatores sociodemográficos que poderiam estar associados às manifestaçöes clínicas e subclínicas da infecçäo pelo HPV