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1.
J Low Genit Tract Dis ; 27(2): 173-179, 2023 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36951987

RESUMO

OBJECTIVE: Vulvodynia (VVD) is a frequent and harrowing condition for which diagnosis and management remain insufficient. Our study aimed to describe and compare vulvovaginal signs and symptoms of Brazilian women with VVD and controls and describe previous medical assessment, past treatments, and vulvar pain relief among women with VVD. METHODS: This cross-sectional descriptive study included Brazilian women with (n = 151) and without VVD (n = 106). All women were assessed for vaginal infection, vulvar pain intensity by means of a cotton swab test based on a numerical rate scale, and answered the Female Sexual Function Index questionnaire and a structured instrument about current vulvar symptoms. Previous treatments were assessed in the VVD group, and vulvar pain relief achieved with previous treatments was qualified through a 4-point Likert scale. RESULTS: Volunteers were mainly White, with mean age of 30 years. Vulvovaginal signs and symptoms were significantly more frequent in women with VVD (p < .05), and vulvar pain duration was 5.8 (±4) years. More than 50% consulted with three or more physicians, and 49% remained without a conclusive diagnosis. Previous diagnosis and treatment of vulvovaginal infection were often reported by women with VVD. Most of the tried prescriptions were self-reported as providing only low vulvar pain relief. CONCLUSIONS: Prolonged duration of vulvar pain, multiple visits to health care professionals, and poor relief of pain are common aspects in the clinical history of women with VVD. In addition to pain, vulvar fissure, edema, erythema, vaginal discharge, and foul odor are common and should be considered to avoid misdiagnosis. Appropriate treatments to VVD are still poorly reported.


Assuntos
Vulvodinia , Adulto , Feminino , Humanos , Brasil , Estudos Transversais , Dor , Manejo da Dor , Vulvodinia/diagnóstico , Vulvodinia/terapia
2.
Sex Transm Dis ; 47(8): 562-569, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32520883

RESUMO

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.


Assuntos
Lactobacillus , Microbiota , Adulto , Brasil , Feminino , Humanos , Lactobacillus/genética , Microbiota/genética , RNA Ribossômico 16S/genética , Vagina
3.
J Low Genit Tract Dis ; 18(3): 261-5, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24633167

RESUMO

OBJECTIVE: The purpose of this study was to assess the cervicovaginal levels of proinflammatory cytokines in women with Chlamydia trachomatis (CT) infection in the presence of bacterial vaginosis (BV) and normal flora and to compare with those negative for CT. MATERIALS AND METHODS: In this cross-sectional study, nonpregnant women were enrolled at 2 outpatient clinics and at 1 primary medical care unit in São Paulo State, Brazil. Cervicovaginal samples from 256 women with BV, of which 68 (26.6%) had concomitant CT infection and 188 (73.4%) were CT-negative, were measured for interleukin-1ß (IL-1ß), IL-6, and IL-8 by enzyme-linked immunosorbent assay. A matching number of samples from women with normal flora, CT-positive (n = 68) and negative (n = 188), were evaluated as control. Cytokine levels were compared by Mann-Whitney test and differences were considered significant at p < .05. RESULTS: In CT-negative women, IL-1ß was increased in BV (p < .001) when compared to normal flora, while the levels of IL-6 and IL8 were unchanged. The presence of CT infection was not associated with differences on cytokine levels in women with normal flora. However, women with BV had higher levels of IL-1ß (p = .02), IL-6 (p = .02), and IL-8 (p = .03) in the presence of CT when compared to those who tested negative for CT. CONCLUSIONS: Detection of endocervical CT is associated with increased cervicovaginal IL-1ß, IL-6, and IL-8 levels in women with concomitant BV but not in those with normal flora.


Assuntos
Líquidos Corporais/química , Infecções por Chlamydia/diagnóstico , Interleucina-1beta/análise , Interleucina-6/análise , Interleucina-8/análise , Vagina/patologia , Vaginose Bacteriana/diagnóstico , Adolescente , Adulto , Brasil , Infecções por Chlamydia/patologia , Chlamydia trachomatis/crescimento & desenvolvimento , Chlamydia trachomatis/isolamento & purificação , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Lactobacillus/crescimento & desenvolvimento , Lactobacillus/isolamento & purificação , Pessoa de Meia-Idade , Vaginose Bacteriana/patologia , Adulto Jovem
4.
Sex Transm Infect ; 89(2): 167-73, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23076402

RESUMO

OBJECTIVES: To investigate if the participation of Atopobium vaginae, Megasphaera sp. and Leptotrichia sp. in the bacterial community of bacterial vaginosis (BV) is associated with distinct patterns of this condition. METHODS: In this cross-sectional controlled study, 205 women with BV and 205 women with normal flora were included. Vaginal rinsing samples were obtained for measuring the levels of pro-inflammatory cytokines and bacterial sialidases. Real-time PCR was used to quantify the BV-associated bacteria and to estimate the total bacterial load using the 16S rRNA. Principal component analysis (PCA) using the measured parameters was performed to compare the BV samples with lower and higher loads of the species of interest. RESULTS: Higher bacterial load (p<0.001), levels of interleukin 1-ß (p<0.001) and sialidase activity (p<0.001) were associated with BV. Women with BV and higher relative loads of A vaginae, Megasphaera sp. and Leptotrichia sp. presented increased sialidase activity, but unchanged cytokine levels. PCA analysis did not indicate a different pattern of BV according to the loads of A vaginae, Megasphaera sp. and Leptotrichia sp. CONCLUSIONS: Greater participation of A vaginae, Megasphaera sp. and Leptotrichia sp. in vaginal bacterial community did not indicate a less severe form of BV; moreover, it was associated with increased sialidase activity.


Assuntos
Actinobacteria/imunologia , Imunidade Inata , Leptotrichia/imunologia , Megasphaera/imunologia , Neuraminidase/metabolismo , Vaginose Bacteriana/imunologia , Adolescente , Adulto , Carga Bacteriana , Biota , Estudos Transversais , Citocinas/análise , Citocinas/imunologia , Feminino , Humanos , Pessoa de Meia-Idade , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Reação em Cadeia da Polimerase em Tempo Real , Ducha Vaginal , Adulto Jovem
5.
Am J Obstet Gynecol ; 204(2): 120.e1-5, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20832044

RESUMO

Ever since the pH of the vagina was found to be much more acidic than blood and interstitial fluids, a belief going back more than a century has persisted that the vagina is protected from pathogenic organisms by the high level of hydronium ions present. A corollary of this belief is that the pH of the vagina and antipathogen activity is due to colonizing Lactobacilli. Unfortunately, this dogma lacks empirical research support. The vaginal pH is determined by the interplay between vaginal physiological processes and microbiology. An acidic vaginal pH and Lactobacilli are components of multiple defense mechanisms active in protection against infection in the lower female genital tract.


Assuntos
Lactobacillus/fisiologia , Vagina/microbiologia , Epitélio/microbiologia , Epitélio/fisiologia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Vagina/fisiologia
6.
Am J Obstet Gynecol ; 205(2): 115.e1-5, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21684518

RESUMO

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.


Assuntos
Neoplasias do Ânus/epidemiologia , Carcinoma in Situ/epidemiologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias dos Genitais Femininos/epidemiologia , Soronegatividade para HIV , Adolescente , Adulto , Distribuição por Idade , Neoplasias do Ânus/patologia , Biópsia por Agulha , Brasil/epidemiologia , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Colposcopia/métodos , Comorbidade , Intervalos de Confiança , Estudos Transversais , Feminino , Seguimentos , Neoplasias dos Genitais Femininos/patologia , Humanos , Imunocompetência , Incidência , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Proctoscopia/métodos , Medição de Risco , Comportamento Sexual , Fatores Socioeconômicos , Adulto Jovem
7.
Am J Obstet Gynecol ; 201(2): 206.e1-5, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19646572

RESUMO

OBJECTIVE: We evaluated whether vaginal concentrations of hyaluronan were altered in women with recurrent vulvovaginal candidiasis (RVVC). STUDY DESIGN: Lavage samples from 17 women with acute RVVC, 27 women who were receiving a maintenance antifungal regimen, and 24 control women were tested for hyaluronan and interleukin (IL)-6, IL-12, and IL-23 by enzyme-linked immunosorbent assay. RESULTS: Median vaginal hyaluronan concentrations were 33.8 ng/mL (range, 21.6-66.3 ng/mL) in women with acute RVVC, 15.0 ng/mL (range, 11.2-50.6 ng/mL) in women who were receiving maintenance therapy, and 4.2 ng/mL (range, 3.6-12.0 ng/mL) in control subjects (P

Assuntos
Líquidos Corporais/metabolismo , Candidíase Vulvovaginal/imunologia , Candidíase Vulvovaginal/metabolismo , Ácido Hialurônico/metabolismo , Vagina/metabolismo , Adulto , Antifúngicos/uso terapêutico , Líquidos Corporais/imunologia , Candidíase Vulvovaginal/tratamento farmacológico , Feminino , Humanos , Interleucina-12/metabolismo , Interleucina-23/metabolismo , Interleucina-6/metabolismo , Pessoa de Meia-Idade , Recidiva , Irrigação Terapêutica , Vagina/imunologia
8.
Diagn Cytopathol ; 47(8): 783-787, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30897299

RESUMO

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.


Assuntos
Canal Anal/patologia , Canal Anal/virologia , Colo do Útero/patologia , Colo do Útero/virologia , Transplante de Rim/efeitos adversos , Biópsia Líquida/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
9.
Clinics (Sao Paulo) ; 74: e934, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31508721

RESUMO

OBJECTIVE: To identify the factors associated with the prescription of vaginal pessaries (VPs) as a conservative treatment for pelvic organ prolapse (POP). METHODS: A cross-sectional study was performed during two annual urogynecology and general obstetrics and gynecology meetings in 2017 (São Paulo, SP, Brazil). A 19-item deidentified questionnaire regarding experiences and practices in prescribing VPs for POP patients was distributed among gynecologists. Our primary outcome was the frequency of prescribing VPs as a conservative treatment for POP. The reasons for prescribing or not prescribing VPs were also investigated. Univariate and multivariate analyses with crude and adjusted odds ratios (ORs) were performed for variables associated with the prescription of pessaries. RESULTS: Three hundred forty completed surveys were analyzed. Half of the respondents (53.53%) were between 30-49 years old; most of them were female (73.53%), were from the Southeast Region (64.12%), were trained in obstetrics and gynecology (80.24%) or urogynecology (61.18%) and worked in private offices (63.42%). More than one-third (36.48%) attended four or more POP cases/week, and 97.65% (n=332) had heard or knew about VPs for POP; however, only 47.06% (n=160) prescribed or offered this treatment to patients. According to the multivariate analysis, physicians aged 18-35 years (OR=1.97[1.00-3.91]; p=0.04), those who participated in a previous urogynecology fellowship (OR=2.34[1.34-4.09]; p<0.01), those with relatively high volumes of POP cases (4 or +) (OR=2.23[1.21-4.47]; p=0.01) and those with PhD degrees (OR=2.75[1.01-7.54]; p=0.05) prescribed more pessaries. CONCLUSIONS: Most gynecologists did not prescribe VPs. Younger physician age, participation in a previous urogynecology fellowship, a PhD degree, and a relatively high volume of POP cases were associated with increased VP prescription rates.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Prolapso de Órgão Pélvico/terapia , Pessários , Adolescente , Adulto , Fatores Etários , Brasil , Estudos Transversais , Feminino , Ginecologia , Humanos , Masculino , Pessoa de Meia-Idade , Prescrições , Inquéritos e Questionários , Vagina , Adulto Jovem
10.
Eur J Obstet Gynecol Reprod Biol ; 137(1): 88-91, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17485158

RESUMO

OBJECTIVES: The objectives were to assess the prevalence of high-risk HPV in the male sexual partners of women with HPV-induced lesions, and correlate it with biopsies guided by peniscopy. STUDY DESIGN: Fifty-four asymptomatic male sexual partners of women with low-grade squamous intra-epithelial lesions (LSIL) associated with high-risk HPV were examined between April 2003 and June 2005. The DNA-HPV was tested using a second-generation hybrid capture technique in scraped penile samples. Peniscopy identified acetowhite lesions leading to biopsy. RESULTS: High-risk HPV was present in 25.9% (14 out of 54) of the cases. Peniscopy led to 13 biopsies (24.07%), which resulted in two cases of condyloma, two cases of intra-epithelial neoplasia (PIN) I, one case of PIN II, and eight cases of normal tissue. The high-risk HPV test demonstrated 80% sensitivity, 100% specificity, 100% positive predictive value, and 88.9% negative predictive value for the identification of penile lesions. There was a greater chance of finding HPV lesions in the biopsy in the positive cases of high-risk HPV with abnormal peniscopy (p=0.007); OR=51 (CI 1.7-1527.1). CONCLUSION: Among asymptomatic male sexual partners of women with low-grade intra-epithelial squamous lesions, those infected by high-risk HPV have a higher chance of having abnormal penile tissue compared with male partners without that infection.


Assuntos
DNA Viral/genética , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/diagnóstico , Doenças do Pênis/virologia , Pênis/virologia , Parceiros Sexuais , Adolescente , Adulto , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/patologia , Carcinoma in Situ/virologia , Estudos Transversais , Testes Diagnósticos de Rotina/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/transmissão , Doenças do Pênis/diagnóstico , Doenças do Pênis/patologia , Neoplasias Penianas/diagnóstico , Neoplasias Penianas/patologia , Neoplasias Penianas/virologia , Pênis/patologia , Prevalência , Sensibilidade e Especificidade , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia
12.
Obstet Gynecol ; 109(5): 1123-8, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17470593

RESUMO

OBJECTIVE: To evaluate associations between polymorphisms in the gene coding for mannose-binding lectin (MBL) and the diagnosis of acute or recurrent vulvovaginal candidiasis and bacterial vaginosis METHODS: Women at two outpatient clinics in Brazil filled out a questionnaire and were examined for the presence of vulvovaginal candidiasis or bacterial vaginosis. A buccal swab was blindly tested for codons 54 and 57 MBL2 gene polymorphisms by polymerase chain reaction and endonuclease digestion. RESULTS: A total of 177 women were enrolled. Vulvovaginal candidiasis was identified in 78 (44.1%) women, 33 (18.6%) had bacterial vaginosis, and 66 (37.3%) were normal controls. Recurrent vulvovaginal candidiasis was present in 50 (64.1%) of the women with vulvovaginal candidiasis; 20 (60.6%) of the bacterial vaginosis patients had recurrent disease. Vulvovaginal candidiasis was associated with white race (P=.007), bacterial vaginosis was associated with nonwhite race (P=.05), and both were associated with a history of allergy (P< or =.02) and having sexual intercourse at least three times a week (P<.001). Carriage of the variant MBL2 codon 54 allele B was more frequent in women with recurrent vulvovaginal candidiasis (25.0%) than in the women with acute vulvovaginal candidiasis (17.9%) or controls (10.6%) (P=.004). Allele B was also more prevalent in women with recurrent bacterial vaginosis (22.5%) than in those with acute bacterial vaginosis (0%) (P=.009). The MBL2 codon 57 polymorphism was infrequent and not associated with vulvovaginal candidiasis or bacterial vaginosis. CONCLUSION: The incidence of vulvovaginal candidiasis and bacterial vaginosis differs by ethnicity in Brazilian women. The MBL2 codon 54 gene polymorphism is associated with both recurrent vulvovaginal candidiasis and recurrent bacterial vaginosis.


Assuntos
Candidíase Vulvovaginal/genética , Lectina de Ligação a Manose/genética , Polimorfismo de Nucleotídeo Único/genética , Vaginose Bacteriana/genética , Doença Aguda , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Candidíase Vulvovaginal/etnologia , Candidíase Vulvovaginal/imunologia , Estudos Transversais , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Lectina de Ligação a Manose/sangue , Pessoa de Meia-Idade , Vaginose Bacteriana/etnologia , Vaginose Bacteriana/imunologia
13.
Int J STD AIDS ; 18(11): 770-3, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18005512

RESUMO

To determine the frequency of abnormal vaginal flora and bacterial vaginosis (BV) in female sex workers (FSW) and the association between douching and vaginal microflora imbalance, a cross-sectional study enrolled 94 users and 61 non-users of vaginal douching. The social-demographic and sexual profile of these women was obtained and their abnormal vaginal flora, BV, vaginal candidiasis, trichomoniasis and cytolitic vaginosis on blinded samples were identified by Gram stain. A stepwise multivariate regression determined the risk of development of vaginal microflora imbalance. Prevalence of abnormal flora, BV, candidiasis, trichomoniasis and cytolytic vaginosis in the entire FSW was 75.5%, 51.0%, 5.1%, 0.64% and 1.9%, respectively. There were no significant differences in these findings between users and non-users of vaginal douching. Regression analysis did not identify any increased risk for altered vaginal flora or BV in vaginal douche users. In conclusion, vaginal douching did not increase the rate of these alterations in FSW.


Assuntos
Candidíase Vulvovaginal/epidemiologia , Vaginite por Trichomonas/epidemiologia , Vagina/microbiologia , Ducha Vaginal , Vaginose Bacteriana/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Análise Multivariada , Prevalência , Análise de Regressão , Fatores de Risco , Trabalho Sexual , Comportamento Sexual , Fatores Socioeconômicos
14.
Braz J Infect Dis ; 11(2): 249-53, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17625772

RESUMO

Diagnosis of vaginal discharge is frequently performed in an empirical way, leading to inadequate treatment. This study tested the accuracy of a self-collection kit for microbiological study of the vaginal content. One hundred and forty-two women of Family Health Program units in Niterói and Piraí cities were enrolled in order to have their vaginal content studied. A brief explanation and a self-collection kit were provided in order to sample the vaginal content. The self-collection kit was composed of one empty plastic tube, two glass slides, a long handle cytobrush, an identification card and guideline notes. The vaginal sample was applied on the glass slides by the women and stained by Gram technique. A second sampling was done by the medical personnel. The microbiological diagnosis in a blinded analysis was made under optical microscopy. A validation diagnosis test was done taking the medical collection results as a gold standard. A total of 106 women had followed the protocol and were included in the study. Microbiological analysis was unsatisfactory in 12 cases (6 cases of self-collection material and 6 cases of medical collection). The microbiological analyses in the self-collection and in the medical collection material were respectively: bacterial vaginosis in 21.7% and 17.9%, non bacillar flora in 10.3% and 11.3%, vaginal trichomoniasis in 5.66% and 5.6%, candidiasis in 3.78% and 2.8% and a normal microbiota in 52.8% and 56.6%. The Kappa coefficient suggested a "very good correlation" of the microbiological results between the two methods of collection (K=0.7945). The self-collection kit provides samples for microbiological analysis of the vaginal microbiota as good as medical collection.


Assuntos
Autocuidado/instrumentação , Esfregaço Vaginal/instrumentação , Vaginite/diagnóstico , Adulto , Feminino , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Autocuidado/métodos , Sensibilidade e Especificidade , Esfregaço Vaginal/métodos , Vaginite/microbiologia
15.
Braz J Infect Dis ; 10(4): 232-4, 2006 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-17293901

RESUMO

The genital mechanisms of defense are not well understood and are therefore ignored during therapy. This fact results in a great number of cases of treatment failure. The mucosa is an important protective factor of the genital female system, through self-defense mechanisms, and secretor antibodies (immunoglobulin A). The lymphoid tissue exerts protective anti-inflammatory activity, besides inhibiting microorganism adherence, neutralizes viruses and toxins and stabilizes the mucosal flora. Although certain microorganisms, such as viruses and fungus, are controlled by cellular immunity, secretory IgA can also exert an important role in the control of these agents.


Assuntos
Imunoglobulina A Secretora/imunologia , Infecções Sexualmente Transmissíveis/imunologia , Vagina/imunologia , Feminino , Humanos , Imunidade nas Mucosas/imunologia , Mucosa
16.
Am J Reprod Immunol ; 75(2): 126-33, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26773532

RESUMO

PROBLEM: A wide variety of mediators are involved in inflammatory processes. However, the identity of those participating in vaginal immune responses has not been established. We correlated extracellular matrix metalloproteinase inducer (EMMPRIN), matrix metalloproteinase-8 (MMP-8), hyaluronan (HA), hyaluronidase-1 (Hyal-1), human ß-defensin-2 (hBD2), and neutrophil gelatinase-associated lipocalin (NGAL) concentrations with the extent of leukocyte infiltration into the vagina and suggest their participation in vaginal inflammation. METHODS OF STUDY: Vaginal fluid was obtained from 233 women seen at the outpatient clinic in the Department of Obstetrics and Gynecology at Campinas University, Brazil. The magnitude of vaginal inflammation was determined by the leukocyte count on vaginal smears and categorized as no inflammation (0 leukocytes/field), moderate inflammation (1-4 leukocytes/field), and intense inflammation (>4 leukocytes/field). Concentrations of EMMPRIN, MMP-8, HA, Hyal-1, hBD2, and NGAL were determined in vaginal fluid by ELISA. RESULTS: EMMPRIN, MMP-8, HA, hBD2, and NGAL concentration increased with elevated leukocyte numbers (P < 0.05), while Hyal-1 did not. EMMPRIN concentrations were correlated with HA and MMP-8 levels. CONCLUSION: EMMPRIN, MMP-8, HA, ß-defensin, and NGAL are elevated in women with vaginal inflammation.


Assuntos
Proteínas de Fase Aguda/imunologia , Basigina/imunologia , Ácido Hialurônico/imunologia , Lipocalinas/imunologia , Metaloproteinase 8 da Matriz/imunologia , Proteínas Proto-Oncogênicas/imunologia , Vaginite/imunologia , beta-Defensinas/imunologia , Adulto , Feminino , Humanos , Hialuronoglucosaminidase/imunologia , Leucócitos/imunologia , Lipocalina-2 , Adulto Jovem
17.
Braz J Infect Dis ; 9(5): 357-62, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16410886

RESUMO

OBJECTIVE: To determine and to compare the levels of secretory immunoglobulin A in samples of colostrum and milk of mothers of term and preterm neonates. MATERIAL AND METHODS: The levels of secretory immunoglobulin A of 10 mothers of term neonates and 10 mothers of preterm neonates were determined from 5 mL of colostrum or milk collected on the 1st, 4th, 10th and 15th days of the puerperal period, using the radial immunodiffusion technique. We employed anamnesis, as well as physical and gynecological exams in women in the puerperal period. All the patients were attended at the Januário Cicco Maternity College. RESULTS: The secretory immunoglobulin A levels were significantly higher in the colostrum and milk of mothers of preterm neonates when compared with the levels found in colostrum and milk of mothers of term neonates (Mann-Whitney test, p<0.0001). There was a significant decline in the secretory immunoglobulin A levels of the colostrum and milk of the mothers of term and preterm neonates during the four periods (Kruskal-Wallis test, p<00001). CONCLUSIONS: The secretory immunoglobulin A levels in colostrum and milk of mothers of preterm neonates were significantly higher than in the mothers of term neonates, demonstrating immunological adaptation in preterm neonate breast-feeding.


Assuntos
Colostro/imunologia , Imunoglobulina A Secretora/análise , Recém-Nascido/imunologia , Lactação/imunologia , Leite Humano/imunologia , Feminino , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro/imunologia , Triagem Neonatal/métodos , Radioimunoensaio , Estatísticas não Paramétricas
18.
Artigo em Inglês | MEDLINE | ID: mdl-26319650

RESUMO

OBJECTIVE: Evaluate TENS effectiveness as a complementary treatment of chronic pelvic pain and deep dyspareunia in women with deep endometriosis. STUDY DESIGN: This randomized controlled trial was performed in a tertiary health care center, including twenty-two women with deep endometriosis undergoing hormone therapy with persistent pelvic pain and/or deep dyspareunia. This study was registered in the Brazilian Record of Clinical Trials (ReBEC), under n RBR-3rndh6. TENS application for 8 weeks followed a randomized allocation into two groups: Group 1 - acupuncture-like TENS (Frequency: 8Hz, pulse duration: 250µs) - VIF (n=11) and Group 2 - self-applied TENS (Frequency: 85Hz, pulse duration: 75µs) (n=11). The intensity applied was "strong, but comfortable". We evaluated patients before and after treatment by the use of the Visual Analogue Scale, Deep Dyspareunia Scale and Endometriosis Quality of Life Questionnaire. We used the Wilcoxon and Mann-Whitney tests to compare before and after treatment conditions. RESULTS: Despite the use of hormone therapy for 1.65±2.08 years, the 22 women with deep endometriosis sustained pelvic pain complaints (VAS=5.95±2.13 and 2.45±2.42, p<.001) and/or deep dyspareunia (DDS=2.29±0.46 and 1.20±1.01, p=.001). We observed significant improvement for chronic pelvic pain, deep dyspareunia and quality of life by the use of TENS. Both application types of TENS were effective for improving the evaluated types of pain. CONCLUSIONS: Both resources (acupuncture-like TENS and self-applied TENS) demonstrated effectiveness as a complementary treatment of pelvic pain and deep dyspareunia, improving quality of life in women with deep endometriosis regardless of the device used for treatment.


Assuntos
Dispareunia/terapia , Endometriose/terapia , Dor Pélvica/terapia , Estimulação Elétrica Nervosa Transcutânea , Adulto , Terapias Complementares , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida
19.
Reprod Sci ; 22(8): 964-8, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25670719

RESUMO

OBJECTIVE: Neutrophil gelatinase-associated lipocalin (NGAL) is a component of innate immunity that prevents iron uptake by microorganisms. We evaluated whether NGAL was present in vaginal fluid and whether concentrations were altered in women with bacterial vaginosis (BV) or vulvovaginal candidiasis (VVC). METHODS: Vaginal secretions from 52 women with VVC, 43 with BV, and 77 healthy controls were assayed by enzyme-linked immunosorbent assay for NGAL and for concentrations of L-lactic acid. RESULTS: The median concentration of NGAL in vaginal fluid was significantly higher in control women (561 pg/mL) than in women with BV (402 pg/mL; P = .0116) and lower in women with VVC (741 pg/mL; P = .0017). Median lactic acid levels were similar in controls (0.11 mmol/L) and women with VVC (0.13 mmol/L) and were lower in women with BV (0.02 mmol/L; P < .0001). The NGAL and lactic acid concentrations were highly correlated (P < .0001). CONCLUSION: A decrease in Lactobacilli and/or lactic acid plus the absence of leukocytes results in lower vaginal NGAL levels that might facilitate the growth of bacteria associated with BV.


Assuntos
Proteínas de Fase Aguda/análise , Líquidos Corporais/química , Candidíase Vulvovaginal/metabolismo , Lipocalinas/análise , Proteínas Proto-Oncogênicas/análise , Vagina/metabolismo , Vaginose Bacteriana/metabolismo , Adulto , Biomarcadores/análise , Líquidos Corporais/metabolismo , Líquidos Corporais/microbiologia , Candidíase Vulvovaginal/diagnóstico , Candidíase Vulvovaginal/imunologia , Candidíase Vulvovaginal/microbiologia , Estudos de Casos e Controles , Regulação para Baixo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunidade Inata , Ácido Láctico/análise , Lipocalina-2 , Vagina/imunologia , Vagina/microbiologia , Vaginose Bacteriana/diagnóstico , Vaginose Bacteriana/imunologia , Vaginose Bacteriana/microbiologia , Adulto Jovem
20.
Reprod Sci ; 22(11): 1393-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25878210

RESUMO

Vaginal glycogen is degraded by host α-amylase and then converted to lactic acid by Lactobacilli. This maintains the vaginal pH at ≤4.5 and prevents growth of other bacteria. Therefore, host α-amylase activity may promote dominance of Lactobacilli. We evaluated whether the α-amylase level in vaginal fluid is altered in women with bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC) and whether its concentration was associated with levels of lactic acid isomers and host mediators. Vaginal fluid was obtained from 43 women with BV, 50 women with VVC, and 62 women with no vulvovaginal disorders. Vaginal fluid concentrations of α-amylase, secretory leukocyte protease inhibitor (SLPI), hyaluronan, hyaluronidase-1, ß-defensin, and elafin were measured by enzyme-linked immunosorbent assay (ELISA). Vaginal concentrations of neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase (MMP) 8, and d- and l-lactic acid levels in these patients were previously reported. The median vaginal fluid α-amylase level was 1.83 mU/mL in control women, 1.45 mU/mL in women with VVC, and 1.07 mU/mL in women with BV. Vaginal levels of α-amylase were correlated with d-lactic acid (P = .003) but not with l-lactic acid (P > .05) and with SLPI (P < .001), hyaluronidase-1 (P < .001), NGAL (P = .001), and MMP-8 (P = .005). The exfoliation of glycogen-rich epithelial cells into the vaginal lumen by hyaluronidase-1 and MMP-8 may increase glycogen availability and promote α-amylase activity. The subsequent enhanced availability of glycogen breakdown products would favor proliferation of Lactobacilli, the primary producers of d-lactic acid in the vagina. Concomitant production of NGAL and SLPI would retard growth of BV-related bacteria.


Assuntos
Candidíase Vulvovaginal/enzimologia , Candidíase Vulvovaginal/microbiologia , Lactobacillus/crescimento & desenvolvimento , Vagina/enzimologia , Vagina/microbiologia , Vaginose Bacteriana/enzimologia , Vaginose Bacteriana/microbiologia , alfa-Amilases/metabolismo , Proteínas de Fase Aguda/metabolismo , Adulto , Candidíase Vulvovaginal/diagnóstico , Estudos de Casos e Controles , Células Epiteliais/enzimologia , Células Epiteliais/microbiologia , Feminino , Glicogênio/metabolismo , Humanos , Hialuronoglucosaminidase/metabolismo , Concentração de Íons de Hidrogênio , Ácido Láctico/metabolismo , Lactobacillus/metabolismo , Lipocalina-2 , Lipocalinas/metabolismo , Metaloproteinase 8 da Matriz/metabolismo , Proteínas Proto-Oncogênicas/metabolismo , Inibidor Secretado de Peptidases Leucocitárias/metabolismo , Vagina/metabolismo , Vaginose Bacteriana/diagnóstico , Adulto Jovem
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