Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis.

BACKGROUND: Dyspareunia is defined as the occurrence of pain during or after sexual intercourse, which directly affects physical, sexual, and mental health. This condition can lead to depression, anxiety, and low self-esteem in women who experience it. OBJECTIVES: The aim of this research was to evaluate the effectiveness of physical therapy interventions for the treatment of female dyspareunia. DESIGN: A systematic review and meta-analysis was conducted. METHOD: Search of publications was conducted in Scopus, Medline, Pubmed, Cinahl and Web of Science. Treatment effects were defined as standardized mean difference and their 95% confidence intervals. Statistical heterogeneity was assessed using Crohan's Q test and quantified using the I2 index. RESULTS: Of the 19 articles selected, six applied multimodal physiotherapy treatments; five, electrotherapy; three, Thiele's massage; two, interdisciplinary interventions or pelvic floor muscle training; and one, extracorporeal shockwave therapy. The meta-analysis showed significant results for the variables pain and quality of life with the interventions based on electrotherapy and electrotherapy combined with pelvic floor muscle training. These interventions did not show significant results for the improvement of sexual function. CONCLUSIONS: Physiotherapy techniques are effective and procedures have been identified with reliable results in improving pain and quality of life in patients with dyspareunia. One of the most important aspects is the strengthening of the perineal musculature and the application of Transcutaneous Electrical Nerve Stimulation. Furthermore, manual trigger point release therapy and Thiele massage, optimize and guarantee the reduction of pain intensity. PROSPERO REGISTRATION: CRD42021236155.

Impact of nonpneumatic antishock garment in the management of patients with hypoperfusion due to massive postpartum hemorrhage.

Objective: The objective of this article was to compare hemodynamic and perfusion parameters as well as the clinical outcomes in critically ill patients with postpartum hemorrhage (PPH) who received treatment with a nonpneumatic antishock garment (NASG) as part of an intervention package, with a group of patients in similar conditions who did not receive an NASG.Methods: This observational study analyzed a historic cohort of 154 patients with PPH, secondary hypovolemic shock and signs of hypoperfusion who were admitted to this institution from 2012 to 2015. Group 1 (n= 77) was managed with NASG and Group 2 (n = 77) received interventions other than NASG. Hypoperfusion markers and maternal outcomes were compared in both groups.Results: Of 154 patients included in the analysis, 36.4% required a total abdominal hysterectomy (TAH) to achieve hemorrhage control, 98.2% of whom belonged to Group 2 and 1.8% to Group 1 (p = .001). The use of blood products was more common in Group 2 (p < .001), as was the administration of vasoactive agents. The mean number of days of hospitalization at the Obstetric High Dependency Unit (OHDU) was significantly lower in Group 1 and reached a statistically significant p value. Only two cases of maternal death occurred in Group 2.Discussion: The use of NASG in the management of PPH is a cost-effective strategy for patients with severe shock and signs of hypoperfusion and is optimal in a limited-resource scenario. In this study, the use of NASG was related to better outcomes in a statistically significant manner with better results regarding maternal outcomes such as uterine preservation and decreased transfusion requirements and hospital days.Conclusions: NASG, associated with the use of uterotonic agents and other strategies for PPH control, is a safe tool that helps reduce morbimortality in critically ill patients with PPH.

Hipertrigliceridemia familiar severa en el embarazo: tratamiento con plasmaféresis. Reporte de un caso y revisión de la bibliografía / Severe familial hypertriglyceridemia: management with plasmapheresis. Case report and literature review

Resumen ANTECEDENTES: Durante el embarazo suceden cambios adaptativos, secundarios a las variaciones hormonales, como las alteraciones en la concentración de lípidos plasmáticos necesarias para garantizar la adecuada nutrición al feto. Algunas veces la concentración de triglicéridos sobrepasa los límites de tolerancia y ello pone en riesgo la salud de la madre. CASO CLÍNICO: Paciente con antecedente de un embarazo, hipertrigliceridemia familiar que se exacerbó por los procesos fisiológicos del embarazo. Se hospitalizó para tratarla y los especialistas en Nutrición y Endocrinología le indicaron fármacos y plasmaféresis. CONCLUSIONES: La plasmaféresis es un método efectivo después de seis sesiones de tratamiento con el que se logran reducir 70% las concentraciones séricas triglicéridos, aunque no fue una medida definitiva y se requirió finalizar el embarazo.

Abstract BACKGROUND: Adaptive changes occur in pregnancy, secondary to hormonal variations, one of which is alterations in the level of plasma lipids that aims to ensure adequate nutrition to the fetus. However, sometimes triglycerides reach such high levels that they could compromise maternal health. CLINICAL CASE: The case of a female patient with a history of familial hypertriglyceridemia, exacerbated by the physiological processes of pregnancy, is presented. It was managed intrahospitalary, followed by nutrition and endocrinology, in addition to the use of pharmacological treatment and plasmapheresis. CONCLUSIONS: The use of plasmapheresis was evaluated as a therapeutic measure, where it was found to be an equally effective method after 6 sessions of treatment, achieving a 70% reduction in serum levels of triglycerides, however it was not a definitive measure and it was necessary to end the pregnancy.