In Pancreatic Adenocarcinoma Alpha-Synuclein Increases and Marks Peri-Neural Infiltration.

α-Synuclein (α-syn) is a protein involved in neuronal degeneration. However, the family of synucleins has recently been demonstrated to be involved in the mechanisms of oncogenesis by selectively accelerating cellular processes leading to cancer. Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal human cancers, with a specifically high neurotropism. The molecular bases of this biological behavior are currently poorly understood. Here, α-synuclein was analyzed concerning the protein expression in PDAC and the potential association with PDAC neurotropism. Tumor (PDAC) and extra-tumor (extra-PDAC) samples from 20 patients affected by PDAC following pancreatic resections were collected at the General Surgery Unit, University of Pisa. All patients were affected by moderately or poorly differentiated PDAC. The amount of α-syn was compared between tumor and extra-tumor specimen (sampled from non-affected neighboring pancreatic areas) by using in situ immuno-staining with peroxidase anti-α-syn immunohistochemistry, α-syn detection by using Western blotting, and electron microscopy by using α-syn-conjugated immuno-gold particles. All the methods consistently indicate that each PDAC sample possesses a higher amount of α-syn compared with extra-PDAC tissue. Moreover, the expression of α-syn was much higher in those PDAC samples from tumors with perineural infiltration compared with tumors without perineural infiltration.

Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial.

STUDY QUESTION: How effective is the vaginal administration of misoprostol in dilating the cervix prior to inserting an intrauterine device (IUD) in nulligravidas? SUMMARY ANSWER: The use of misoprostol at a dose of 400 µg administered vaginally 4 h prior to IUD insertion increased the ease of insertion and reduced the incidence of pain during the procedure, although the frequency of cramps increased following misoprostol use. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Misoprostol has been widely used in Obstetrics and Gynecology; however, its usefulness and efficacy in facilitating IUD insertion in nulligravidas have yet to be established. The present study shows that the benefits of misoprostol use prior to IUD insertion include facilitating insertion and reducing pain during the procedure; therefore, weighing up the benefits encountered against the only negative side effect (cramps prior to insertion), these results suggest that misoprostol use should become standard practice to facilitate IUD insertion in nulligravidas. STUDY DESIGN, SIZE DURATION: A randomized, double-blind clinical trial was conducted. PARTICIPANTS/MATERIALS, SETTING METHODS: Nulligravid women of reproductive age were submitted to IUD insertion between July 2009 and November 2011 at the Instituto de Medicina Integral Prof. Fernando Figueira in Recife, Pernambuco, Brazil. A total of 179 women were randomly allocated to two groups: 86 to receive 400 µg of misoprostol vaginally 4 h prior to IUD insertion and 93 to receive placebo. Risk ratios (RRs) were calculated as measures of relative risk, together with their 95% confidence intervals (95% CI). The number needed to treat (NNT) and the number needed to harm (NNH) were also calculated. MAIN RESULTS AND THE ROLE OF CHANCE: Significant differences were found between the groups for all the immediate end points studied, with less difficulty in inserting the IUD [RR = 0.49 (23/86 versus 51/93); 95% CI: 0.33-0.72; P = 0.00005], a lower risk of dilatation <4 mm [RR = 0.48 (24/86 versus 54/93); 95% CI: 0.33-0.70; P = 0.0001], a reduction in moderate-to-severe pain at IUD insertion [RR = 0.56 (32/86 versus 62/93]; 95% CI: 0.41-0.76; P = 0.00008), as well as a lesser likelihood of experiencing a disagreeable or very disagreeable sensation [RR = 0.49(29/86 versus 64/93); 95% CI: 0.35-0.68; P = 0.000004] in the group that was given misoprostol compared with the group that received placebo. There was no significant difference between the groups in relation to complications during IUD insertion. There were no cases of uterine perforation in either group. The frequency of cramps was 40% higher in the misoprostol group. LIMITATIONS, REASONS FOR CAUTION: The present study showed a positive balance between the benefits and risks of the use of misoprostol; however, it is not feasible to conclude that its use is imperative prior to IUD insertion in nulligravidas and IUD insertion should not be canceled when the medication is unavailable. WINDER IMPLICATIONS OF THE FINDINGS: In view of its effect in promoting cervical dilatation, misoprostol may be used prior to IUD insertion both in nulligravidas and in any women with cervical stenosis irrespective of parity. STUDY FUNDING: This study was funded by the Instituto de Medicina Integral Prof Fernando Figueira. COMPETING INTERESTS: None.

Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients.

BACKGROUND: The purpose of this multicentric prospective study was to evaluate postoperative HRQL and satisfaction with care after laparoscopic colonic resection for colorectal cancer in elderly patients. METHODS: A total of 116 patients were enrolled in this study: 33 patients older than age 70 years had laparoscopic colectomy, whereas 24 had open colectomy; 44 patients younger than age 70 years had laparoscopic colectomy and 15 of them had open colectomy. The patients answered to three questionnaires about generic (EORTC QLQ C30) and disease-specific quality of life (EORTC CR29) and about treatment satisfaction (EORTC IN-PATSAT32). Nonparametric tests and forward stepwise multiple regression analysis were used for statistical analysis. RESULTS: One month after surgery, global quality of life (QL2 item) was significantly impaired in elderly patients who had laparoscopic colectomy compared with younger patients who had the same operation (p = 0.003). Similarly, role function (RF), physical function (PF), emotional function (EF), cognitive function (CF), and social function (SF) were impaired in elderly patients who had laparoscopic colectomy compared with younger patients (p < 0.001, p < 0.001, p = 0.013, p < 0.001, p = 0.01, respectively). Fatigue (FA), sleep disturbances (SL), appetite loss (AP), and dyspnea (DY) affected the quality of life of these patients more than younger patients (p < 0.001, p = 0.055, p = 0.051, and p = 0.003, respectively). CONCLUSIONS: Elderly patients undergoing laparoscopic colectomy for cancer experience less postoperative local complications than elderly patients undergoing open colectomy. Nevertheless, in the first postoperative month, these patients experience a worse global quality of life than younger patients undergoing the same operation with impairment of all the functions and the presence of fatigue, sleep disturbances, appetite loss, and dyspnea.

Comparison between 200 µg and 800 µg of vaginal misoprostol for cervical ripening before operative hysteroscopy: A randomized controlled trial.

OBJECTIVE: To compare between 200 and 800 µg of vaginal misoprostol for cervical ripening before operative hysteroscopy. METHODS: Quadruple-blind randomized clinical trial conducted between November 2019 and September 2020 involving 76 patients undergoing cervical dilatation before surgical hysteroscopy at teaching hospitals in Pernambuco, Brazil. Women received the vaginal misoprostol dosage of 200 or 800 µg,10-12 h before operative hysteroscopy. The cervical width was the primary outcome, and secondary outcomes were patient satisfaction, adverse effects, surgical complications, and duration of cervical dilatation. Chi-square tests of association, Fisher's exact and Mann-Whitney U tests were used with an α error of <5%. RESULTS: There was no statistical difference between the groups in the mean of the cervical width (800 µg: 6.5 ± 1.6 mm vs 200 µg: 5.8 ± 1.8 mm, P = 0.055), patient satisfaction, and surgical findings, but the duration of cervical dilatation was lower in the 800-µg group (28.16 ± 28.5 s vs 41.97 ± 31.0 s, P = 0.035). Among the adverse effects, diarrhea was more frequent in the 800-µg group with statistical difference (100% vs 0%; P = 0.01). CONCLUSION: For cervical ripening, 200 µg misoprostol is equally effective with fewer adverse effects than 800 µg before operative hysteroscopy. CLINICALTRIALS: gov: NCT04152317. https://clinicaltrials.gov/ct2/show/NCT04152317.

Frequency and Factors Associated with Urinary Incontinence in Pregnant Adolescents: A Cross-Sectional Study.

STUDY OBJECTIVE: To determine the overall frequency of urinary incontinence in pregnant adolescents, focusing particularly on the presence of symptoms of stress urinary incontinence (SUI) and coital incontinence (CI), and to describe the biological, sociodemographic, clinical, urinary, reproductive, sexual, and lifestyle factors associated with incontinence. DESIGN: A cross-sectional, descriptive study. SETTING: The outpatient clinic for high-risk pregnancies at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) in Recife, Pernambuco, in the Northeast of Brazil. PARTICIPANTS: A convenience sample of 103 pregnant adolescents who attended for prenatal consultations during the study period. INTERVENTIONS: Data were collected on the participants' characteristics and information based on the Incontinence Severity Index (ISI) questionnaire. MAIN OUTCOME MEASURES: Frequency of urinary incontinence and possible correlations between the women's characteristics and SUI and CI symptoms. RESULTS: Mean age (±standard deviation) was 16.76 ± 1.8 years. Urinary incontinence was present in 60.1% of the patients. Of these, 37.8% had SUI and 33.9% CI. In addition, 30.8% of the patients with CI also had SUI. There were statistically significant associations between CI and the occurrence of SUI prior to pregnancy (100%; PR: 1.77; 95% CI: 1.48-2.13; P = .011), between SUI and chronic coughing (60%; PR = 1.95; 95% CI: 1.23-3.09; P = .009), and between CI and height (41.9%; PR = 1.00; 95% CI: 0.27-1.00; P = .036). CONCLUSION: Urinary incontinence is a dysfunction that may affect pregnant adolescents, with symptoms possibly beginning as early as the first trimester of pregnancy.

Changes in the expression of suppressor of cytokine signalling (SOCS) 2 in the colonic mucosa of acromegalic patients are associated with hyperplastic polyps.

BACKGROUND: Acromegalic patients have increased prevalence of colonic polyps. Development of hyperplastic polyps was related to suppressor of cytokine signalling (SOCS) 2 haploinsufficiency in animal models of acromegaly. OBJECTIVE AND PATIENTS: To evaluate whether variations in SOCS2 expression in the colonic mucosa of acromegalic patients might be associated to hyperplastic polyps, patients with active acromegaly or disease in remission with or without hyperplastic polyps were studied; controls were non-acromegalic subjects age- and sex- matched with or without polyps. MEASUREMENTS: Expression of SOCS1-3 was evaluated by RT-PCR, immunofluorescence and Western blot in the colonic mucosa. Coimmunoprecipatiton was used to evaluate multimeric protein complexes. RESULTS: Acromegalic patients with active disease and hyperplastic polyps had higher levels of SOCS2 transcripts; on the contrary, SOCS1 and SOCS3 transcripts did not differ among the study groups. While the expression of SOCS2 and SOCS3 protein was indistinguishable with that of the corresponding transcripts, SOCS1 protein expression was reduced in active acromegalic patients with polyps. SOCS1 protein was reduced owing to its increased proteasome degradation mediated by SOCS2. The increased SOCS2 and reduced SOCS1 led to increased STAT5b expression, suggesting a higher GH signalling transduction. CONCLUSIONS: Acromegalic patients with active disease and hyperplastic polyps have high levels of SOCS2 and increased SOCS1 degradation, leading to reduced negative feedback on GH signalling, likely favouring a hyperplastic polyps phenotype.

[Factors associated with bacteriuria after indwelling urethral catheterization in gynecologic surgery]. / Fatores associados à bacteriúria após sondagem vesical na cirurgia ginecológica.

OBJECTIVES: To determine the frequency and risk factors associated to bacteriuria after urinary catheterization in women submitted to elective gynecological surgery. METHODS: A cohort study was carried out among women submitted to gynecological surgery after urinary catheterization. This study took place at the 'Instituto de Medicina Integral Professor Fernando Figueira' from January to May of 2007. Uroculture samples were collected during two periods: in the first 24 hours and seven to ten days after catheter removal. To demonstrate the association between risk factors and bacteriuria, the relative risk was calculated with a confidence interval of 95%. RESULTS: This study included 249 women. At 24 hours after catheter removal, 23.6% of the urocultures collected were positive, while on days 7 to 10 this was reduced to 11.1%. Of all participants studied only 2.4% had symptomatic bacteriuria. Risk of bacteriuria at 7/10 days was reduced when the patient reported a positive history of treatment for vulvovaginitis in the previous three months. However this association was not found after multivariate analysis. There was no significant association with age, education, stage of reproductive phase, number of pregnancies and deliveries, type and duration of surgery, type of anesthetics, use of prophylactic antibiotic, professional who introduced the catheter and time of urinary catheterization. CONCLUSION: Frequency of bacteriruria was 23.6% at 24 hours and 11.1% seven days after catheter removal. There was no association between bacteriuria at 7/10 days and any of the variables analyzed.

Quality of life in the climacteric of nurses working in primary care.

OBJECTIVE: to evaluate the quality of life of primary care nurses in the climacteric. METHOD: A cross-sectional descriptive-analytic study, performed with 98 female nurses, aged 40-65 years, using the WHOQOL-Bref questionnaire. RESULTS: the worst level of quality of life was observed for professionals aged 50-59 years, non-white, specialists, divorced or widowed, with children, a lower income, with another employment relationship, a weekly workload of more than 40 hours, who consumed alcoholic beverages weekly, with chronic disease, in continuous use of medications, sedentary, who did not menstruate and did not receive hormonal treatment, and who went through menopause between the ages of 43-47 years. CONCLUSION: Although the variables "physical activity" and "age" have a statistically significant association with quality of life, other variables seem to interfere in these professionals' lives, indicating the need for a more critical and deep reflection on these relations.

[Chlamydia infection in patients with and without cervical intra-epithelial lesions]. / Infecção por Chlamydia em pacientes com e sem lesões intra-epiteliais cervicais.

OBJECTIVES: To determine the frequency of Chlamydia trachomatis infection in patients with and without intraepithelial cervical lesions attended at specialized ambulatory in Recife (2007) and its association with biologic and demographic variables, habits, reproductive, clinical and gynecologic characteristics. METHODS: A cross-sectional study was conducted including 70 women (35 with cytological cervical lesions and 35 with normal smears). Colposcopy and biopsy when necessary were performed and Chlamydia infection was determined by direct immunofluorescence. Analysis variables were age, race, precedence, schooling, marital status, menarche, age at first sexual intercourse, parity, number of sexual partners, vaginal discharge, previous Pap smear, STD episodes, cervical cauterization, contraceptive methods, familial antecedents of cervical cancer, alcohol intake, use of illicit and immunosuppressive drugs, Papanicolaou result and cervical Chlamydia l infection. To determine the strength of association prevalence ratio (PR) and its 95% confidence interval were calculated. Multivariate analysis was performed for controlling potentially confounding variables. RESULTS: the frequency of Chlamydia l infection was significantly greater in patients with intraepithelial cervical lesions (80.0% vs. 14.3%; PR=5.60; 95% CI=2.44-12.82). When the factors associated with Chlamydia l infection were analyzed, the only variable that remained significantly associated after multivariate analysis was previous episode of STD (OR=63.47; 95% CI=13.93-289.09). CONCLUSION: Chlamydia trachomatis infection is associated with intraepithelial cervical lesions and history of STD should be considered for treatment and follow-up of these patients.

Conhecimento, atitude e prática dos médicos residentes de ginecologia e obstetrícia de Pernambuco sobre anticoncepção / Knowledge, attitude and practice of resident physicians in gynecology and obstetrics in Pernambuco about contraception

Resumo Introdução: Anticoncepção corresponde ao uso de métodos e técnicas com a finalidade de impedir que o relacionamento sexual resulte em gravidez. O médico residente em ginecologia e obstetrícia deve estar intimamente familiarizado com as múltiplas opções contraceptivas existentes, o modo de uso, os efeitos colaterais e suas contraindicações. Objetivo: Este estudo teve como objetivos identificar o nível de conhecimento, atitude e prática dos médicos residentes de ginecologia e obstetrícia do estado de Pernambuco sobre anticoncepção, determinar sua autopercepção em indicar e contraindicar os métodos contraceptivos, avaliar as melhores indicações clínicas, como prescrevê-los e orientar seu uso. Método: Foi realizado um estudo de inquérito, do tipo corte transversal, com componente analítico. Durante o período de maio a julho de 2022, aplicou-se um questionário à população-alvo, composta pelos médicos residentes de ginecologia e obstetrícia do estado de Pernambuco, e obteve-se um tamanho amostral de 157 respostas, que foram analisadas no programa estatístico Stata, versão 12.0. Resultado: Os métodos contraceptivos mais utilizados por eles foram o ACO, o DIU Mirena, a camisinha peniana e o DIU de cobre. Mais de 90% da amostra afirmou conhecer os critérios de elegibilidade e o índice de Pearl, e pouco mais da metade respondeu corretamente aos casos clínicos sobre contracepção; 52,9% relataram que não faziam uso da dupla proteção, e 40,1% da amostra mencionou que nunca usava camisinha. A maioria dos entrevistados atestou possuir uma boa prática com LARC e com esterilização cirúrgica; uma boa parcela dos residentes entrevistados considerou-se apta a orientar todos os métodos anticoncepcionais. Conclusão: O conhecimento das indicações e contraindicações pode ser considerado satisfatório, apesar de chamar a atenção a presença de uma disparidade entre a autopercepção do saber e os acertos das questões a respeito de casos clínicos específicos. Em relação à atitude, as respostas foram controversas. No âmbito da prática, obtiveram-se os melhores resultados de autopercepção de habilidade, com destaque para a prática com os LARC e a esterilização cirúrgica. As autoavaliações demonstraram que mais da metade da amostra considerou seus conhecimentos, suas atitudes e suas práticas muito satisfatórios e/ou adequados.

Abstract Introduction: Contraception corresponds to the use of methods and techniques with the purpose of preventing sexual intercourse from resulting in pregnancy. The resident physician in gynecology and obstetrics must be intimately familiar with the multiple existing contraceptive options, how to use them, their side effects and contraindications. Objectives: To identify the level of knowledge, attitude and practice among Gynecology and Obstetrics residents in the state of Pernambuco regarding contraception, determine their self-perception in indicating and contraindicating contraceptive methods, evaluating the best clinical indications, how to prescribe them and offer guidance for their use. Methods: A cross-sectional survey study with an analytical component. During the period from May to July 2022, a test was applied to the target population, composed by resident physicians of Gynecology and Obstetrics in the state of Pernambuco. A sample size of 157 responses was obtained, which were analyzed in the program STATA statistics, version 12.0. Results: The contraceptive methods most used by the resident physicians were the ACO, Mirena IUD, penile condom and copper IUD. More than 90% of the sample claimed to know the Eligibility Criteria and the Pearl Index, and just over half correctly answered the clinical cases on contraception; 52.9% reported not using double protection and 40.1% of the sample stated that they never used condoms. Most interviewees attested to having a good practice with LARC and with surgical sterilization; a good portion of the interviewed residents considered themselves able to guide all contraceptive methods. Conclusion: The knowledge of indications and contraindications can be considered satisfactory, despite a disparity between self-perceived knowledge and correct answers to questions regarding specific clinical cases; regarding attitude, the answers were controversial; within the scope of practice, the best results of self-perceived ability were obtained, with emphasis on the practice with LARC and surgical sterilization. Self-assessments showed that more than half of the sample considered their knowledge, attitudes and practices very satisfactory and/or adequate.

Direitos sexuais e reprodutivos de mulheres em situação de rua: protocolo de revisão de escopo / Sexual and reproductive rights of homeless women: a scoping review protocol / Derechos sexuales y reproductivos de las mujeres en situación de calle: protocolo de revisión de alcance

OBJETIVO: Traçar o panorama do exercício dos direitos sexuais e reprodutivos de meninas e mulheres em situação de rua no Brasil. MÉTODO: Revisão de escopo para responder à pergunta: Qual o panorama do exercício dos direitos sexuais e reprodutivos de meninas e mulheres em situação de rua no Brasil? O levantamento de dados se dará no PUBMED, SCOPUS, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (Scielo), Google Acadêmico, Directory of Open Access Journals (DOAJ), Portal Brasileiro de publicações científicas em acesso aberto (OasisBr) e Portal Brasileiro de teses e dissertações. Os artigos encontrados serão agrupados no software Mendeley. Dois revisores independentes selecionarão os títulos, resumos e artigos completos quanto aos critérios de elegibilidade e extrairão os dados que respondem à pergunta de pesquisa. Os dados serão submetidos à análise descritiva e narrativa, o software IRAMUTEQ auxiliará na análise e apresentação dos mesmos.

OBJECTIVE: To outline an overview for the exercise of sexual and reproductive rights of homeless girls and women in Brazil. METHOD: A scoping review to answer the following question: What is the overview for the exercise of sexual and reproductive rights of homeless girls and women in Brazil? Data collection will take place in PUBMED, SCOPUS, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Google Scholar, Directory of Open Access Journals (DOAJ), the Brazilian Publications Portal for scientific journals in open access (OasisBr) and the Brazilian Portal of Theses and Dissertations. The articles found will be grouped in the Mendeley software. Two independent reviewers will select the titles, abstracts and full articles regarding the eligibility criteria and will extract the data that answer the research question. The data will be submitted to descriptive and narrative analysis and the IRAMUTEQ software will assist in their analysis and presentation.

OBJETIVO: Caracterizar el panorama del ejercicio de los derechos sexuales y reproductivos de las niñas y mujeres en situación de calle en Brasil. MÉTODO: Revisión de alcance para responder a la pregunta: ¿Cuál es el panorama del ejercicio de los derechos sexuales y reproductivos de las niñas y mujeres en situación de calle en Brasil? La recolección de datos se realizará en PUBMED, SCOPUS, Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Scientific Electronic Library Online (Scielo), Google Académico, Directory of Open Access Journals (DOAJ), Portal Brasileiro de publicações científicas em acesso aberto (OasisBr) y el Portal Brasileño de Tesis y Disertaciones. Los artículos encontrados se agruparán en el software Mendeley. Dos revisores independientes seleccionarán los títulos, resúmenes y artículos completos según los criterios de elegibilidad y extraerán los datos que respondan a la pregunta de investigación. Los datos serán sometidos a análisis descriptivo y narrativo, el software IRAMUTEQ ayudará con el análisis y la presentación.

Maternal and perinatal outcomes in women with and without hypertensive syndromes submitted to induction of labor with misoprostol.

OBJECTIVES: To determine maternal and perinatal outcomes according to the mode of delivery in normotensive and hypertensive women bearing a live, full-term fetus, who were submitted to labor induction with misoprostol. METHODS: Retrospective cohort study. The endpoints were tachysystole, uterine hyperstimulation, indications for cesarean section, severe maternal morbidity, side effects, maternal death, 1st/5th minute Apgar, neonatal death, requirement for neonatal intensive care, and birth weight (grams). The chi-square or Fisher's exact test was applied at a significance level of 5%. Risk ratios (RRs) and their 95% confidence intervals (95% CI) were calculated. RESULTS: No significant differences were found in maternal outcome as a function of mode of delivery. First-minute Apgar score <7 was less common with vaginal deliveries in normotensive women (RR = 0.41; 95% CI: 0.18-0.90), this being the only significant difference in perinatal outcome. CONCLUSION: Maternal and perinatal outcomes were similar in hypertensive and normotensive women submitted to labor induction with misoprostol.

Assistência em enfermagem à luz da teoria transcultural / Atención de enfermería a la luz de la teoria transcultural / Nursing care in the light of the transcultural theory

Objetivo: Analisar as evidências cientificas de como a Teoria da Universalidade e Diversidade do Cuidado Cultural está sendo utilizada na prática da assistência em enfermagem. Métodos: Revisão Integrativa da literatura, na qual a busca de artigos foi realizada na Biblioteca Virtual em Saúde com os descritores "Culturally Competent Care; Nursing Care; Nursing Theory e Transcultural Nursing, com o operador boleano "AND", no período de maio e junho de 2021. Inicialmente foram encontrados 750 estudos e após o aperfeiçoamento, 9 foram incluídos. Foi utilizado para auxiliar no desenvolvimento desta revisão o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: a teoria favorece a prestação de cuidados de enfermagem considerando o fator cultural, capacitando o indivíduo a efetuar atividades segundo padrões definidos por uma variação de crenças, valores e condições socioeconômicas em uma sociedade. Conclusão: Sua aplicabilidade resulta numa assistência mais humana diante das diferentes demandas da sociedade contemporânea.(AU)

Objective: Analyze the scientific evidence of how the Theory of Universality and Diversity in Cultural Care is being used in the practice of nursing care. Methods: Integrative literature review, in which the search for articles was performed in the Virtual Health Library with the descriptors "Culturally Competent Care; Nursing Care; Nursing Theory and Transcultural Nursing, with the Boolean operator "AND", from May to June 2021. Initially, 750 studies were found and after improvement, 9 were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to assist in the development of this review. Results: the theory favors the provision of nursing care considering the cultural factor, enabling the individual to perform activities according to patterns defined by a variation of beliefs, values and socioeconomic conditions in a society. Conclusion: Its applicability results in a more humane assistance in face of the different demands of contemporary society(AU)

Objetivo: Analizar la evidencia científica de cómo se está utilizando la Teoría de la Universalidad y la Diversidad en el Cuidado Cultural en la práctica del cuidado de enfermería. Métodos: Revisión integrativa de la literatura, en la que se realizó la búsqueda de artículos en la Biblioteca Virtual en Salud con los descriptores "Atención Culturalmente Competente; Cuidado de enfermera; Teoría de Enfermería y Enfermería Transcultural, con el operador booleano "AND", de mayo a junio de 2021. Inicialmente se encontraron 750 estudios y luego de la mejoría se incluyeron 9. Se utilizó para ayudar en el desarrollo de esta revisión lo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: la teoría favorece la prestación del cuidado de enfermería considerando el factor cultural, capacitando al individuo para realizar actividades según patrones definidos por una variación de creencias, valores y condiciones socioeconómicas en una Sociedad. Conclusión: su aplicabilidad da como resultado una asistencia más humana frente a las diferentes demandas de la sociedad contemporánea(AU)

Identification of acromegalic patients at risk of developing colonic adenomas.

BACKGROUND: Acromegaly seems to be associated with an increased prevalence of colonic adenomas, although factors affecting their development and recurrence of the latter are not fully known. SUBJECTS AND METHODS: Seventy-nine patients with active acromegaly were prospectively followed up for 5 yr. Two hundred eighty healthy subjects served as controls. Colonoscopy and assessment of acromegaly activity were performed at 1-yr intervals. Acromegaly was defined as controlled if serum IGF-I levels were within the normal age-adjusted range. RESULTS: Colonic adenomas were found in 26 of 79 acromegalic patients (32.9%) and 60 of 280 controls (21.4%) at baseline (P = 0.035, adjusted for age and sex, odds ratio 1.82, 95% confidence interval, 1.02-3.25). Seven patients had hyperplastic polyps; the remaining 46 acromegalic patients had no detectable lesions at baseline and did not develop adenomas during the study period. Of the 26 patients with colonic adenomas at baseline, 16 (61.5%) had at least one recurrence of colonic adenomas (P < 0.0001 vs. patients without colonic lesions at baseline), and multiple recurrences were more frequent in patients with uncontrolled acromegaly (66.7% vs. 17.6% in patients with controlled acromegaly, P = 0.028). CONCLUSIONS: The first colonoscopy helps to identify acromegalic patients at high risk of developing colonic adenomas. If colonic adenomas are not present initially, it is unlikely that they develop thereafter, independently of metabolic control of acromegaly. Conversely, new lesions are frequent (and often multiple) in patients who already have colonic adenomas at baseline, particularly if acromegalic disease is poorly controlled by treatment.

Native vaginal tissue repair for genital prolapse surgical treatment: a minimum of 30 months of results.

OBJECTIVE: The aim of this study was to assess the impact of using native vaginal tissue repair as a surgical treatment for pelvic organ prolapse (POP) on quality of life using validated questionnaires. STUDY DESIGN: Fifty-one women underwent surgical POP repair. All of the women were evaluated by physical examination using the POP-Q, ICIQ-VS and P-QoL questionnaires prior to surgery as well as six and at least 30 months after surgery. RESULTS: Fifty-one patients returned for assessment at least 30 months after surgery (median 36 months, range 30-50 months). There was significant improvement in most points - Aa, Ba, C, Bp, Ap, and hg - and at the stage of prolapse. There were statistically significant improvements in bulge symptoms after surgery (p<0.001), and significant differences were also seen regarding questions related to urinary and bowel symptoms. Indeed, most quality of life questionnaire domains showed significant differences before and after surgery. CONCLUSION: Native vaginal tissue repair improved POP-related symptoms and quality of life after 30-50 months of assessment.

Representaciones sociales del VIH construidas por jóvenes embarazadas atendidas en un hospital universitario de Recife-Brasil / Social representations of HIV constructed by young pregnant women assisted at a university hospital in Recife

Objetivo: analizar las representaciones sociales del VIH construidas por las jóvenes embarazadas de un hospital universitario en Recife, Brasil. Metodología: investigación descriptiva, cualitativa, basada en la teoría de las Representaciones Sociales en su enfoque estructural. Se utilizó el término VIH/SIDA en el contexto normativo y contranormativo, con una muestra de 120 jóvenes embarazadas. Los resultados fueron analizados con el software IRAMUTEQ. Resultados: fueron encontradas en su núcleo central las representaciones sociales de “prejuicio” y “muerte,” señalando negativamente a la dimensión “información” e “imaginación” que se tenía sobre este virus al comienzo de la epidemia. Conclusiones: aunque se han realizado avances en la forma de transmitir la información, esta continúa siendo arcaica y negativa. Por lo tanto, es importante reflexionar sobre el lenguaje de la información transmitida a los jóvenes, así como la falta de interés de estos y de los profesionales en saber y actualizarse sobre lo que realmente sucede cuando se está infectado con el virus. (AU)

Objective: to analyze the Social Representations of HIV constructed by young pregnant women. Methodology: field research, descriptive, qualitative, based on the Theory of Social Representations in its structural approach. Using the term HIV / AIDS in the normative and counter-normative context. The free evocation technique was used with 120 young pregnant women. Its analysis with the aid of the software IRAMUTEQ. Results: were found at its central core, the social representations of prejudice and death, which negatively point to the informative and imaginary dimension that had about the virus at the beginning of the epidemic. Conclusions: although there are advances in the means of transmitting information, it remains archaic and negative. Realizing thus, the importance of reflecting on the language of information passed on to young people and / or little interest in knowing and being updated on what really happens when you have the virus. (AU)

Planejamento familiar: dilemas bioéticos encontrados na literatura / Family planning: bioethical dilemmas found in the literature / Planificación familiar: dilemas bioéticos encontrados en la literatura

Resumo O artigo traz resultados de revisão integrativa realizada conforme as recomendações do método Preferred Reporting Items for Systematic Reviews and Meta-Analyses. O objetivo era investigar, à luz do modelo principialista, os dilemas bioéticos que emergem do planejamento familiar, de acordo com a literatura. Os dados foram levantados em pesquisa nas bases Medline, Lilacs e Scopus, por meio do cruzamento dos descritores "family planning and bioethics". Após aplicação dos critérios de elegibilidade, sete artigos publicados entre 2011 e 2018 foram selecionados para compor o estudo. Esses artigos foram submetidos a análise de conteúdo, como proposta por Bardin. Quatro categorias temáticas foram observadas: direito a liberdade e autonomia sexual/reprodutiva; interferência de governos no planejamento familiar e reprodutivo; barreiras socioculturais e religiosas ao planejamento familiar; e aprimoramento de tecnologias voltadas à manipulação de pré-embriões. Os resultados sugerem que os avanços científicos andam mais rápido do que as discussões bioéticas, criando dilemas práticos e teóricos.

Abstract This integrative review, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method, investigates the bioethical dilemmas that emerge from family planning, in light of principlism. Data were collected based on literature research conducted at the Medline, Lilacs and Scopus databases, using the descriptors "family planning and bioethics." After applying the eligibility criteria, seven papers published between 2011 and 2018 were selected for content analysis, performed according to Bardin's proposal. The study identified four thematic categories: right to freedom and sexual/reproductive autonomy; government interference in family and reproductive planning; sociocultural and religious barriers to family planning; and technological enhancement for pre-embryo handling. Results suggest that scientific advances move faster than bioethical discussions, creating practical and theoretical dilemmas.

Resumen Este artículo presenta los resultados de una revisión integrativa conforme al Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Su objetivo fue investigar, desde el modelo principialista, los dilemas bioéticos que surgen de la planificación familiar en la literatura. Para la recopilación de datos se llevó a cabo búsquedas en las bases de datos Medline, Lilacs y Scopus utilizando los descriptores "family planning and bioethics". Tras la aplicación de criterios de elegibilidad, se seleccionaron siete artículos publicados entre 2011 y 2018. Se aplicó a los artículos el análisis de contenido propuesto por Bardin. Se obtuvieron cuatro categorías temáticas: derecho a la libertad y autonomía sexual/reproductiva; interferencia del gobierno en la planificación familiar y reproductiva; barreras socioculturales y religiosas a la planificación familiar; y mejora de tecnologías relacionadas al manejo de los preembriones. Los resultados apuntaron que los avances científicos van más rápido que las discusiones bioéticas, ocasionando dilemas prácticos y teóricos.

Changes in family structure and regret following tubal sterilization.

Tubal sterilization is one of the contraceptive methods whose use has increased the most in Brazil, but a growing number of women have expressed regret after the procedure. A case-control study was conducted at the Centro Integrado de Saúde Amaury de Medeiros (CISAM), Recife, Pernambuco, Brazil, in 1997 to investigate the association between changes in family structure and request for or submittal to surgical reversal of tubal sterilization, comparing 304 sterilized women who had requested or submitted to reversal of tubal sterilization and 304 women who were also sterilized but had not requested, had not submitted to, and who did not wish to submit to reversal. The simple and adjusted odds ratios were estimated using logistic regression. The results of the current study showed that death of children, partners without children prior to the current union, and partner change after tubal sterilization were associated with the request for or submittal to reversal of tubal sterilization. More strict criteria are suggested in the indication of tubal sterilization, including an in-depth profile of the woman requesting tubal sterilization and identification of risk factors for future regret.

Maternal near miss in the intensive care unit: clinical and epidemiological aspects.

OBJECTIVE: To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria. METHODS: A descriptive cross-sectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, education, place of origin, number of pregnancies and prenatal consultations, complications and procedures performed, mode of delivery, gestational age at delivery, and maternal near miss criteria. The descriptive analysis was performed using the program Epi-Info 3.5.1. RESULTS: Two hundred fifty-five cases of maternal near miss were identified, with an overall ratio of maternal near miss of 12.8/1,000 live births. Among these cases, 43.2% of the women had incomplete primary education, 44.7% were primiparous, and 20.5% had undergone a previous cesarean section. Regarding specific diagnoses, there was a predominance of hypertensive disorders (62.7%), many of which were complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (41.2%). The laboratory near miss criteria were the most often observed (59.6%), due mainly to the high frequency of acute thrombocytopenia (32.5%). CONCLUSIONS: A high frequency of women who had a low level of education and who were primiparous was observed. According to the new criteria proposed by the World Health Organization, hypertensive pregnancy disorders are still the most common among maternal near miss cases. The high frequency of HELLP syndrome was also striking, which contributed to acute thrombocytopenia being the most frequent near miss criterion.