Study of 138 vulvar lichen sclerosus patients and the malignant risk transformation

Abstract Objective To report the prevalence of malignant transformation of vulvar lichen sclerosus (VLS) and possible risk factors. Methods This is a cohort study with data analysis from medical records of 138 patients with histological diagnosis of VLS registered at the Vulvar Pathology Outpatient Clinic of the University Hospital, between 2007 and 2017. Predominance of risk factors was performed using logistic regression analysis. The variables studied were the length of follow-up, age, regular or irregular follow up; presence of symptoms (dyspareunia, pruritus and/or vulvar burning); histology characteristics, the presence of epithelial hyperplasia; and the presence of autoimmune diseases. Results There were 138 patients included in the study, and among them five progressed to malignant transformation. The patients had a median age of 59 years and 83% were symptomatic. The most frequent symptom was itching with 72%. Autoimmune diseases were present in 11.6%, the most prevalent being thyroid disease. All five case of malignant transformation (0.6%) had an irregular follow up. The logistic regression analysis was used among the studied variables, and no statistical significance was found among them (p ≥ 0.05). The relationship between hyperplasia and the clinical outcome of malignant transformation, in which non-significant but acceptable p value close to 0.05 was observed. Conclusion The prevalence of malignant transformation in patients with VLS was 0.6%, and common factors were the lack of adherence to medical treatments and the loss of follow-up.

Validation of the Brazilian 10-item Cervantes Scale for the assessment of menopausal symptoms

Abstract Objective: To validate the 10-item Cervantes Scale (CS-10) among Brazilian women. Methods: This is a cross-sectional observational study involving women in the community aged 40-55 years in the Southern region of Brazil. They completed a general health, habits and socio-demographic questionnaire, the CS-10 and the Women's Health Questionnaire (WHQ). Women unable to understand the survey, not consenting to participate, or having incapacity imposing difficulties during the completion of the questionnaire were excluded. A Confirmatory Factor Analysis (CFA) was conducted with the AMOS 16.0 software. Chi-square of degrees of freedom (χ2/df), the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI) and the Root-Mean-Square Error of Approximation (RMSEA) were used as indices of goodness of fit. Cronbach's alpha coefficient was used for internal consistency. Results: A total of 422 women were included (premenopausal n=35, perimenopausal n=172, postmenopausal n=215). The CFA for the CS-10 showed a good fit (χ²/df=1.454, CFI=0.989; TLI=0.985; RMSEA=0.033; CI 90%=0.002-0.052; PCLOSE=0.921; Model p=0.049). Good reliability was established in CS-10 and WHQ (Cronbach's alpha=0.724). Postmenopausal women had higher total CS-10 scores (p≤0.0001), reflecting worse quality of life (QoL) related to menopause symptoms and confirming the greater symptomatology evaluated by high total scores for WHQ found in this population when compared to those in the premenopausal period (p=0.041). Conclusion: The CS-10 is a consistent tool for health-related QoL in Brazilian mid-aged women.

Validation of the six-item female sexual function index in middle-aged brazilian women / Validação do índice de funcionamento sexual feminino-6 em mulheres brasileiras de meia-idade

Abstract Objective To validate the six-item female sexual function index (FSFI-6) in middleaged Brazilian women. Methods Cross-sectional observational study, involving 737 (premenopausal n = 117, perimenopausal n = 249, postmenopausal n = 371) Brazilian sexually active women, aged between 40 and 55 years, not using hormonal contraceptive methods. The Brazilian FSFI-6 was developed from the translation and cultural adaptation of the Portuguese FSFI-6 version. The participants completed a general questionnaire, the FSFI-6, and the menopause rating scale (MRS). The validation was performed by AMOS 16.0 software (SPSS, Inc., Chicago, IL, USA) for a confirmatory factor analysis (CFA). The chi-square of degrees of freedom (χ2/df), the comparative fit index (CFI), the Tucker- Lewis index (TLI) and the root-mean-square error of approximation (RMSEA) were used as indices of goodness of fit. Cronbach α coefficient was used for internal consistency. Results The process of cultural adaptation has not altered the Brazilian FSFI-6, as compared with the original content. The CFA for the FSFI-6 score showed an acceptable fit (χ2/df = 3.434, CFI = 0.990, TLI = 0.980, RMSEA = 0.058, 90% confidence interval (90%CI) = 0.033-0.083, p ≤ 0.001) and a good reliability was established in FSFI-6 and MRS (Cronbach α = 0.840 and = 0.854, respectively). In addition, 53.5% of the sample had low sexual function. Conclusion The FSFI-6 was translated and adapted to the Brazilian culture and is a consistent and reliable tool for female sexual dysfunction screening in Brazilianmiddleaged women.

Resumo Objetivo Validar o Índice de Função Sexual Feminina - 6 itens (FSFI-6, na sigla em inglês) para mulheres brasileiras de meia-idade. Métodos Estudo transversal observacional que incluiu 737 (pré-menopausa n = 117, perimenopausa n = 249, pós-menopausa n = 371) mulheres brasileiras sexualmente ativas, entre 40 e 55 anos, sem métodos contraceptivos hormonais. A versão brasileira do FSFI-6 foi desenvolvida através da tradução e adaptação cultural da versão portuguesa do questionário. As participantes preencheramumquestionário comdados gerais, o FSFI-6 e a escala de avaliação da menopausa (menopause rating scale [MRS]). A validação do instrumento se deu através de análise fatorial confirmatória (CFA, na sigla em inglês), realizada pelo software AMOS 16.0 (SPSS, Inc., Chicago, IL, EUA). Qui-quadrado sobre graus de liberdade (χ2/df), índice de ajuste comparativo (CFI, na siglaeminglês), índice de Tucker- Lewis (TLI) e raiz média dos quadrados dos erros de aproximação (RMSEA, na sigla em inglês) foram utilizados como índices de adequação de ajustes. O coeficiente alfa de Cronbach foi utilizado para avaliar a consistência interna. Resultados O processo de adaptação cultural não alterou a versão brasileira do FSFI-6, comparado ao conteúdo original. O CFA para o escore do FSFI-6 demonstrou ajuste aceitável (χ2/df = 3,434; CFI = 0,990; TLI = 0,980; RMSEA = 0,058; 90% IC = 0,033 a 0,083; p ≤ 0,001). Demonstrou-se boa confiabilidade entre FSFI-6 e MRS (alfa de Cronbach = 0,840 e = 0,854, respectivamente). Do total, 53,5% da amostra apresentou baixa função sexual. Conclusão O FSFI-6 foi traduzido e adaptado culturalmente, e é uma ferramenta consistente e confiável no rastreamento de disfunções sexuais em mulheres brasileiras de meia-idade.

Parto pretérmino: aspectos socio-demográficos en gestantes del hospital gineco-obstétrico “Enrique C. Sotomayor”, Guayaquil, Ecuador / Preterm delivery: socio-demographic aspects in expectant mothers of the “Enrique C. Sotomayor” ob/gyn hospital, Guayaquil, Ecuador

Objetivo: conocer las características socio-demográficas del parto pretérmino que presentaron las mujeres gestantes del hospital gineco-obstétrico “Enrique C. Sotomayor”. Metodología: se estudiaron mujeres gestantes que presentaron parto pretérmino inducido o espontáneo entre junio y agosto de 2009, en el hospital gineco-obstétrico “Enrique C. Sotomayor”, mediante un estudio descriptivo que enumera las características socio-demográficas más importantes. Resultados: en total se evaluaron 300 gestantes, 260 pacientes de raza mestiza (87%) con edades entre 20 y 30 años (54%). Generalmente con grado de escolaridad menor de 12 años (81%), menos de cinco controles prenatales (49%), fumadoras (51%). Se evaluó estado nutricional: Hb <12mg/dl (57%) e IMC <18.5 (38%). Relación entre nivel de escolaridad y controles prenatales (R2 =0.75), relación Hb y antecedentes de parto prematuro p=0.04 OR=1.77, relación IMC con APP p=0.04. Conclusión: los factores de riesgo encontrados demostraron tener relación con los mencionados en las publicaciones científicas lo que indica la significancia que presentaron las variables descritas. Se evidenció que existe una estrecha relación entre la actitud de las pacientes y el conocimiento que tenían acerca del parto prematuro.

Objective: to know the socio-demographic characteristics of preterm delivery among pregnant women of the “Enrique C. Sotomayor” ob/gyn hospital. Methodology: pregnant women who had induced or spontaneous pre-term delivery between June and August 2009 at the “Enrique C. Sotomayor” ob/gyn hospital were evaluated through a descriptive study that lists their most important socio-demographic characteristics. Results: in total, 300 pregnant women were evaluated, with 260 patients of mixed race (87%), aged between 20 and 30 years (54%), generally with an educational level of less than 12 years (81%), with less than five prenatal visits (49%), and smokers (51%). Nutritional status was assessed: Hb <12mg/dl (57%) and BMI <18.5 (38%). Relationship between education level and prenatal care (R2 = 0,75); relationship between Hb and a history of pre-term delivery p=0.04 OR=1.77; relationship between BMI and APP p=0.04. Conclusion: the risk factors found were related to those factors mentioned in the scientific literature, which explains the significance of the relationships with the described variables. It was evident that there was a close relationship between the attitudes of patients and the knowledge that they had about premature birth.