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1.
Am J Obstet Gynecol ; 222(2): 114-122, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31513780

RESUMO

Vaginitis is one of the most common causes of patient visits to gynecologists, primary care providers, and urgent care centers. However, many women leave without a clear diagnosis or experience recurrent symptoms despite treatment. The 3 most common etiologies of vaginitis are trichomonas, bacterial vaginosis, and vulvovaginal candidiasis, which account for an estimated 70% of cases. The remaining 30% may be related to other causes of vaginitis, including atrophic vaginitis, desquamative inflammatory vaginitis, and vaginal erosive disease. The purpose of this review is to describe the noncandidal causes of acute and recurrent vaginitis, with the goal of improving the likelihood of accurate diagnosis as well as efficient and effective therapy. We excluded candidal vaginitis from our review because there was a recently published review on this topic in the Journal. The clinical presentation and evaluation of patients with symptoms of vaginitis can be triaged into 1 of 2 diagnostic pathways: noninflammatory and inflammatory vaginitis. The most common noninflammatory cause is bacterial vaginosis. Features such as irritation, purulent discharge, and the presence of polymorphonuclear neutrophils are more suggestive of an inflammatory process. Trichomoniasis is the most common cause of inflammatory vaginitis. Other well-described forms of inflammatory vaginitis include atrophic vaginitis, desquamative inflammatory vaginitis, and erosive disease. We present a review of the pathogenesis, symptoms, examination findings, diagnostic testing, and treatment for each of these causes of noncandidal vaginitis.


Assuntos
Anti-Infecciosos/uso terapêutico , Vaginite Atrófica/diagnóstico , Candidíase Vulvovaginal/diagnóstico , Vaginite por Trichomonas/diagnóstico , Vaginose Bacteriana/diagnóstico , Administração Intravaginal , Administração Oral , Anti-Inflamatórios/uso terapêutico , Vaginite Atrófica/terapia , Clindamicina/uso terapêutico , Desidroepiandrosterona/uso terapêutico , Diagnóstico Diferencial , Terapia de Reposição de Estrogênios , Estrogênios/uso terapêutico , Feminino , Humanos , Hidrocortisona/uso terapêutico , Inflamação , Líquen Plano/diagnóstico , Líquen Plano/terapia , Metronidazol/análogos & derivados , Metronidazol/uso terapêutico , Penfigoide Mucomembranoso Benigno/diagnóstico , Penfigoide Mucomembranoso Benigno/terapia , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/terapia , Pênfigo/diagnóstico , Pênfigo/terapia , Tamoxifeno/análogos & derivados , Tamoxifeno/uso terapêutico , Tinidazol/uso terapêutico , Vaginite por Trichomonas/terapia , Vaginite/diagnóstico , Vaginite/terapia , Vaginose Bacteriana/terapia
4.
Pak J Pharm Sci ; 31(5(Special)): 2283-2286, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30463825

RESUMO

To observe and analyze the effect of conjugated estrogen cream in the treatment of postmenopausal atrophic vaginitis. The 160 patients clearly diagnosed with postmenopausal atrophic vaginitis and treated in our hospital were selected as subjects and divided into study group and reference group with equal number of cases. The reference group was treated with compound metronidazole suppository, while the study group was treated with conjugated estrogen cream. The treatment efficacy of the two groups was compared and observed. Comparison of estradiol and folliclestimulating hormone levels after treatment in the two groups show that the study group has obvious advantage over the reference group, p<0.05; comparison of vagina cleanliness in the two groups after treatment shows the study group is significantly superior to the reference group, p<0.05; comparison of incidence of adverse reactions in the two groups shows that the study group has lower incidence, with statistical significance in comparison between the groups, p<0.05. Treatment of postmenopausal atrophic vaginitis with combination of conjugated estrogen cream and compound metronidazole suppository can achieve good results with high safety and reliability.


Assuntos
Vaginite Atrófica/tratamento farmacológico , Estrogênios Conjugados (USP)/administração & dosagem , Pomadas/administração & dosagem , Pós-Menopausa/efeitos dos fármacos , Vagina/efeitos dos fármacos , Administração Intravaginal , Idoso , Vaginite Atrófica/metabolismo , Estradiol/metabolismo , Feminino , Hormônio Foliculoestimulante/metabolismo , Humanos , Metronidazol/administração & dosagem , Pessoa de Meia-Idade , Pós-Menopausa/metabolismo , Resultado do Tratamento , Vagina/metabolismo
5.
Menopause ; 25(11): 1208-1213, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30358715

RESUMO

OBJECTIVES: The efficacy and safety of 25-µg 17ß-estradiol vaginal tablets (Vagifem) were assessed and compared with 1.25-mg conjugated equine estrogen vaginal cream (Premarin Vaginal Cream) for the relief of menopausal-derived atrophic vaginitis, resulting from estrogen deficiency. DESIGN: In a multicenter, open-label, randomized, parallel-group study, 159 menopausal women were treated for 24 weeks with either vaginal tablets or vaginal cream. Efficacy was evaluated by relief of vaginal symptoms and concentrations of serum estradiol and follicle-stimulating hormone. Safety was monitored by the incidence of adverse events, evaluation of endometrial biopsies, and clinical laboratory results. Patients also assessed the acceptability of the study medications. RESULTS: Composite scores of vaginal symptoms (dryness, soreness, and irritation) demonstrated that both treatments provided equivalent relief of the symptoms of atrophic vaginitis. At weeks 2, 12, and 24, increases in serum estradiol concentrations and suppression of follicle-stimulating hormone were observed in significantly more patients who were using the vaginal cream than in those who were using the vaginal tablets (p < 0.001). Fewer patients who were using the vaginal tablets experienced endometrial proliferation or hyperplasia compared with patients who were using the vaginal cream. Significantly more patients who were using the vaginal tablets rated their medication favorably than did patients who were using the vaginal cream (p ≤ 0.001). Patients who were receiving the vaginal tablets also had a lower incidence of patient withdrawal (10% versus 32%). CONCLUSIONS: Treatment regimens with 25-µg 17ß-estradiol vaginal tablets and with 1.25-mg conjugated equine estrogen vaginal cream were equivalent in relieving symptoms of atrophic vaginitis. The vaginal tablets demonstrated a localized effect without appreciable systemic estradiol increases or estrogenic side effects. Vaginal tablet therapy resulted in greater patient acceptance and lower withdrawal rates compared with vaginal cream therapy.


Assuntos
Vaginite Atrófica/tratamento farmacológico , Estradiol/uso terapêutico , Estrogênios Conjugados (USP)/uso terapêutico , Estrogênios/uso terapêutico , Menopausa/efeitos dos fármacos , Cremes, Espumas e Géis Vaginais/uso terapêutico , Administração Intravaginal , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Vaginite Atrófica/sangue , Hiperplasia Endometrial/etiologia , Estradiol/administração & dosagem , Estradiol/efeitos adversos , Estradiol/sangue , Estrogênios/administração & dosagem , Estrogênios Conjugados (USP)/administração & dosagem , Feminino , Hormônio Foliculoestimulante/sangue , Humanos , Menopausa/sangue , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Resultado do Tratamento , Cremes, Espumas e Géis Vaginais/administração & dosagem , Cremes, Espumas e Géis Vaginais/efeitos adversos
6.
Nurs Womens Health ; 22(5): 423-430, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30170002

RESUMO

Genitourinary syndrome of menopause (GSM), formerly referred to as vulvovaginal atrophy or atrophic vaginitis, is a common chronic condition that requires a collaborative treatment plan between a health care provider and a woman to relieve symptoms and improve quality of life. Many women are not aware that symptoms can be controlled with treatment. Current treatment options approved for GSM include vaginal moisturizers, lubricants, and hormones. For women with GSM symptoms that are unresponsive to nonhormonal therapy, low-dose vaginal estrogen therapy is the preferred pharmacologic treatment. Clinicians should be trained to routinely ask appropriate questions during the history to elicit sufficient information to assess for GSM. Physical examination findings may further confirm suspicion of GSM.


Assuntos
Vaginite Atrófica/diagnóstico , Vaginite Atrófica/terapia , Menopausa , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome
7.
Ugeskr Laeger ; 180(10)2018 Mar 05.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29536840

RESUMO

Clitoral phimosis or preputial fusion may occur as a result of atrophic vaginitis among other conditions. A 72-year-old woman presented with atrophic vaginitis, preputial fusion, and a painful periclitorial pseudocyst. We suggest that a minimal surgery approach in a manual retraction of the synarchies without making an incision is a gentle and effective surgical management of preputial fusion. Suturing the ends from each other combined with continuous topical prophylaxis will minimise the risk of recurrence of pseudo-cyst and prevent worsening scar tissue formation.


Assuntos
Clitóris , Cistos , Doenças da Vulva , Idoso , Vaginite Atrófica/complicações , Clitóris/patologia , Clitóris/cirurgia , Cistos/etiologia , Cistos/patologia , Cistos/cirurgia , Feminino , Humanos , Doenças da Vulva/complicações , Doenças da Vulva/patologia , Doenças da Vulva/cirurgia
8.
Natl Med J India ; 31(3): 149-150, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31044761

RESUMO

Discharge per vaginum is a common symptom of a variety of gynaecological diseases. Among post-menopausal women, atrophic vaginitis, cervicitis and cervical carcinoma are common causes of this symptom. We present a 64-year-old woman who had foul-smelling discharge per vaginum for the past 1 year. Per speculum examination revealed an unhealthy-looking cervix and white discharge. On bi-manual examination, the cervix was flush with the vagina. There was no obvious growth felt, the exact uterine size could not be ascertained and the finger was stained with thick discharge. A biopsy of the cervix showed epithelioid cell granulomas and a diagnosis of tuberculosis was made. The patient responded to antitubercular therapy. Tuberculosis of the cervix may be a rare cause of foul- smelling discharge per vaginum in post-menopausal women but there should be a high index of suspicion of this condition, especially in areas where tuberculosis is common. We report this post-menopausal woman owing to the rarity of tuberculosis of the cervix mimicking a gynaecological malignancy.


Assuntos
Antituberculosos/administração & dosagem , Tuberculose dos Genitais Femininos/diagnóstico , Descarga Vaginal/diagnóstico , Vaginite Atrófica/diagnóstico , Colo do Útero/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Pós-Menopausa , Resultado do Tratamento , Tuberculose dos Genitais Femininos/complicações , Tuberculose dos Genitais Femininos/tratamento farmacológico , Tuberculose dos Genitais Femininos/patologia , Neoplasias do Colo do Útero/diagnóstico , Cervicite Uterina/diagnóstico , Descarga Vaginal/tratamento farmacológico , Descarga Vaginal/etiologia , Descarga Vaginal/patologia
9.
Gynecol Endocrinol ; 34(2): 140-143, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28853624

RESUMO

Aim of this study was to evaluate the efficacy of ospemifene in the prevention of recurrent lower urinary tract infections in postmenopausal women with vulvovaginal atrophy. The study have a retrospective design. Thirty-nine patients were enrolled. Patients underwent clinical examination and urine culture. The urinary symptoms and the quality of life were evaluated with UTISA score, PUF and SF-36 questionnaires before and after treatment. All 39 patients received ospemifene 60 mg one tablet/daily for 6 months. Adverse effects and complications were assessed. Thirty-nine patients were enrolled in the study. Two patients experienced one new UTI episode and the mean number of positive urine culture decreased significantly after 6 months (3.65 ± 2.12 vs 0.25 ± 0.17, p < .0001). The mean number of urinary infection symptoms decreased significantly after treatment; dysuria reduced (4.76 ± 2.45 vs 0.89 ± 1.12). PUF score and SF-36 showed a statistically significant change (22.43 ± 5.89 vs 12.14 ± 3.21) and (52.86 ± 9.21 vs 83.43 ± 10.76). No adverse effects were reported and the total success rate was the 92.3% after 6 months at PGI-I. Ospemifene is a valid alternative with excellent tolerability for the UTIS prevention in postmenopausal patients.


Assuntos
Vaginite Atrófica/tratamento farmacológico , Pós-Menopausa , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Tamoxifeno/análogos & derivados , Infecções Urinárias/prevenção & controle , Vulvovaginite/tratamento farmacológico , Idoso , Vaginite Atrófica/complicações , Vaginite Atrófica/fisiopatologia , Vaginite Atrófica/urina , Disuria/etiologia , Disuria/prevenção & controle , Feminino , Seguimentos , Hospitais Universitários , Humanos , Itália/epidemiologia , Perda de Seguimento , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco , Prevenção Secundária , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Autorrelato , Índice de Gravidade de Doença , Tamoxifeno/efeitos adversos , Tamoxifeno/uso terapêutico , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Urina/microbiologia , Vulvovaginite/complicações , Vulvovaginite/fisiopatologia , Vulvovaginite/urina
10.
Mayo Clin Proc ; 92(12): 1842-1849, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29202940

RESUMO

Genitourinary syndrome of menopause (GSM), previously known as atrophic vaginitis or vulvovaginal atrophy, affects more than half of postmenopausal women. Caused by low estrogen levels after menopause, it results in bothersome symptoms, including vaginal dryness, itching, dyspareunia, urinary urgency and increased frequency, and urinary tract infections. Even though women with GSM can have sexual dysfunction that interferes with partner relationships, women are often embarrassed to seek treatment, and health care professionals do not always actively screen for GSM. As a result, GSM remains underdiagnosed and undertreated. Several effective treatments exist, but low-dose vaginal estrogen therapy is the criterion standard. It is effective and safe for most patients, but caution is suggested for survivors of hormone-sensitive cancers. Newer treatment options include selective estrogen receptor modulators, vaginal dehydroepiandrosterone, and laser therapy. Nonprescription treatments include vaginal lubricants, moisturizers, and dilators. Pelvic floor physical therapy may be indicated for some women with concomitant pelvic floor muscle dysfunction. Sex therapy may be helpful for women with sexual dysfunction. This concise review presents a practical approach to the evaluation and management of GSM for the primary care physician.


Assuntos
Vaginite Atrófica/terapia , Menopausa , Incontinência Urinária/terapia , Doenças Vaginais/terapia , Doenças da Vulva/terapia , Saúde da Mulher , Terapia de Reposição de Estrogênios , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Síndrome
11.
Mar Drugs ; 15(10)2017 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-29048359

RESUMO

The aim of the present work was the development of chitosan ascorbate nanoparticles (CSA NPs) loaded into a fast-dissolving matrix for the delivery of antibiotic drugs in the treatment of atrophic vaginitis. CSA NPs loaded with amoxicillin trihydrate (AX) were obtained by ionotropic gelation in the presence of pentasodium tripolyphosphate (TPP). Different CSA:TPP and CSA:AX weight ratios were considered and their influence on the particle size, polydispersion index and production yield were investigated. CSA NPs were characterized for mucoadhesive, wound healing and antimicrobial properties. Subsequently, CSA NPs were loaded in polymeric matrices, whose composition was optimized using a DoE (Design of Experiments) approach (simplex centroid design). Matrices were obtained by freeze-drying aqueous solutions of three hydrophilic excipients, polyvinylpirrolidone, mannitol and glycin. They should possess a mechanical resistance suitable for the administration into the vaginal cavity and should readily dissolve in the vaginal fluid. In addition to antioxidant properties, due to the presence of ascorbic acid, CSA NPs showed in vitro mucoadhesive, wound healing and antimicrobial properties. In particular, nanoparticles were characterized by an improved antimicrobial activity with respect to a chitosan solution, prepared at the same concentration. The optimized matrix was characterized by mechanical resistance and by the fast release in simulated vaginal fluid of nanoparticles characterized by unchanged size.


Assuntos
Antibacterianos/farmacologia , Antioxidantes/farmacologia , Vaginite Atrófica/tratamento farmacológico , Sistemas de Liberação de Medicamentos/métodos , Nanopartículas/química , Amoxicilina/farmacologia , Antioxidantes/química , Organismos Aquáticos/química , Ácido Ascórbico/química , Ácido Ascórbico/farmacologia , Células Cultivadas , Quitosana/química , Quitosana/farmacologia , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Excipientes/química , Feminino , Fibroblastos , Liofilização , Humanos , Oceanos e Mares , Solubilidade , Cicatrização/efeitos dos fármacos
13.
Mol Cells ; 40(9): 677-684, 2017 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-28843271

RESUMO

Postmenopausal atrophic vagina (PAV) is the thinning of the walls of the vagina and decreased lugae of the vagina. PAV is caused by decreased estrogen levels in postmenopausal women. However, the harmful effects of hormone replacement therapy (HRT) have resulted in considerable caution in its use. Various estrogen agonist treatment options are available. Vitamin D is influences the regulation of differentiation and proliferation of various cells, especially tissues lining stratified squamous epithelium, such as the vaginal epithelium. In this study, we hypothesized that vitamin D could provide an alternative and a safe treatment option for PAV by promoting the proliferation and differentiation of the vaginal epithelium. Thirty six patients were enrolled in this case-control study. Vitamin D associated proteins in a vitamin D and sex hormone treated vaginal epithelial cell line as well as normal and PAV tissues were measured. To confirm of cell-to-cell junction protein expression, cell line and tissue studies included RT-PCR, immunohistochemistry staining, and immunoblot analyses. The expression of cell-to-cell junction proteins was higher in women with symptoms of atrophic vagina tissue compared to women without the symptoms. Vitamin D stimulated the proliferation of the vaginal epithelium by activating p-RhoA and Erzin through the vitamin D receptor (VDR). The results suggest that vitamin D positively regulates cell-to-cell junction by increasing the VDR/p-RhoA/p-Ezrin pathway. This is the first study to verify the relationship of the expression of RhoA and Ezrin proteins in vaginal tissue of PAV.


Assuntos
Vaginite Atrófica/tratamento farmacológico , Proliferação de Células/efeitos dos fármacos , Proteínas do Citoesqueleto/genética , Vitamina D/administração & dosagem , Proteína rhoA de Ligação ao GTP/genética , Idoso , Vaginite Atrófica/genética , Vaginite Atrófica/patologia , Atrofia/tratamento farmacológico , Atrofia/genética , Atrofia/patologia , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular , Proliferação de Células/genética , Células Epiteliais/efeitos dos fármacos , Estrogênios/metabolismo , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Pós-Menopausa/efeitos dos fármacos , Pós-Menopausa/genética , Receptores de Calcitriol/genética , Vagina/efeitos dos fármacos , Vagina/patologia
14.
Br J Nurs ; 26(9): S12-S19, 2017 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-28493770

RESUMO

In her lifetime, a woman is highly likely to develop at least one lower urinary tract infection. Early detection and treatment are key. Being aware of predisposing factors for infection and understanding appropriate diagnosis and treatment regimens will help nurses in both primary and acute care manage these patients correctly. This will not only benefit patients but will also help prevent incorrect antimicrobial management and avoid unplanned admissions. This aim of this article is to provide nurses with the information they need to best advise both colleagues and patients on how to manage lower urinary tract infections in women.


Assuntos
Antibacterianos/uso terapêutico , Infecções Assintomáticas , Farmacorresistência Bacteriana , Infecções Urinárias/tratamento farmacológico , Fatores Etários , Anti-Infecciosos Urinários/uso terapêutico , Vaginite Atrófica/tratamento farmacológico , Vaginite Atrófica/epidemiologia , Bacteriúria/diagnóstico , Bacteriúria/tratamento farmacológico , Bacteriúria/prevenção & controle , Bacteriúria/urina , Anticoncepção , Técnicas de Cultura , Terapia de Reposição de Estrogênios , Feminino , Hipuratos/uso terapêutico , Humanos , Metenamina/análogos & derivados , Metenamina/uso terapêutico , Nitritos/urina , Educação de Pacientes como Assunto , Probióticos/uso terapêutico , Recidiva , Fatores de Risco , Comportamento Sexual , Infecções Urinárias/diagnóstico , Infecções Urinárias/prevenção & controle
15.
J Cutan Med Surg ; 21(5): 418-424, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28453946

RESUMO

BACKGROUND: Genitourinary syndrome of menopause (GSM) is a debilitating condition caused by hypoestrogenism that presents with vaginal dryness and dyspareunia as well as other genital, sexual, and urinary symptoms. Previously known as atrophic vaginitis, the term GSM is now used. OBJECTIVE: To help familiarise dermatologists with diagnosing and managing GSM. METHODS: In total, 218 articles were identified and reviewed by 2 independent authors using PubMed. Articles included were from December 2005 to December 2015. Sixty-seven articles met our inclusion criteria. RESULTS: GSM is a clinical diagnosis, requiring the presence of symptoms that should be bothersome and not accounted for by another condition. A pH test may help with diagnosis as vaginal pH will be increased from acidic to neutral. The Papanicolaou test is not recommended because of poor clinical correlation. First-line treatment is low-dose local vaginal estrogen therapy, which has proven efficacy and safety. Serum estrogen levels are not significantly affected with the exception of creams containing high-dose conjugated equine estrogens. Other options have yet to be approved for use in Canada but show promise. CONCLUSION: GSM is a debilitating and common condition that suffers from barriers to diagnosis and treatment. Current treatments are well tolerated, rewarding, and effective with rapid onset.


Assuntos
Vaginite Atrófica/tratamento farmacológico , Dermatologia , Dispareunia/tratamento farmacológico , Estrogênios/uso terapêutico , Menopausa , Papel do Médico , Vaginite Atrófica/diagnóstico , Dispareunia/diagnóstico , Estrogênios/administração & dosagem , Feminino , Humanos , Concentração de Íons de Hidrogênio , Síndrome , Vagina/química , Cremes, Espumas e Géis Vaginais
16.
Arch Pathol Lab Med ; 141(5): 666-670, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28301226

RESUMO

CONTEXT: - Adenocarcinoma in situ (AIS) is difficult to correctly interpret on Papanicolaou (Pap) cytology slides and false-negative interpretations of AIS can cause significant problems in daily practice. OBJECTIVE: - To investigate the false-negative interpretation rate of AIS and the factors related to false-negative interpretation through responses in an educational environment. DESIGN: - We retrospectively evaluated 11 337 responses in the PAP Education Program (PAP-Edu) from 173 AIS slides from 2011 to 2015. The false-negative interpretation rate, most common false-negative interpretations, and related other factors were evaluated. RESULTS: - The overall false-negative rate was 6.9% (784 of 11 337). Respondents correctly interpreted AIS 50.0% (5667 of 11 337) of the time; high-grade intraepithelial lesion (HSIL) and malignancies (adenocarcinoma, squamous cell carcinoma, and other carcinomas) accounted for 42.7% (4842 of 11 337) and low-grade intraepithelial lesion accounted for 0.4% (44 of 11 337) of responses. Overall, 92.7% (10 509 of 11 337) of responses were HSIL and above. Among 784 false-negative responses, negative for intraepithelial lesion or malignancy was the most common (61.5% [482 of 784]), followed by reparative changes (24.1% [189 of 784]) and atrophic vaginitis (7.7% [60 of 784]). Overall, pathologists' responses showed a significantly higher false-negative rate than cytotechnologists' responses (8.3%, 403 of 4835 versus 5.7%, 275 of 4816; P < .001). The false-negative response rates were not statistically different among preparation types. CONCLUSIONS: - The low correct interpretation rate and higher false-negative rate for AIS demonstrate the difficulty in interpreting AIS on Pap cytology, which may cause clinical consequences. The higher false-negative rate with pathologists than with cytotechnologists suggests cytotechnologists' higher screening sensitivity for AIS or cautious interpretation to avoid false-positive results by pathologists.


Assuntos
Adenocarcinoma in Situ/patologia , Vaginite Atrófica/patologia , Carcinoma de Células Escamosas/patologia , Patologia Clínica/educação , Patologia Molecular/educação , Adenocarcinoma in Situ/diagnóstico , American Medical Association , Vaginite Atrófica/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Erros de Diagnóstico , Reações Falso-Negativas , Feminino , Humanos , Teste de Papanicolaou , Estudos Retrospectivos , Estados Unidos
17.
Eur J Obstet Gynecol Reprod Biol ; 207: 125-128, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27838537

RESUMO

OBJECTIVE: To assess whether the orally administered combination of hyaluronic acid (HA), chondroitin sulfate (CS), curcumin and quercetin could be effective in preventing recurrent cystitis in postmenopausal women and whether its efficacy was conditioned by the concurrent use of local estrogen therapy. STUDY DESIGN: This was a prospective evaluation of 145 postmenopausal women consecutively recruited from the database of three different investigators. All women should have mild-to-moderate urogenital atrophy and a history of recurrent urinary tract infections (≥2 episodes within 6 months or ≥3 episodes within 12 months documented by positive urine cultures) during the last year. Patients were assigned to three different therapeutic regimens: the first group was treated only with vaginal estrogens, the second group only with HA, CS, curcumin and quercetin per os, and the third group was treated with HA, CS, curcumin and quercetin associated with local estrogens. We evaluated the number of patients with <2 infective episodes in the 6-month follow-up and <3 episodes in the 12-month follow-up (main aim definition) and the reduction of related symptoms through a Visual Analog Scale (VAS) and the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale. Student's t-test and chi-squared test were used for data analysis as appropriate. RESULTS: At 6-month follow up, the main aim rate was 8%, 11.1% and 25% in the three groups, respectively (p<0.05 compared to baseline only in group 3). Although the reduction in the number of recurrent episodes became significant in all groups at 1 year follow-up, the main aim rate was almost double in women receiving both local estrogens and oral therapy (group 3) compared to those receiving single treatments. The improvement of related symptoms was significant in all groups at 12-month follow-up. CONCLUSIONS: In postmenopausal women, the combination of HA, CS, curcumin and quercetin per os was effective in preventing recurrent urinary tract infections, especially if administered with vaginal estrogen therapy.


Assuntos
Envelhecimento , Sulfatos de Condroitina/uso terapêutico , Curcumina/uso terapêutico , Suplementos Nutricionais , Ácido Hialurônico/uso terapêutico , Quercetina/uso terapêutico , Infecções Urinárias/prevenção & controle , Anti-Infecciosos Urinários/efeitos adversos , Anti-Infecciosos Urinários/uso terapêutico , Antioxidantes/efeitos adversos , Antioxidantes/uso terapêutico , Vaginite Atrófica/complicações , Vaginite Atrófica/tratamento farmacológico , Vaginite Atrófica/fisiopatologia , Sulfatos de Condroitina/efeitos adversos , Terapia Combinada/efeitos adversos , Curcumina/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Resistência à Doença/efeitos dos fármacos , Estriol/efeitos adversos , Estriol/uso terapêutico , Terapia de Reposição de Estrogênios/efeitos adversos , Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Feminino , Humanos , Ácido Hialurônico/efeitos adversos , Pessoa de Meia-Idade , Pós-Menopausa , Quercetina/efeitos adversos , Prevenção Secundária , Índice de Gravidade de Doença , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Infecções Urinárias/urina , Cremes, Espumas e Géis Vaginais/efeitos adversos , Cremes, Espumas e Géis Vaginais/uso terapêutico
18.
J Huazhong Univ Sci Technolog Med Sci ; 36(5): 723-726, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27752911

RESUMO

This study investigated the prevalence and risk factors of urinary incontinence (UI) among perimenopausal women in Wuhan. A cross-sectional survey was performed on 1067 women aged 40-65 years sampled in Wuhan urban area from April to October 2014. Information about demographic characteristics, menstruation, parity and UI symptoms was collected using a questionnaire. The data were evaluated by Chi-square test and multiple Logistic regression analysis. The prevalence rate of UI was 37.2%, with stress UI (32.2%) being more prevalent than urgency UI (21.6%) and mixed UI (16.6%). 31.2% women with UI stated that UI had negative impact on their life. Risk factors for UI included menstrual disorder, menopause, overweight, perineal laceration, atrophic vaginitis, constipation and pelvic organ prolapse. Appropriate investigation apropos the factors associated with UI should be performed to diminish its impact on women's life.


Assuntos
Perimenopausa/fisiologia , Incontinência Urinária/epidemiologia , Adulto , Idoso , Vaginite Atrófica/epidemiologia , Vaginite Atrófica/fisiopatologia , Constipação Intestinal/epidemiologia , Constipação Intestinal/fisiopatologia , Feminino , Humanos , Lacerações/epidemiologia , Lacerações/fisiopatologia , Ciclo Menstrual/fisiologia , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Sobrepeso/fisiopatologia , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/fisiopatologia , Gravidez , Fatores de Risco , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia
19.
Am J Obstet Gynecol ; 215(6): 704-711, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27472999

RESUMO

Genitourinary syndrome of menopause, a new term for a condition more renowned as atrophic vaginitis, is a hypoestrogenic condition with external genital, urological, and sexual implications that affects >50% of postmenopausal women. Due to sexual embarrassment and the sensitive nature of discussing symptoms, genitourinary syndrome of menopause is greatly underdiagnosed. The most up-to-date literature pertaining to clinical manifestations, pathophysiology, etiology, evaluation, and management of genitourinary syndrome of menopause is comprehensively reviewed. Early detection and individually tailored pharmacologic (eg, estrogen therapy, selective estrogen receptor modulator, synthetic steroid, oxytocin, and dehydroepiandrosterone) and/or nonpharmacologic (eg, laser therapies, moisturizers and lubricants, homeopathic remedies, and lifestyle modifications) treatment is paramount for not only improving quality of life but also for preventing exacerbation of symptoms in women with this condition.


Assuntos
Vaginite Atrófica/fisiopatologia , Dispareunia/fisiopatologia , Menopausa , Incontinência Urinária/fisiopatologia , Doenças da Vulva/fisiopatologia , Vaginite Atrófica/diagnóstico , Vaginite Atrófica/metabolismo , Vaginite Atrófica/terapia , Desidroepiandrosterona/uso terapêutico , Dispareunia/diagnóstico , Dispareunia/metabolismo , Dispareunia/terapia , Terapia de Reposição de Estrogênios/métodos , Feminino , Humanos , Estilo de Vida , Terapia com Luz de Baixa Intensidade/métodos , Lubrificantes/uso terapêutico , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Qualidade de Vida , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Síndrome , Incontinência Urinária/diagnóstico , Incontinência Urinária/metabolismo , Incontinência Urinária/terapia , Doenças da Vulva/diagnóstico , Doenças da Vulva/metabolismo , Doenças da Vulva/terapia
20.
Breast Cancer Res Treat ; 157(2): 203-210, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27178335

RESUMO

Atrophic vaginitis represents a major barrier to compliance with aromatase inhibitor (AI) therapy in breast cancer (BC) survivors. While local estrogen therapy is effective for postmenopausal vaginal dryness, the efficacy of such therapies has not been evaluated systematically in hormone receptor-positive (HR+) BC patients on AI therapy. Furthermore, the potential risk of breast cancer recurrence with vaginal estrogen therapy represents a long-term safety concern for the patients with HR + BC. Unfortunately, there is no standardized assay to measure very low concentrations of estradiol (E2) in these women being treated with AI therapy. This makes it difficult to evaluate even indirectly the potential risk of BC recurrence with vaginal estrogen therapy in HR + BC patients on AI therapy. In this review, we describe available assays to measure very low concentrations of E2, discuss the Food and Drug Administration-approved vaginal estrogen products on the market, and summarize published and ongoing clinical trials evaluating the safety and efficacy of vaginal estrogen in HR + BC patients on AI therapy. In the absence of any randomized controlled clinical trials, this review serves as a summary of available clinical data and ongoing studies to aid clinicians in selecting the best available option for their patients.


Assuntos
Inibidores da Aromatase/efeitos adversos , Vaginite Atrófica/tratamento farmacológico , Neoplasias da Mama/tratamento farmacológico , Estrogênios/administração & dosagem , Recidiva Local de Neoplasia/induzido quimicamente , Administração Intravaginal , Inibidores da Aromatase/uso terapêutico , Vaginite Atrófica/sangue , Vaginite Atrófica/induzido quimicamente , Neoplasias da Mama/sangue , Ensaios Clínicos como Assunto , Estradiol/sangue , Estrogênios/efeitos adversos , Feminino , Humanos , Cooperação do Paciente , Pós-Menopausa , Sobreviventes
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