Critical analysis of methods for assessing genitourinary syndrome of menopause used in clinical trials.

OBJECTIVE: The aim of the study was to determine the most used methods for assessing genitourinary syndrome of menopause by the latest studies on the subject, and to critically assess their differences and comparability. METHODS: A narrative review of the literature was conducted, employing the terms genitourinary syndrome, vaginal atrophy, urogenital atrophy, and atrophic vaginitis, to analyze methods used to assess treatment efficacy. Only controlled randomized clinical trials assessing improvement of genitourinary syndrome of menopause, conducted in the last 5 years, and considering all types of treatment, were selected. RESULTS: Of the 37 studies included, 24 combined both objective and subjective methods thereby ensuring reproducibility and efficacy of symptom relief of the treatment analyzed. The vaginal maturation index was the most used objective method, followed by vaginal pH. One study used histological and immunohistochemistry tests. Regarding subjective methods, the "Most bothering Symptom" and other questionnaires as the Female Sexual Function Index for sex life, the Verbal Rating Scale, among others, were used. CONCLUSIONS: Despite the heterogeneity observed, particularly for subjective assessment of symptoms, there was a tendency to standardize methods and to use an objective method together with a subjective, which seems to be fundamental to guarantee reproducibility and comparability of results of each treatment analyzed. Histological and immunohistochemistry tests may be an option as an objective method in further studies, to better assess thickness, vascularization, among other parameters.

Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause.

OBJECTIVES: The objective of this prospective comparative cohort study was to establish the effectiveness and safety of Erbium:YAG (Er:YAG) laser treatment for genitourinary syndrome of menopause and to compare it with an established topical estriol treatment. METHODS: Fifty patients with genitourinary syndrome of menopause were divided into two groups. The estriol group received a treatment of 0.5 mg estriol ovules for 8 weeks and the laser group was first treated for 2 weeks with 0.5 mg estriol ovules 3 times per week to hydrate the mucosa and then received three sessions with 2,940 nm Er:YAG laser in non-ablative mode. Biopsies were taken before and at 1, 3, 6, and 12 months post-treatment. Maturation index, maturation value and pH where recorded up to 12-months post-treatment, while the VAS analysis of symptoms was recorded up to 18 months post-treatment. RESULTS: Statistically significant (P < 0.05), reduction of all assessed symptoms was observed in the laser group at all follow-ups up to 18 months post-treatment. Significant improvement in maturation value and a decrease of pH in the laser group was detected up to 12 months after treatment. The improvement in all endpoints was more pronounced and longer lasting in the laser group. Histological examination showed changes in the tropism of the vaginal mucosa and also angiogenesis, congestion, and restructuring of the lamina propria in the laser group. Side effects were minimal and of transient nature in both groups, affecting 4% of patients in the laser group and 12% of patients in the estriol group. CONCLUSIONS: Our results show that Er:YAG laser treatment successfully relieves symptoms of genitourinary syndrome of menopause and that the results are more pronounced and longer lasting compared to topical estriol treatment. Lasers Surg. Med. 49:160-168, 2017. © 2016 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Female aging / Envelhecimento feminino

SUMMARY Female aging is a process that involves hypoestrogenism time, the individual impact on each woman, and what we can do as experts to reduce morbidity and provide quality of life. This natural process in the female life cycle has been of concern to women after menopause. Changes in different biophysical and psychosocial aspects, and their individual experiences, have repercussions on the lives of patients seeking specialized and multidisciplinary support to reduce the harmful effects of prolonged hypoestrogenism. Overweight and obesity, inadequate living habits and the presence of multi-morbidities cause damage to the quality of life and impact the functional capacity. Behavioral prescription and hormone therapy are among the treatments given to ease symptoms and reduce morbidity. A better understanding of these factors can help identify groups that require more care after menopause.

RESUMO O envelhecimento feminino é um processo em que devemos correlacionar o tempo do hipoestrogenismo com o impacto individual em cada mulher e o que poderemos fazer, enquanto especialistas, para reduzir morbidades e proporcionar qualidade de vida. Esse processo natural no ciclo de vida da mulher tem sido motivo de preocupação das mulheres na pós-menopausa. As transformações nos diferentes aspectos biofísicos, psicossociais e em suas vivências individuais trazem repercussões na vida das pacientes, que buscam apoio especializado e multiprofissional para reduzir os efeitos deletérios do hipoestrogenismo prolongado. O sobrepeso e a obesidade, inadequados hábitos de vida e a presença de multimorbidades trazem prejuízos à qualidade de vida e impactam a capacidade funcional. A prescrição comportamental e a terapia hormonal são tratamentos indicados para amenizar os sintomas e reduzir morbidades. Assim, uma melhor compreensão desses fatores pode ajudar a identificar grupos propensos a cuidados na pós-menopausa.

Female aging.

Female aging is a process that involves hypoestrogenism time, the individual impact on each woman, and what we can do as experts to reduce morbidity and provide quality of life. This natural process in the female life cycle has been of concern to women after menopause. Changes in different biophysical and psychosocial aspects, and their individual experiences, have repercussions on the lives of patients seeking specialized and multidisciplinary support to reduce the harmful effects of prolonged hypoestrogenism. Overweight and obesity, inadequate living habits and the presence of multi-morbidities cause damage to the quality of life and impact the functional capacity. Behavioral prescription and hormone therapy are among the treatments given to ease symptoms and reduce morbidity. A better understanding of these factors can help identify groups that require more care after menopause.

Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections / Ruptura prematura das membranas fetais pré-termo: associação com fatores sociodemográficos e infecções geniturinárias maternas

OBJECTIVE: tthis study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. METHODS: this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight > 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. RESULTS: of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR] = 1.94), with lower level of schooling (PR = 2.43), age > 29 years (PR = 2.49), and smokers (PR = 2.04). It was also associated with threatened miscarriage (PR = 1.68) and preterm labor, (PR = 3.40). There was no association with maternal urinary tract infection or presence of genital discharge. CONCLUSIONS: the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach. .

OBJETIVO: o objetivo deste estudo foi verificar a ocorrência da ruptura prematura das membranas fetais pré-termo em gestações únicas e sua associação com fatores sociodemográficos maternos e infecções geniturinárias autorreferidas. MÉTODOS: estudo transversal de base populacional onde foram incluídas todas as mães dos recém-nascidos dos partos únicos ocorridos no ano de 2010, com peso ao nascer igual ou superior a 500 gramas, residentes no município. As puérperas foram entrevistadas nas duas maternidades da cidade. Foram considerados casos as gestantes que perderam líquido amniótico antes da internação hospitalar e cujo tempo de gestação fosse inferior a 37 semanas. Foi realizada análise estatística por níveis, para controle de fatores de confusão por meio da regressão de Poisson. RESULTADOS: das 2.244 mulheres elegíveis para o estudo, 3,1% apresentaram ruptura prematura das membranas fetais pré-termo, a qual foi mais frequente, após ajuste, nas mulheres de menor nível econômico, razão de prevalência (RP) de 1,94, menor escolaridade, RP de 2,43, com idade superior a 29 anos, RP de 2,49 e tabagistas, RP de 2,04. Também esteve relacionada com ameaça de aborto, RP de 1,68, e de trabalho de parto pré-termo, RP de 3,40. Não houve associação com infecção urinária materna ou presença de corrimento genital. CONCLUSÕES: o desfecho foi mais frequente nas puérperas com menor escolaridade, mais pobres, mais velhas e tabagistas, assim como naquelas com histórico de ameaça de abortamento e trabalho de parto prematuro. Estes fatores devem ser considerados na sua abordagem preventiva, diagnóstica e terapêutica. .

Preterm premature rupture of the fetal membranes: association with sociodemographic factors and maternal genitourinary infections.

OBJECTIVE: this study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. METHODS: this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight ≥ 500 grams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. RESULTS: of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR]=1.94), with lower level of schooling (PR=2.43), age > 29 years (PR=2.49), and smokers (PR=2.04). It was also associated with threatened miscarriage (PR=1.68) and preterm labor, (PR=3.40). There was no association with maternal urinary tract infection or presence of genital discharge. CONCLUSIONS: the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach.

Ketorolac tromethamine improves the analgesic effect of hyoscine butylbromide in patients with intense cramping pain from gastrointestinal or genitourinary origin.

The symptomatic treatment of pain associated with spasm of gastrointestinal or genitourinary origin can include the use of spasmolytic agents and/or non-steroidal anti-inflammatory drugs. However, the evidence of a superior effectiveness of combination in comparison with individual drugs is scarce and controversial. A double-blind, randomised, clinical trial study was designed to characterize the analgesic effect and safety of ketorolac and hyoscine butylbromide against hyoscine butylbromide alone in patients with ambulatory acute cramping pain of gastrointestinal and genitourinary origin. 160 patients with a pain level ≥4 in a 1-10 cm visual analogue scale were allocated to receive a fixed dose of ketorolac/hyoscine butylbromide (10 mg/20 mg) or hyoscine butylbromide (20 mg) alone at 6 h intervals, during a 48 h period. Both treatments were similarly effective when compared as a whole or when groups were classified by pain origin. Conversely, when treatments were grouped by pain intensity, ketorolac/hyoscine butylbromide combination showed a significant better pain relief profile than hyoscine butylbromide alone in pain intensity ≥7, but not <7. Data indicate that the oral ketorolac/hyoscine butylbromide mixture could be a better option than hyoscine butylbromide alone in the treatment of some acute intense cramping painful conditions.

Factores de riesgo en la corioamnionitis / Chorioamnionitis risk factors

Se realizó un estudio de casos y controles de 96 gestantes (48 en cada grupo) que parieron en el Hospital Ginecoobstétrico Docente Tamara Bunke Bider de Santiago de Cuba, en el bienio 2008-2009, para determinar algunos factores clinicoepidemiológicos que incidieron en la aparición de corioamnionitis. En la investigación fueron incluidas todas las embarazadas con 28 semanas de gestación y más. Para validar los resultados se utilizaron la prueba no paramétrica de Ji al cuadrado, el método porcentual y las proporciones. En la casuística, los factores determinantes de la ocurrencia del proceso infeccioso, fueron: malnutrición materna por defecto (en 26,8 por ciento), politactos (más de 3 en 15,5 por ciento), infecciones genitales asociadas al embarazo (en 74,2 por ciento), tiempo de rotura de membranas e inicio del trabajo de parto después de 24 horas (en 22,7 por ciento).

A case-control study of 96 pregnant women (48 in each group) who delivered at Tamara Bunke Bider Teaching Gynecobstetric Hospital from Santiago de Cuba was carried out during the biennium 2008-2009, in order to determine some clinical-epidemiological factors that influence in the chorioamnionitis onset. All pregnant women with 28 gestation weeks or more were included in the research. Non-parametric chi-square test, percentage method, and proportions were used to validate the results. Determinant factors of the occurrence of the infectious process in the case material were as follows: maternal malnutrition by default (in 26,8 percent), multiple vaginal examination (more than 3 in 15,5 percent), pregnancy-associated genital infections (in 74,2 percent), and membrane rupture time and labor initiation after 24 hours (in 22,7 percent).

Measurement of damage in 210 Mexican patients with systemic lupus erythematosus: relationship with disease duration.

The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index is a validated instrument specifically designed to ascertain damage in SLE; this instrument has been applied mainly to Caucasians and African-American SLE patients. The objective of this study was to assess damage using the SLICC/ACR Damage Index in Mexican SLE patients. The SLICC/ACR Damage Index was applied to 210 consecutive SLE patients with disease of variable duration. The SLICC/ACR Damage Index was assessed by review of hospital clinical records, interview and physical examination. One hundred and seventeen (55.5%) patients had some damage. The proportion of patients with damage increased significantly with disease duration (33% at 1-60 months, 66% at 61-120 months and 70% at > or = 121 months, P < 0.001). The main organ systems involved were musculoskeletal (osteonecrosis), neuropsychiatric (neuropathy, seizures), gonadal (amenorrhea prior to age 40 years), ocular (cataracts), renal (glomerular filtration < 50%) and peripheral vascular (permanent damage by venous thrombosis). Damage was frequent, increased over time, particularly for ocular, renal, musculoskeletal and gonadal. Patients who experienced damage were older, had a longer disease duration, a greater number of ACR criteria at diagnosis, and were more likely to have renal involvement and antibodies to dsDNA. The damage occurred in many different domains and started to develop early after disease onset. Mexican patients had more peripheral vascular and gonadal involvement compared with published data from non-Hispanic SLE populations.

[Pre-existing diseases as risk factors and prognosis of genito-urinary infection in pregnancy]. / Antecedentes mórbidos de riesgo y predicción de la infección génito-urinaria durante el embarazo.

With the intention of reducing the abortion, preterm delivery and perinatal mortality caused by the genito urinary infection (GUI) we attempt to identify the risk factors and with those make a diagnostic test, that permits detection and prediction of GUI during gestation period. Morbidity records that suggests alterations of immune response were studied in a group of 165 pregnant women that presented GUI and were compared with 86 pregnant women without GUI. As risk antecedents, we found: spontaneous abortions of second trimester 42.4% (study group) and 6.9% (control group) (p < 0.01), repeated vaginitis 31.5% and 2.3% (p < 0.01) urinary tract infection (UTI) 29.7% and 6.92% (p < 0.01), preterm deliveries 17.6% and 3.52% (p < 0.01), puerperal infection 9.12% and 0.0% (p < 0.05), familiar diabetes 21.2% and 8.12% (p < 0.05). Psychiatric pathology 12.72 and 3.5% (p < 0.05), typhoid fever 12.1% and 3.5% (p < 0.05) and surgical infections 16.4% and 8.12% (p < 0.1). A score was elaborated assigning 1/2 point to: puerperal infections, familiar diabetes, psychiatric pathology, typhoid fever and surgical infections; 1 point to: abortion, vaginitis, UTI and preterm delivery and 2 points to: repeated abortion, UTI and preterm delivery. Patients were divided in multiparous and primiparas. In multiparous with 1 or more points we found: sensitivity 75.3%, specificity 81%, positive predictive value 89.3%, negative predictive value 60.7% and accuracy 77.1%. In primiparas with 1/2 or more points we found: sensitivity 61.8%, specificity 70.5%, positive predictive value 78.3%, negative predictive value 51.7% and accuracy 65%.