Herlyn-Werner-Wunderlich syndrome: clinical considerations and management.

Herlyn-Werner-Wunderlich syndrome (HWWS), defined by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis, is a rare Mullerian duct malformation, usually diagnosed after menarche, when symptoms related to haematocolpos arise. We report a case of a 14-year-old patient who presented to the emergency department complaining of proctalgia and pelvic pain treated in our medical centre. Ultrasound and abdomino-pelvic MRI imaging studies confirmed the diagnosis. Treatment was surgical incision of the vaginal septum. At the follow-up visit, after the initial procedure, excess vaginal tissue was excised using a hysteroscopic approach during diagnostic vaginoscopy. Vaginoscopy-assisted treatment of the patient proved to be a safe and effective minimally invasive treatment modality that resulted in symptomatic relief and fertility preservation. In conclusion, although premenarche is asymptomatic in the vast majority of cases, HWWS would be optimally diagnosed in childhood to avoid acute late complications, although it is usually first diagnosed after menarche as a result of haematocolpos. Gynaecologists should consider the syndrome in the presence of pelvic mass, renal agenesis, menstrual changes and cyclic pelvic pain.

COVID-19: distanciamento social e seus desafios no contexto Brasileiro / COVID-19: social distancing and its challenges in the Brazilian context

A pandemia do novo coronavírus (COVID-19), que surgiu em Wuhan, China, e rapidamente, se espalhou pelo mundo inteiro exigiu a tomada de inúmeras medidas de proteção, tais como a higiene das mãos, uso de álcool em gel, uso de máscaras faciais individuais e a recomendação do distanciamento social, visto. Este estudo apresenta os aspectos do distanciamento social para enfrentamento da pandemia COVID-19 e os desafios de sua implantação no brasil. Foi realizada uma revisão da literatura especializada, publicada em 2019 e 2020 nas bases de dados Medline, Lilacs, Scielo, Google Acadêmico e Periódicos Capes. Na ausência de medidas farmacológicas eficazes a restrição de movimento combinado com isolamento de casos, rastreamento rigoroso de contato e quarentena de todos os contatos, teve um impacto substancial na interrupção da cadeia de transmissão do COVID-19. No entanto tais estratégias podem representar riscos socioeconômicos importantes como a redução do emprego e renda, afetando desproporcionalmente as populações menos favorecidas: políticas para diminuir tais riscos são urgentemente necessárias.

The new coronavirus (COVID-19) pandemic, which emerged in Wuhan, China, and quickly spread throughout the world required numerous protective measures, such as hand hygiene, use of alcohol gel, individual face masks and the recommendation of social distancing. This study presents the aspects of social distancing to cope with the COVID-19 pandemic and the challenges of its implementation in Brazil. A review of the specialized literature was carried out on published data in 2019 and 2020 in Medline, Lilacs, Scielo, google scholar and Capes journals. In the absence of effective pharmacological measures, a movement restriction combined with case isolation, strict contact tracking and quarantine of all contacts had a substantial impact on the interruption of the COVID-19 transmission chain. However, such strategies may pose important socioeconomic risks such as the reduction of employment and income, disproportionately affecting the less favored populations: policies to reduce such risks are urgently needed.

Use of a clinical-laboratory score to guide treatment of gestational diabetes.

OBJECTIVE: To assess the outcomes of implementing a clinical-laboratory score in the treatment of pregnant women with gestational diabetes. METHODS: A retrospective before-and-after implementation analysis was undertaken using data and neonatal outcomes for pregnant women with gestational diabetes treated before (January 2011-December 2012; control group) and after (January 2013-December 2014; score group) introduction of a newly developed score. To evaluate the effects of score adoption, odds ratios with 95% confidence intervals were calculated after adjustment for confounding factors. RESULTS: The control group included a greater proportion of women treated with diet alone (170/312 [54.5%]) than the study group did (122/391 [31.2%]; P<0.001). By contrast, more women in the study group received metformin (172 [44.0%] vs 77 [24.7%]; P<0.001). The neonatal outcomes, including low Apgar scores at 1 minute and at 5 minutes and neonatal intensive care unit admission, were similar in both groups. Multivariate logistic regression analysis showed that the adoption of the score did not significantly affect the choice of treatment or the birth weight rating. CONCLUSION: The score served well as an orientation tool in therapeutic decision making and had no negative effect on the treatment choice and perinatal outcomes.

Pelvic organ prolapse: prevalence and risk factors in a Brazilian population.

INTRODUCTION AND HYPOTHESIS: Although pelvic organ prolapse (POP) is a prevalent condition among Brazilians, population-based epidemiological studies of POP are scarce. We studied POP in a population of women undergoing routine examination to determine its prevalence, distribution and relationship to risk factors. METHODS: This quantitative descriptive study surveyed 432 women, based on prolapse prevalence, who sought routine care and were assessed for prolapse staging using the Pelvic Organ Prolapse Quantification system (POP-Q). Demographics, health history, socioeconomic data, symptoms and risk factors for prolapse were self-reported by the participants. RESULTS: A total of 226 (52.3%) of the examined women had POP. The prevalences of POP in relation to stage were as follows: stage 1 (27.8%), stage 2 (23.1%), and stage 3 (1.4%). Regarding risk factors, a history of vaginal delivery (odds ratio, OR, 6.678, 95% confidence interval, CI, 4.16-10.73), delivery of a newborn heavier than 4 kg (OR 2.056, 95% CI 1.19-3.56) and menopausal status (OR 2.793, 95% CI 1.66-4.70) were all associated with a higher risk of prolapse. CONCLUSIONS: We found that a majority of the population sample exhibited some degree of prolapse, suggesting that POP deserves substantial clinical attention. The risk factors identified suggest that eventual prolapse may be unavoidable in some women. Public policies should be implemented with respect to modifiable risk factors and antenatal care.

Prolapsos de órgãos pélvicos: revisando a literatura / Pelvic organ prolapse: literature review

O presente artigo faz uma revisão sobre a epidemiologia, sintomas, diagnóstico e tratamento dos prolapsos de órgãos pélvicos - POP. Sua elaboração foi possível por intermédio de uma pesquisa eletrônica acerca do tema na base de dados Pubmed. Do universo das publicações encontradas, foram consideradas e revisadas aquelas que despontam com maior relevância na área, nos últimos 10 anos. POP, a herniação dos órgãos pélvicos através da vagina, é uma condição comum em saúde feminina. Muitas mulheres com prolapso têm sintomas que causam impacto no dia a dia, na função sexual e atividade física. O diagnóstico é baseado no exame POP-Q e o tratamento pode ser cirúrgico ou conservador. Há muito a ser estudado sobre os POP e os fatores de risco individuais devem ser identificados para estabelecer estratégias de prevenção.

This article aims to review epidemiology, clinical manifestations , diagnosis and treatment of pelvic organ prolapse- POP. A Pubmed search has been performed and selected preferentially publications from the last ten years . POP is the herniation of the pelvic organs to or beyond the vaginal walls, is a common condition. Many women with prolapse experience symptoms that impact daily activities, sexual function, and exercise. Diagnosis is based on POP-Q examination and treatment cab be either conservative or surgical. There is much to be learned about POP and its natural history. Individual risk factors must be clearly delineated, and preventive strategies devised.