Three-dimensional ultrasound evaluation of the pelvic floor in postmenopausal women using hormone therapy.

OBJECTIVE: To evaluate the three-dimensional (3D) ultrasound characteristics of the pelvic floor muscles (PFM) in two groups of postmenopausal women: users and nonusers of menopausal hormone therapy (MHT). STUDY DESIGN: Observational, cross-sectional cohort study. MAIN OUTCOME MEASURES: In this study 226 sexually active heterosexual women, aged 45-60 years with amenorrhea >12 months and without clinical pelvic floor disorders or urinary incontinence were included. Women using MHT ≥ 6 months were classified as systemic users. PFM strength was assessed by digital vaginal palpation and scored on the Modified Oxford Scale. Biometry of the PFM was performed by 3D transperineal ultrasound for evaluation of total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. RESULTS: The participants were divided into users (n = 78) and nonusers (n = 148) of MHT. There were no differences in clinical or anthropometric parameters between groups. The mean age was 55 years and the time since menopause was six years in both groups. The mean duration of MHT use was 43.4 ± 33.3 months. Users of MHT had greater levator ani muscle thickness (p = 0.001) and higher PFM strength (p = 0.029) than nonusers. Risk analysis adjusted for age, time since menopause, BMI, parity, and type of delivery showed an association of MHT use with greater levator ani muscle thickness (OR = 2.69; 95% CI 1.42-5.11, p = 0.029), and higher PFM strength (OR = 1.78; 95% CI1.01-3.29, p = 0.046). There was a weak positive correlation between levator ani muscle thickness and duration of MHT use (r = 0.25, p = 0.0002) and PFM strength (r = 0.12, p = 0.043). CONCLUSIONS: Postmenopausal women using MHT had a greater levator ani muscle thickness associated with higher PFM strength than nonusers.

Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women.

INTRODUCTION: Although pelvic floor muscle (PFM) weakness can be associated with pelvic floor dysfunctions, knowledge about the relationship with sexual dysfunction is limited. AIM: The aim of this study was to evaluate the association between PFM strength and sexual function in postmenopausal women. METHODS: An analytical cross-sectional study was conducted on 226 sexually active heterosexual women aged 45-65 years with amenorrhea >12 months and without pelvic floor disorders. The Female Sexual Function Index (FSFI) was used for the evaluation of sexual function (total score ≤26.5 indicating sexual dysfunction). PFM strength was assessed by bidigital vaginal palpation using the modified Oxford scale (score 0-5) and was categorized into nonfunctional (scores 0-1, without contraction) and functional (scores 2-5, with contraction). Three-dimensional transperineal ultrasound was used to evaluate total urogenital hiatus area, transverse and anteroposterior diameters, and levator ani muscle thickness. MAIN OUTCOME MEASURE: The main outcome measure was to determine the relationship between sexual dysfunction and PFM strength. RESULTS: The participants were classified as functional PFM (n = 143) and nonfunctional PFM (n = 83). There were no differences between groups in clinical and anthropometric parameters. A higher percentage of menopausal hormone therapy users was observed in the group with functional PFM (39.2%) compared to the nonfunctional group (24.1%; P = .043). Women classified as functional PFM exhibited greater levator ani muscle thickness than those classified as nonfunctional (P = .049). Women with nonfunctional PFM had poorer sexual function in the desire (P = .005), arousal (P = .001), and orgasm (P = 0.006) domains and in total FSFI score (P = .006) compared to the functional group. There was a weak positive correlation of PFM strength with the desire (r = 0.35; P = .0003), arousal (r = 0.21; P = .013), and orgasm (r = 0.23; P = .033) domains and with total FSFI score (r = 0.28; P = .004). Ultrasonographic levator ani muscle thickness showed a weak positive correlation with PFM strength (r = 0.21; P = .046) and with the arousal domain (r = 0.23; P = .044). Risk analysis adjusted for age, time since menopause, parity, and body mass index showed a lower risk of sexual dysfunction in menopausal hormone therapy users (odds ratio = 0.26; 95% CI 0.11-0.60; P = .002) and in women with greater levator ani muscle thickness (odds ratio = 0.85; 95% CI 0.73-0.98; P = .025). CLINICAL IMPLICATIONS: The maintenance of PFM strength in the climacteric period is an important factor in postmenopausal women's sexual function. STRENGTH & LIMITATIONS: The main strength of the study is that, to our knowledge, this is the first study that evaluated the correlation of PFM strength and 3D transperineal ultrasound with different domains of sexual function in postmenopausal women. The main limitation is the cross-sectional design does not permit to establish a cause-effect relationship. CONCLUSION: Postmenopausal women with PFM dysfunction have poorer sexual function than women with functional PFM. Omodei MS, Marques Gomes Delmanto LR, Carvalho-Pessoa E, et al. Association Between Pelvic Floor Muscle Strength and Sexual Function in Postmenopausal Women. J Sex Med 2019;16:1938-1946.

Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials.

CONTEXT AND OBJECTIVE:: This systematic review compared reiki and prayer with drug use for relieving pain during hospitalization for cesarean, given that the popularity of integrative medicine and spiritual healing has been increasing. It had the aim of evaluating whether reiki or prayer is effective in relieving pain during cesarean section. DESIGN AND SETTING:: Systematic review with meta-analysis conducted at Botucatu Medical School, UNESP, São Paulo, Brazil. METHODS:: The following databases were searched up to March 2016: MEDLINE, Embase, LILACS and CENTRAL. Randomized controlled trials published in English or Portuguese were included in the review. Two reviewers independently screened eligible articles, extracted data and assessed the risk of bias. A GRADE table was produced to evaluate the risk of bias. RESULTS:: There was evidence with a high risk of bias showing a statistically significant decrease in pain score through use of reiki and prayer, in relation to the protocol group: mean difference = -1.68; 95% confidence interval: -1.92 to -1.43; P < 0.00001; I2 = 92%. Furthermore, there was no statistically significant difference in heart rate or systolic or diastolic blood pressure. CONCLUSION:: Evidence with a high risk of bias suggested that reiki and prayer meditation might be associated with pain reduction.

Is reiki or prayer effective in relieving pain during hospitalization for cesarean? A systematic review and meta-analysis of randomized controlled trials / O reiki ou a oração são efetivos no alívio da dor durante a internação da cesariana? Uma revisão sistemática e metanálise de ensaios clínicos randomizados

ABSTRACT CONTEXT AND OBJECTIVE: This systematic review compared reiki and prayer with drug use for relieving pain during hospitalization for cesarean, given that the popularity of integrative medicine and spiritual healing has been increasing. It had the aim of evaluating whether reiki or prayer is effective in relieving pain during cesarean section. DESIGN AND SETTING: Systematic review with meta-analysis conducted at Botucatu Medical School, UNESP, São Paulo, Brazil. METHODS: The following databases were searched up to March 2016: MEDLINE, Embase, LILACS and CENTRAL. Randomized controlled trials published in English or Portuguese were included in the review. Two reviewers independently screened eligible articles, extracted data and assessed the risk of bias. A GRADE table was produced to evaluate the risk of bias. RESULTS: There was evidence with a high risk of bias showing a statistically significant decrease in pain score through use of reiki and prayer, in relation to the protocol group: mean difference = -1.68; 95% confidence interval: -1.92 to -1.43; P < 0.00001; I2 = 92%. Furthermore, there was no statistically significant difference in heart rate or systolic or diastolic blood pressure. CONCLUSION: Evidence with a high risk of bias suggested that reiki and prayer meditation might be associated with pain reduction.

RESUMO CONTEXTO E OBJETIVO: Esta revisão sistemática comparou o reiki e a oração ao uso de medicamentos, a fim de aliviar a dor durante a internação para cesariana, visto que há um aumento na popularidade da medicina integrativa e cura espiritual. Esta revisão teve como objetivo avaliar se o reiki ou oração são eficazes no alívio da dor durante a cesariana. TIPO DE ESTUDO E LOCAL: Revisão sistemática com metanálise realizada na Faculdade de Medicina de Botucatu UNESP, São Paulo, Brasil. MÉTODOS: As seguintes bases de dados foram pesquisadas até março de 2016: MEDLINE, Embase, LILACS e CENTRAL. Nesse sentido, foram incluídos ensaios clínicos randomizados publicados em inglês e português. Dois revisores rastrearam independentemente artigos elegíveis, extraíram dados e avaliaram o risco de viés. A tabela GRADE foi realizada para avaliar o risco de viés. RESULTADOS: Evidências com alto índice de viés encontraram uma diminuição estatisticamente significativa na redução da dor (diferença média = -1,68; intervalo de confiança de 95%: -1,92 a -1,43; P < 0,00001; I2 = 92%), com o uso de reiki e oração comparado com o grupo protocolar. Além disso, não houve diferença estatisticamente significativa na frequência cardíaca, pressão arterial sistólica e diastólica. CONCLUSÃO: Evidência com alto risco de viés sugeriu que reiki e meditação oração podem ser associadas com a redução da dor.

Adhesion study of cultured human lens capsule cells on hydrophilic intraocular lenses coated with polyethylene glycol.

PURPOSE: To evaluate the adhesion of human lens capsule cells on hydrophilic acrylic intraocular lenses (IOLs) coated with polyethylene glycol (PEG). SETTING: Department of Ophthalmology, Faculty of Medicine, Universidade Estadual Paulista-Botucatu, São Paulo, Brazil. DESIGN: Experimental study. METHODS: Human anterior lens capsules obtained during cataract surgery were cultured and seeded (200 cells/IOLs) in triplicates on the surface of a copolymer comprising hydroxyethyl methacrylate, ethyl methacrylate, and methyl methacrylate IOLs (Loflex) treated or not treated with PEG. After 26 hours, the number of viable adherent cells was estimated by counting in a hemocytometer. RESULTS: The coating of hydrophilic acrylic IOLs with PEG was effective in inhibiting cell adhesion (P < .05). Cells showing 2 distinct morphologic patterns-epithelial and dendritic-like-were observed during the in vitro establishment of the cultures. A tendency toward greater adhesion of dendritic-like cells was observed in untreated IOLs compared with treated IOLs (P = .095). CONCLUSION: Coating hydrophilic acrylic IOLs with PEG was effective in inhibiting cell adhesion. This treatment might play a role in posterior capsule opacification prevention. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

[Prevalence of low bone mineral density in postmenopausal breast cancer survivors]. / Prevalência da baixa densidade mineral óssea em mulheres na pós-menopausa tratadas de câncer de mama.

PURPOSE: To evaluate the prevalence of low bone mineral density (BMD) in postmenopausal breast cancer survivors. METHODS: In this cross-sectional study, 115 breast cancer survivors, seeking healthcare at a University Hospital in Brazil, were evaluated. Eligibility criteria included women with amenorrhea ≥ 12 months and age ≥ 45 years, treated for breast cancer and metastasis-free for at least five years. BMD was measured by DEXA at the lumbar spine (L1-L4) and femoral neck. Low BMD was considered when total-spine and/or femoral-neck T-score values were <-1.0 Delphi Score (DP) (osteopenia and osteoporosis). The risk factors for low BMD were assessed by interview. Data were analyzed statistically by the χ(2) test and Fisher's exact test. RESULTS: The mean age of breast cancer survivors was 61.6 ± 10.1 years and time since menopause was 14.2 ± 5.6 years, with a mean follow-up of 10.1 ± 3.9 years. Considering spine and femoral neck, 60% of breast cancer survivors had low BMD. By evaluating the risk factors for low BMD, a significant difference was found in the percent distribution for age (higher % of women >50 years with low BMD), personal history of previous fracture (11.6% with low BMD versus 0% with normal BMD) and BMI. A higher frequency of obesity was observed among women with normal BMD (63%) compared to those with low BMD (26.1%) (p<0.05). CONCLUSION: Postmenopausal breast cancer survivors had a high prevalence of osteopenia and osteoporosis.

Prevalência da baixa densidade mineral óssea em mulheres na pós-menopausa tratadas de câncer de mama / Prevalence of low bone mineral density in postmenopausal breast cancer survivors

OBJETIVO: Avaliar a prevalência da baixa densidade mineral óssea (DMO) em mulheres na pós-menopausa tratadas de câncer de mama. MÉTODOS: Estudo de corte transversal que incluiu 115 mulheres tratadas de câncer de mama atendidas em Hospital Universitário do Sudeste do Brasil. Foram incluídas mulheres com amenorreia há 12 meses ou mais e 45 anos ou mais de idade, tratadas de câncer de mama e livres de doença há pelo menos 5 anos. A DMO foi mensurada pelos raios-X de dupla energia em coluna lombar (L1 a L4) e colo de fêmur. Considerou-se baixa DMO quando valores de T-score de coluna total e/ou colo de fêmur <-1,0 Score de Delphi (DP) (osteopenia e osteoporose). Por meio de entrevista, foram avaliados fatores de risco para baixa DMO. Na análise estatística, empregaram-se os testes do χ2 ou Exato de Fisher. RESULTADOS: A média de idade das pacientes foi 61,6±10,1 anos e o tempo de menopausa, 14,2±5,6 anos, com tempo médio de seguimento de 10,1±3,9 anos. Considerando coluna e colo de fêmur, 60% das mulheres tratadas de câncer de mama apresentavam baixa DMO. Avaliando os fatores de risco para baixa DMO, foi encontrada diferença significativa na distribuição percentual quanto à idade (maior porcentagem de mulheres com mais de 50 anos e baixa DMO), história pessoal de fratura prévia (11,6% com baixa DMO e nenhuma com DMO normal) e índice de massa corpórea. Maior frequência de obesidade foi observada entre mulheres com DMO normal (63%) quando comparadas àquelas com baixa DMO (26,1%; p<0,05). CONCLUSÃO: Mulheres na pós-menopausa tratadas de câncer de mama apresentaram elevada prevalência de baixa DMO (osteopenia e/ou osteoporose). .

PURPOSE: To evaluate the prevalence of low bone mineral density (BMD) in postmenopausal breast cancer survivors. METHODS: In this cross-sectional study, 115 breast cancer survivors, seeking healthcare at a University Hospital in Brazil, were evaluated. Eligibility criteria included women with amenorrhea ≥12 months and age ≥45 years, treated for breast cancer and metastasis-free for at least five years. BMD was measured by DEXA at the lumbar spine (L1-L4) and femoral neck. Low BMD was considered when total-spine and/or femoral-neck T-score values were <-1.0 Delphi Score (DP) (osteopenia and osteoporosis). The risk factors for low BMD were assessed by interview. Data were analyzed statistically by the χ2 test and Fisher's exact test. RESULTS: The mean age of breast cancer survivors was 61.6±10.1 years and time since menopause was 14.2±5.6 years, with a mean follow-up of 10.1±3.9 years. Considering spine and femoral neck, 60% of breast cancer survivors had low BMD. By evaluating the risk factors for low BMD, a significant difference was found in the percent distribution for age (higher % of women >50 years with low BMD), personal history of previous fracture (11.6% with low BMD versus 0% with normal BMD) and BMI. A higher frequency of obesity was observed among women with normal BMD (63%) compared to those with low BMD (26.1%) (p<0.05). CONCLUSION: Postmenopausal breast cancer survivors had a high prevalence of osteopenia and osteoporosis. .

Avaliação dos fatores de risco de quedas em mulheres na pós-menopausa inicial / Evaluation of risk factors of falls in early postmenopausal Women

OBJETIVO: Foi avaliar a frequência e os fatores de risco de quedas em mulheres na pós-menopausa. MÉTODOS: Estudo clínico, transversal, envolvendo 358 mulheres (idade entre 45 e 65 anos e amenorreia >12 meses) com tempo de pós-menopausa <10 anos. Os critérios de exclusão foram: doença neurológica ou músculo esquelético, vestibulopatias, hipertensão arterial não controlada, hipotensão postural, déficit visual sem correção, uso de medicamentos (sedativos e hipnóticos). A queda foi definida como mudança de posição inesperada, não intencional, que faz com que o indivíduo permaneça em nível inferior à posição inicial. Foram analisados o histórico de quedas (últimos 24 meses) e as características clínicas, antropométricas (índice de massa corpórea (IMC) e circunferência da cintura (CC)) e densidade mineral óssea. Na comparação segundo grupo de mulheres com e sem histórico de queda, foi empregado o Teste do Qui-quadrado ou Exato de Fisher e regressão logística com cálculo do odds ratio (OR). RESULTADOS: Entre as mulheres incluídas, 48,0% (172/358) referiram queda, com fratura em 17,4% (30/172). A queda ocorreu dentro de casa em 58,7% (101/172). A média de idade foi 55,7±6,5 anos, tempo de menopausa de 5,8±3,5anos, IMC 28,3±4,6 kg/m² e CC 89,0±11,4 cm. Foi observada maior frequência de tabagismo e diabetes entre as mulheres com histórico de quedas quando comparadas àquelas sem queda, de 25,6 versus 16,1% e 12,8 versus 5,9%, respectivamente (p<0,05). Na análise multivariada em função das variáveis clínicas influentes, o risco de queda aumentou com o tabagismo atual (OR 1,93; IC95% 1,01-3,71). Demais variáveis clínicas e antropométricas não influenciaram no risco de queda. CONCLUSÕES: Em mulheres na pós-menopausa inicial houve expressiva frequência de quedas. O tabagismo foi indicador clínico de risco para queda. Com o reconhecimento de fatores determinantes para queda, medidas preventivas são importantes, como a orientação de abolir o tabagismo.

PURPOSE: It was to evaluate the frequency and the risk factors of falls in early postmenopausal women. METHODS: A cross-sectional study was conducted on 358 women (age: 45-65 years and amenorrhea >12 months) with time since menopause <10 years. Exclusion criteria were: neurological or musculoskeletal disorders, vestibulopathies, uncorrected visual deficit, uncontrolled hypertension and postural hypotension, or drug use (sedative and hypnotic agents). A fall was identified as an unexpected unintentional change in position which causes an individual to remain in a lower level in relation to the initial position. The history of self-reported falls during the previous 24 months, and clinical and anthropometric data (body mass index (BMI) and waist circumference (WC)) and bone densitometric measures were analyzed. For statistical analysis, c² trend test and the logistic regression method (odds ratio (OR)) were used for the comparison between groups of women with and without falls. RESULTS: Of the 358 women, 48.0% (172/358) had a history of falls and 17.4% (30/172) had fractures. The fall occurred indoors (at home) in 58.7% (101/172). The mean age was 53.7±6.5 years, time since menopause 5.8±3.5 years, BMI 28.3±4.6 kg/m² and WC 89.0±11.4 cm. There were differences as the occurrence of smoking and diabetes, with greater frequency among fallers vs. non-fallers, 25.6 versus 16.1% and 12.8 versus 5.9%, respectively (p<0.05). By evaluating the risk of falls in the presence of influential variables, it was observed that risk increased with current smoking status (OR 1.93; 95%CI 1.01-3.71), whereas other clinical and anthropometric variables did not influence this risk. CONCLUSIONS: In early postmenopausal women there was higher frequency of falls. Current smoking was clinical indicators of risk for falls. With the recognition of factors for falling, preventive measures become important, as the orientation of abolishing smoking.

[Evaluation of risk factors of falls in early postmenopausal women]. / Avaliação dos fatores de risco de quedas em mulheres na pós-menopausa inicial.

PURPOSE: It was to evaluate the frequency and the risk factors of falls in early postmenopausal women. METHODS: A cross-sectional study was conducted on 358 women (age: 45-65 years and amenorrhea >12 months) with time since menopause <10 years. Exclusion criteria were: neurological or musculoskeletal disorders, vestibulopathies, uncorrected visual deficit, uncontrolled hypertension and postural hypotension, or drug use (sedative and hypnotic agents). A fall was identified as an unexpected unintentional change in position which causes an individual to remain in a lower level in relation to the initial position. The history of self-reported falls during the previous 24 months, and clinical and anthropometric data (body mass index (BMI) and waist circumference (WC)) and bone densitometric measures were analyzed. For statistical analysis, c² trend test and the logistic regression method (odds ratio (OR)) were used for the comparison between groups of women with and without falls. RESULTS: Of the 358 women, 48.0% (172/358) had a history of falls and 17.4% (30/172) had fractures. The fall occurred indoors (at home) in 58.7% (101/172). The mean age was 53.7 ± 6.5 years, time since menopause 5.8 ± 3.5 years, BMI 28.3 ± 4.6 kg/m² and WC 89.0 ± 11.4 cm. There were differences as the occurrence of smoking and diabetes, with greater frequency among fallers vs. non-fallers, 25.6 versus 16.1% and 12.8 versus 5.9%, respectively (p<0.05). By evaluating the risk of falls in the presence of influential variables, it was observed that risk increased with current smoking status (OR 1.93; 95%CI 1.01-3.71), whereas other clinical and anthropometric variables did not influence this risk. CONCLUSIONS: In early postmenopausal women there was higher frequency of falls. Current smoking was clinical indicators of risk for falls. With the recognition of factors for falling, preventive measures become important, as the orientation of abolishing smoking.