Nonbacterial thrombotic endocarditis of mitral valve associated with a lymphoproliferative malignancy: case report and literature review.

BACKGROUND: Non-bacterial thrombotic endocarditis (NBTE) is a rare condition marked by sterile vegetations on cardiac valves, often linked to rheumatologic diseases, autoimmune disorders, and advanced solid malignancies. An early diagnosis and treatment of the associated clinical condition are mandatory, although they do not usually eliminate valvular vegetations, making anticoagulation essential to prevent embolic events. Despite variability, the prognosis of NBTE is usually unfavorable due to recurrent embolic events and the severity of the primary condition, typically advanced cancer. CASE PRESENTATION: We present a case of a 57 years-old male who presented to the emergency department with a 5-day history of painful bilateral digital edema and color change episodes (from pallor to cyanosis). Physical examination revealed erythrocyanosis in the distal extremities, prompting consideration of secondary Raynaud syndrome. Despite medical therapy, progressive digital ischemia led to multiple finger amputations. During etiological investigation, anticoagulation tests and autoimmune analysis yielded negative results. A transesophageal echocardiogram was performed, revealing an irregular hyperechogenic mass on the anterior leaflet of the mitral valve without valve dysfunction, and a thoracic computed tomography scan with contrast showed an enlarged right paratracheal lymph node. Histopathological analysis from a transthoracic needle biopsy of the paratracheal lymph node revealed diffuse large B-cell lymphoma. The patient underwent aggressive R-CHOP chemotherapy, achieving a favorable complete response. CONCLUSION: This is a particular case involving the occurrence of NBTE and Raynaud phenomenon as the initial paraneoplastic manifestations in a previously healthy young man. Reports of NBTE associated with lymphoproliferative conditions are quite rare, with fewer than ten cases described in the literature. To our knowledge, this is the first case of NBTE specifically associated with diffuse large B-cell lymphoma.

Progression in Myeloid Neoplasms: Beyond the Myeloblast.

Disease progression in myelodysplastic syndromes (MDS), myelodysplastic-myeloproliferative neoplasms (MDS/MPN), and myeloproliferative neoplasms (MPN), altogether referred to as myeloid neoplasms (MN), is a major source of mortality. Apart from transformation to acute myeloid leukemia, the clinical progression of MN is mostly due to the overgrowth of pre-existing hematopoiesis by the MN without an additional transforming event. Still, MN may evolve along other recurrent yet less well-known scenarios: (1) acquisition of MPN features in MDS or (2) MDS features in MPN, (3) progressive myelofibrosis (MF), (4) acquisition of chronic myelomonocytic leukemia (CMML)-like characteristics in MPN or MDS, (5) development of myeloid sarcoma (MS), (6) lymphoblastic (LB) transformation, (7) histiocytic/dendritic outgrowths. These MN-transformation types exhibit a propensity for extramedullary sites (e.g., skin, lymph nodes, liver), highlighting the importance of lesional biopsies in diagnosis. Gain of distinct mutations/mutational patterns seems to be causative or at least accompanying several of the above-mentioned scenarios. MDS developing MPN features often acquire MPN driver mutations (usually JAK2), and MF. Conversely, MPN gaining MDS features develop, e.g., ASXL1, IDH1/2, SF3B1, and/or SRSF2 mutations. Mutations of RAS-genes are often detected in CMML-like MPN progression. MS ex MN is characterized by complex karyotypes, FLT3 and/or NPM1 mutations, and often monoblastic phenotype. MN with LB transformation is associated with secondary genetic events linked to lineage reprogramming leading to the deregulation of ETV6, IKZF1, PAX5, PU.1, and RUNX1. Finally, the acquisition of MAPK-pathway gene mutations may shape MN toward histiocytic differentiation. Awareness of all these less well-known MN-progression types is important to guide optimal individual patient management.

Knowledge about human papillomavirus transmission and prevention among physicians in Rio de Janeiro state, Brazil.

OBJECTIVE: This study aimed to assess physicians' knowledge about human papillomavirus infection and its prevention. METHODS: Descriptive web-based survey with 15 objective questions targeted to physicians affiliated with the Regional Council of Medicine from Rio de Janeiro state, Brazil. Participants were invited by e-mail and the Council social networks, between January and December 2019. RESULTS: The study sample had 623 participants, with a median age of 45 years, predominantly women (63%). The most frequent specialties were Obstetrics and Gynecology (21.1%), Pediatrics (11.2%), and Internists (10.5%). Concerning human papillomavirus knowledge, 27.9% of the participants were able to identify accurately all possible forms of transmission, and none of them could recognize all the risk factors of infection. Nevertheless, 95% recognized that asymptomatic infection could occur in both sexes. Regarding knowledge about clinical manifestations, diagnosis, and screening, only 46.5% were able to identify all human papillomavirus-related cancers, 42.6% were aware of the periodicity of Pap smears, and 39.4% indicated that serological test was not adequate for diagnosis. The recommended age group for human papillomavirus vaccination was recognized by 94% of the participants, as well as the need for a Pap smear and the use of condoms, even after vaccination. CONCLUSIONS: There is good knowledge about prevention and screening for human papillomavirus infections; many gaps were identified regarding transmission, risk factors, and associated diseases among physicians in Rio de Janeiro state.

Evaluation of PIK3CA mutations in advanced ER+/HER2-breast cancer in Portugal - U-PIK Project.

Background: Around 40% of ER+/HER2-breast carcinomas (BC) present mutations in the PIK3CA gene. Assessment of PIK3CA mutational status is required to identify patients eligible for treatment with PI3Kα inhibitors, with alpelisib currently the only approved tyrosine kinase inhibitor in this setting. U-PIK project aimed to conduct a ring trial to validate and implement the PIK3CA mutation testing in several Portuguese centers, decentralizing it and optimizing its quality at national level. Methods: Eight Tester centers selected two samples of patients with advanced ER+/HER2- BC and generated eight replicates of each (n = 16). PIK3CA mutational status was assessed in two rounds. Six centers used the cobas® PIK3CA mutation test, and two used PCR and Sanger sequencing. In parallel, two reference centers (IPATIMUP and the Portuguese Institute of Oncology [IPO]-Porto) performed PIK3CA mutation testing by NGS in the two rounds. The quality of molecular reports describing the results was also assessed. Testing results and molecular reports were received and analyzed by U-PIK coordinators: IPATIMUP, IPO-Porto, and IPO-Lisboa. Results: Overall, five centers achieved a concordance rate with NGS results (allele frequency [AF] ≥5%) of 100%, one of 94%, one of 93%, and one of 87.5%, considering the overall performance in the two testing rounds. NGS reassessment of discrepancies in the results of the methods used by the Tester centers and the reference centers identified one probable false positive and two mutations with low AF (1-3%, at the analytical sensitivity threshold), interpreted as subclonal variants with heterogeneous representation in the tissue sections processed by the respective centers. The analysis of molecular reports revealed the need to implement the use of appropriate sequence variant nomenclature with the identification of reference sequences (HGVS-nomenclature) and to state the tumor cell content in each sample. Conclusion: The concordance rates between the method used by each tester center and NGS validate the use of the PIK3CA mutational status test performed at these centers in clinical practice in patients with advanced ER+/HER2- BC.

Knowledge about human papillomavirus transmission and prevention among physicians in Rio de Janeiro state, Brazil

SUMMARY OBJECTIVE: This study aimed to assess physicians' knowledge about human papillomavirus infection and its prevention. METHODS: Descriptive web-based survey with 15 objective questions targeted to physicians affiliated with the Regional Council of Medicine from Rio de Janeiro state, Brazil. Participants were invited by e-mail and the Council social networks, between January and December 2019. RESULTS: The study sample had 623 participants, with a median age of 45 years, predominantly women (63%). The most frequent specialties were Obstetrics and Gynecology (21.1%), Pediatrics (11.2%), and Internists (10.5%). Concerning human papillomavirus knowledge, 27.9% of the participants were able to identify accurately all possible forms of transmission, and none of them could recognize all the risk factors of infection. Nevertheless, 95% recognized that asymptomatic infection could occur in both sexes. Regarding knowledge about clinical manifestations, diagnosis, and screening, only 46.5% were able to identify all human papillomavirus-related cancers, 42.6% were aware of the periodicity of Pap smears, and 39.4% indicated that serological test was not adequate for diagnosis. The recommended age group for human papillomavirus vaccination was recognized by 94% of the participants, as well as the need for a Pap smear and the use of condoms, even after vaccination. CONCLUSIONS: There is good knowledge about prevention and screening for human papillomavirus infections; many gaps were identified regarding transmission, risk factors, and associated diseases among physicians in Rio de Janeiro state.

Hodgkin's variant of Richter transformation during ibrutinib therapy: A case report and review of the literature.

Hodgkin's variant of Richter transformation is a rare complication of chronic lymphocytic leukemia and is associated with inferior outcomes compared to de novo Hodgkin lymphoma. Further data concerning prognosis and treatment of Hodgkin's variant of Richter transformation occurring in the setting of novel targeted therapies are needed.

Underwater Energy Harvesting to Extend Operation Time of Submersible Sensors.

A linear electromagnetic energy harvesting device for underwater applications, fabricated with a simple manufacturing process, was developed to operate with movement frequencies from 0.1 to 0.4 Hz. The generator has two coils, and the effect of the combination of the two coils was investigated. The experimental study has shown that the energy capture system was able to supply energy to several ocean sensors, producing 7.77 mJ per second with wave movements at 0.4 Hz. This study shows that this energy is enough to restore the energy used by the battery or the capacitor and continue supplying energy to the sensors used in the experimental work. For an ocean wave frequency of 0.4 Hz, the generator can supply power to 8 sensors or 48 sensors, depending on the energy consumed and its optimization.

Evaluation of sensitivity profiles to fosfomycin in bacterial urine samples from outpatients.

OBJECTIVE: To evaluate and compare the susceptibilities of bacteria found in outpatient cultures to fosfomycin and other main antibiotics commonly available in clinical practice. STUDY DESIGN: A retrospective cross-sectional study was conducted using 2,673 positive urine cultures collected between 2014 and 2017 at private laboratories located in the cities of Niterói and São Gonçalo. Susceptibilities to fosfomycin and other antibiotics were tested using the McNemar test with the level of significance set at 5 %. RESULTS: Out of the 2,673 samples tested, 94.1 % were susceptible to fosfomycin. Escherichia coli was responsible for 68.8 % of the positive samples, and susceptibility to fosfomycin was observed in 97.9 % of these cases. Susceptibility to fosfomycin in Klebsiella spp. represented 86.6 % of cases, Enterococcus spp., 94.9 % and Proteus mirabilis, 83.3 %. The highest rate of susceptibility for E. coli was observed with fosfomycin, with the only exception being imipenem (p < 0.001). Klebsiella spp. showed a similar profile, except that there was no difference between susceptibilities to fosfomycin and gentamicin (p = 0.91). Susceptibility of Enterococcus spp. to fosfomycin was like that of nitrofurantoin and ampicillin. Finally, the susceptibility of P. mirabilis to fosfomycin was greater than it was for trimethoprim-sulfamethoxazole and nitrofurantoin. CONCLUSIONS: The microbiological profile established here shows substantial sensitivity to fosfomycin in the urine samples analysed. In most cases, there was a sensitivity profile that was favourable to the use of fosfomycin or at least comparable to the other antibiotics studied.

Momentos de "des-existir" e espaços vazios de "des-existência" / Moments of "de-existing" and empty spaces of "de-existence" / Momentos de "des-existir" y espacios vacíos de "des-existencia"

A utilização do conceito des-existir, usado por mim neste e em outros trabalhos, resulta de uma necessidade de nomear e delimitar situações em geral transitórias limitadas à esfera psíquica. Diferencia-se do conceito de matar, verbo ativo que implica na ação de um sujeito, seja em termos físicos ou metafóricos. Assim como diferencia-se também do conceito de morrer, ligado a algo mais definitivo em termos naturais ou figurados. Des-existir refere-se a uma situação momentânea, temporária e às vezes prolongada, em que o sujeito entra em processo de falência como sujeito psíquico por desinvestimento. Pode ser des-existido em diferentes graus de apagamento em um espectro que se estende entre a situação ativa de sujeito e a condição passiva de objeto da pulsão de morte (AU)

I employ the idea of de-existing, in this and other papers, as a result from an urge to name and delimit usually transient situations limited to the psychic sphere. It differs from the idea of killing, active verb that implies the action of a subject, in physical or metaphorical terms. As well as it also differs from the idea of dying, connected to something more definitive in natural or figurative terms. De-existing refers to a momentary, temporary situation, sometimes long-lasting, in which, due to disinvestment, the subject goes into a process of failure as psychic subject. It may be de-existed in different levels of effacement in a spectrum that extends between the active situation as subject and the passive condition of object of the death drive (AU)

El uso del concepto des-existir, que utilizo en este y otros trabajos, resulta de una necesidad de nombrar y delimitar en general situaciones transitorias limitadas a la esfera psíquica. Se diferencia del concepto de matar, verbo activo que implica la acción de un sujeto, ya sea en términos físicos o metafóricos. Además, también se diferencia del concepto de morir, ligado a algo más definitivo en términos naturales o figurativos. El des-existir se refiere a una situación momentánea, temporal y en ocasiones prolongada en la que el sujeto entra en proceso de desplome como sujeto psíquico debido a la desinversión. Puede ser des-existido en diferentes grados de desvanecimiento en un espectro que se extiende entre la situación activa del sujeto y la condición pasiva de objeto de la pulsión de muerte (AU)

Predictors for de novo stress urinary incontinence following pelvic reconstructive surgery with mesh.

OBJECTIVE: The aims of this study are to describe the postoperative incidence of de novo stress urinary incontinence (SUI) in women who underwent anterior vaginal compartment prolapse repair using synthetic polypropylene mesh and to identify risk factors for this outcome. STUDY DESIGN: A retrospective cohort study of 146 women who underwent anterior vaginal repair from 2007 to 2017 and followed by a minimum period of 12 months was performed. The incidence of de novo SUI was evaluated at 3 and 12 months of follow-up. Women with concomitant or prior anti-incontinence surgery were not included. Preoperatively, all patients had a negative stress test and no evidence of occult SUI on urodynamics. The outcome was considered positive if the patient had complaints of SUI at the follow-up. Variables associated with the outcome with a p-value ≤ 0.10 were included in a logistic regression model to calculate the relative risk (RR) for de novo SUI. For multivariate analysis, all analyzes were performed considering a significant p-value ≤ 0.05. RESULTS: The incidence of de novo SUI at 3 and 12 months of follow-up was 15.8 % and 20.5 %, respectively. Higher body mass index (BMI), diabetes, anterior vaginal wall prolapse stage ≥ 3, older age at first pregnancy and higher first desire to void during the urodynamic evaluation were positively associated with de novo SUI in the bivariate analysis (p ≤ 0.10). Previous perineoplasty had a negative association with the outcome analyzed, suggesting a protective effect. After the multivariate analysis, higher BMI (RR 1.19, 95 % confidence interval [CI] 1.05-1.36), diabetes (RR 4.18, 95 % CI 1.32-13.21) and anterior vaginal wall prolapse stage ≥ 3 (RR 14.74, 95 % CI 1.64-132.0) remained as risk factors for de novo SUI (p ≤ 0.01). CONCLUSION: The incidence of de novo SUI after the surgical correction of anterior vaginal wall prolapse with synthetic mesh in this population was 15.8 % and 20.5 % at 3 and 12 months of follow-up, respectively. Continent women who underwent this surgical procedure and who had a higher BMI, diabetes and anterior vaginal wall prolapse stage ≥ 3 had a higher risk of presenting de novo SUI.

Nocturia: Prevalence and associated factors in community-dwelling subjects - a population- based study

OBJECTIVES To assess the prevalence of nocturia and identify factors associated with it in a community-dwelling population. METHODS A cross-sectional study was conducted in subjects aged 45 years or more and registered with a Family Doctor Program. Information was collected about nocturia, other urinary symptoms, physical examination, co-morbidities, demographics, socio-economic, and lifestyle factors. Multiple logistics regression models were developed to analyze associated factors for nocturia according to gender and the number of nocturnal micturitions(≥1 and ≥2). RESULTS Out of the 661 individuals included in the study, 62.3% were women. Among the women, the prevalence rates for nocturia ≥1 time and ≥2 times were, respectively, 68.4% and 49%, whereas, among the men, they were 64.3% and 43.8%. Among the women, nocturia ≥1 time was associated with brown skin, a higher BMI, lower schooling, and calcium channel blockers(CCB) use, while nocturia ≥2 times showed association with higher BMI, lower schooling, obstructive sleep apnea (OSA), and the use of CCB. Among the men, nocturia ≥1 time was associated positively with age, alcohol intake, and OSA, and negatively with angiotensin receptor blockers and beta-blockers use. Besides, nocturia ≥2 times was associated with age, not having health insurance, and OSA. CONCLUSIONS Nocturia is a condition highly prevalent in the studied population. For the female subjects, a higher BMI, lower schooling, and the use of CCB were associated with nocturia regardless of the definition used, whereas, among the men, that same association was found with age, not having health insurance, and OSA.

Prevalence and associated factors in community-dwelling subjects - a population-based study

SUMMARY OBJECTIVES To assess the prevalence of nocturia and identify factors associated with it in a community-dwelling population. METHODS A cross-sectional study was conducted in subjects aged 45 years or more and registered with a Family Doctor Program. Information was collected about nocturia, other urinary symptoms, physical examination, co-morbidities, demographics, socio-economic, and lifestyle factors. Multiple logistics regression models were developed to analyze associated factors for nocturia according to gender and the number of nocturnal micturitions(≥1 and ≥2). RESULTS Out of the 661 individuals included in the study, 62.3% were women. Among the women, the prevalence rates for nocturia ≥1 time and ≥2 times were, respectively, 68.4% and 49%, whereas, among the men, they were 64.3% and 43.8%. Among the women, nocturia ≥1 time was associated with brown skin, a higher BMI, lower schooling, and calcium channel blockers(CCB) use, while nocturia ≥2 times showed association with higher BMI, lower schooling, obstructive sleep apnea (OSA), and the use of CCB. Among the men, nocturia ≥1 time was associated positively with age, alcohol intake, and OSA, and negatively with angiotensin receptor blockers and beta-blockers use. Besides, nocturia ≥2 times was associated with age, not having health insurance, and OSA. CONCLUSIONS Nocturia is a condition highly prevalent in the studied population. For the female subjects, a higher BMI, lower schooling, and the use of CCB were associated with nocturia regardless of the definition used, whereas, among the men, that same association was found with age, not having health insurance, and OSA.

RESUMO OBJETIVOS Estimar a prevalência de noctúria e identificar fatores demográficos, socioeconômicos, clínicos e de estilo de vida associados ao sintoma em uma população comunitária. MÉTODO Estudo transversal em indivíduos com 45 anos ou mais. Foram obtidas informações demográficas, socioeconômicas, sobre noctúria, outros sintomas urinários, exame físico, comorbidades e estilo de vida. As análises foram feitas separadamente de acordo com o gênero e com o número de micções noturnas (≥1 vez e ≥2 vezes). RESULTADOS Dentre os 661 indivíduos incluídos, 62,3% eram mulheres. Entre elas, a prevalência de noctúria ≥1 vez e ≥2 vezes foi, respectivamente, de 68,4% e 49%, enquanto entre os homens foi de 64,3% e 43,8%. Entre as mulheres, a noctúria ≥1 mostrou associação com cor da pele parda, maior IMC, baixa escolaridade e uso de bloqueadores dos canais de cálcio (BCC), enquanto noctúria ≥2 vezes mostrou associação com maior IMC, baixa escolaridade, apneia obstrutiva do sono (AOS) e uso de BCC. Entre os homens, a noctúria ≥1 vez esteve associada positivamente com idade, ingestão de álcool e AOS, e negativamente com uso de bloqueadores dos receptores da angiotensina e de beta-bloqueadores. Além disso, noctúria ≥2 vezes associou-se a idade, não ter plano de saúde e AOS. CONCLUSÕES A noctúria é uma condição altamente prevalente na população estudada. Para as mulheres, IMC elevado, baixa escolaridade e uso de BCC estiveram associados com noctúria independente da definição, enquanto que, para os homens, a mesma associação foi identificada com idade, não ter plano de saúde e AOS.

Captive-born collared peccaries learning about their predators: Lessons learnt but not remembered.

Captive-born animals frequently lose their anti-predatory abilities due to the absence of encounters with their predators, but these abilities can be regained through specific training. Anti-predator training can, thus, enhance the success of reintroduction programs with predator naïve animals. In addition, a good memory is important to guarantee the effects of the anti-predator training and increase survival rate after release into the wild. In the present study, anti-predator training sessions were applied to 11 captive-born collared peccaries (Pecari tajacu), followed by memory tests at 30, 60 and 90 days after the end of the training sessions. The collared peccaries responded appropriately to training against predators, showing alert, escape and predator avoidance behaviors after anti-predator training; however, the animals maintained these acquired behaviors for only 30 days after the end of the anti-predator training. After 60 days, peccaries responded to the predator in a 'relaxed' manner, exhibiting no anti-predator behaviors. For the trained collared peccaries to be released into the wild, reinforcement in the anti-predator training would be required at least 30 days prior to release.

Erratum: Martins, M.S., et al. Wideband and Wide Beam Polyvinylidene Difluoride (PVDF) Acoustic Transducer for Broadband Underwater. Sensors 2019, 19, 3991.

The authors wish to make the following erratum to this paper [...].

Wideband and Wide Beam Polyvinylidene Difluoride (PVDF) Acoustic Transducer for Broadband Underwater Communications.

The advances in wireless communications are still very limited when intended to be used on Underwater Communication Systems mainly due to the adverse proprieties of the submarine channel to the acoustic and radio frequency (RF) waves propagation. This work describes the development and characterization of a polyvinylidene difluoride ultrasound transducer to be used as an emitter in underwater wireless communications. The transducer has a beam up to 10° × 70° degrees and a usable frequency band up to 1 MHz. The transducer was designed using Finite Elements Methods and compared with real measurements. Pool trials show a transmitting voltage response (TVR) of approximately 150 dB re µPa/V@1 m from 750 kHz to 1 MHz. Sea trials were carried in Ria Formosa, Faro (Portugal) over a 15 m source-receiver communication link. All the signals were successfully detected by cross-correlation using 10 chirp signals between 10 to 900 kHz.

Qualidade de vida em pacientes com incontinência urinária diagnosticada por estudo urodinâmico / Quality of life in patients with urinary incontinence diagnosed using urodynamics

Objetivo: O objetivo deste trabalho foi avaliar o impacto da incontinência urinária feminina sobre a qualidade de vida (QV), levando em consideração o resultado do estudo urodinâmico. A incontinência urinária é queixa frequente em mulheres, afetando negativamente a QV. Métodos: Trata-se de estudo transversal, retrospectivo, em banco de dados contendo informações sociodemográficas, clínicas e do estudo urodinâmico e os escores de QV da versão brasileira do King's Health Questionnaire de pacientes atendidas em hospital universitário. Resultados: Não foi observada diferença no impacto dos diferentes diagnósticos urodinâmicos, inclusive exames normais, sobre os domínios percepção geral de saúde e impacto da incontinência. Conclusão: Comparada com a incontinência de esforço e exames normais, a incontinência mista mostrou piores escores nos domínios limitações físicas e limitações das atividades diárias. Já a hiperatividade do detrusor esteve associada a piores escores de limitações das atividades diárias e sono, comparada com a incontinência de esforço, e de limitações físicas, comparada com exames normais.(AU)

Objective: This study aimed to assess the impact of female urinary incontinence on quality of life, according to urodynamic diagnosis. Urinary incontinence is a frequent complaint among women and affects the quality of life negatively. Methods: A retrospective cross-sectional study using a database containing sociodemographic and clinical information, the results from urodynamics and the scores of the Brazilian version of the King's Health Questionnaire of patients attended at a university hospital was performed. Results: There was no difference in the impact of urodynamics diagnosis, including normal exams, in the scores of the general health perception and incontinence impact domains. Conclusion: When compared to normal exams and urinary stress incontinence, mixed incontinence showed lower scores in the role limitations and physical limitations domains. Detrusor overactivity was associated with lower scores in the sleep and role limitations domains, in comparison with urinary stress incontinence, and in the physical limitation domain, compared to normal exams.(AU)

Incontinência dupla: fatores associados e impacto sobre a qualidade de vida em mulheres atendidas em serviço de referência / Double incontinence: associated factors and impact on the quality of life of women attended at a health referral service

OBJETIVO: Avaliar, em uma população feminina com incontinência urinária, a prevalência de incontinência dupla, seus fatores associados e seu impacto sobre a qualidade de vida. MÉTIDO: Estudo transversal em mulheres com incontinência urinária ou dupla (incontinência urinária e fecal) atendidas em um hospital terciário do Sistema Único de Saúde. Foram colhidas informações sociodemográficas e clínicas, e a qualidade de vida foi avaliada por meio de questionários validados. A associação entre as variáveis e os tipos de disfunção (incontinência urinária e dupla) e com a pior percepção geral de saúde foi determinada pelos testes de Mann-Whitney, qui-quadrado e Fisher. RESULTADOS: A amostra do estudo foi composta por 227 mulheres, das quais 120 (52,9%) eram idosas. A prevalência de incontinência dupla foi de 14,1%, e os fatores a ela associados foram maior número de comorbidades (p-valor=0,04), polifarmácia (p-valor=0,04) e presença de retocele (p-valor=0,02). Mostraram associação com pior percepção geral de saúde o IMC (quanto maior, pior; p-valor=0,02) e maior número de comorbidades (p-valor=0,05), mas não a incontinência dupla (p-valor=0,36). CONCLUSÃO: A prevalência de incontinência dupla foi diferente da encontrada em estudos realizados em cenários semelhantes. A população estudada apresenta baixos escores de percepção geral de saúde, mas a incontinência dupla não esteve associada a tais escores. A presença de múltiplas comorbidades está associada tanto à presença de incontinência dupla quanto à pior percepção geral de saúde. AU

Objective: To evaluate the prevalence, associated factors, and impact on quality of life of double incontinence in a group of women with urinary incontinence. METHOD: A cross-sectional study was performed, including female patients with urinary or double incontinence (urinary and fecal incontinence) treated at a tertiary hospital from the public healthcare system. Information about sociodemographic and clinical characteristics was collected, and quality of life was assessed using validated questionnaires. The Mann-Whitney, Chi-square, and Fisher tests were used to evaluate the association between the variables and the types of dysfunction (urinary or double incontinence) and a worse general health perception. RESULTS: Of 227 incontinent women included in the study, 120 (52,9%) were older individuals. The prevalence of double incontinence was 14.1% (32 patients). Double incontinence was associated with a higher number of comorbidities (p-value=0.04), polypharmacy (p-value=0.04), and rectocele (p-valor=0.02). Higher BMI (p-value=0.02) and number of comorbidities (p-value=0.05), but not double incontinence (p-value=0.36), were associated with low general health perception scores. CONCLUSION: the prevalence of double incontinence was different from other studies conducted in similar scenarios. The group of women included in the study presented low general health perception scores, but this was not associated with the presence of double incontinence. A higher number of comorbidities was associated with both double incontinence and a lower general health perception. AU

Prevalência de incontinências anal e dupla em idosas e impacto na qualidade de vida / Prevalence of anal and double incontinence in elderly women and impact on their quality of life

Introdução: A prevalência das incontinências anal e urinária que são mais comuns em mulheres, aumenta com a idade. Tais disfunções podem ser encontradas isoladamente ou em associação (incontinência dupla) e podem provocar grande impacto na qualidade de vida. Objetivos: Avaliar a prevalência das incontinências anal e dupla e o impacto dessas condições sobre a qualidade de vida de mulheres idosas da comunidade. Casuística e Métodos: Estudo observacional descritivo, realizado em mulheres com mais de 60 anos que buscaram a unidade básica de saúde para vacinação. Para a triagem de incontinência urinária e anal, foram utilizadas versões brasileiras dos questionários International Consultation on Incontinence Questionnaire - Short Form e do Índice de Incontinência Anal. Mulheres que apresentaram escores diferentes de zero em ambos questionários receberam diagnóstico de incontinência dupla. A avaliação do impacto da incontinência anal na qualidade de vida foi feita por meio do questionário Fecal Incontinence Quality of Life Questionnaire. As variáveis foram estudadas de maneira descritiva, por meio do cálculo de frequências absolutas e relativas e, no caso da variável idade e dos escores de qualidade de vida, por meio do cálculo da média e desvio-padrão. Resultados: Participaram da pesquisa 66 mulheres, com média de idade de 69,6±7,2 anos. A prevalência de incontinência anal foi de 28,8% (n=19), e a prevalência de incontinência dupla foi de 18,1% (n=12). Pacientes com incontinência anal isolada e dupla apresentaram impacto negativo na qualidade de vida, conforme indicado pelos escores dos domínios avaliados. Conclusão: A prevalência de incontinência anal foi mais elevada do que a prevalência de incontinência fecal isolada ou de incontinência anal encontrada em outras populações. O mesmo foi observado em relação à prevalência de incontinência dupla. Houve impacto negativo de ambas as condições em todos os domínios de qualidade de vida avaliados.

Introduction: The prevalence of anal and urinary incontinence is more frequent in women, and it increases with age. Such dysfunctions may be found alone or in combination (double incontinence), and they may have a major impact on quality of life. Objectives: Evaluate the prevalence of anal and double incontinence, as well as the impact these conditions cause on the quality of life of elderly women residents in a community. Patients and Methods: We carried out an observational descriptive study involving women aged 60 and over who sought the Primary Health Care Unit for vaccination. For the urinary and anal incontinence screening, Brazilian versions of the International Consultation on Incontinence Questionnaire - Short Form and the Anal Incontinence Index were used.Women who presented scores different from zero in bothquestionnaires were diagnosed with double incontinence. Theevaluation on the impact of anal incontinence on quality of lifewas done through the Brazilian version of Fecal IncontinenceQuality of Life Questionnaire. We used descriptive statistics tocalculate relative and absolute frequencies. Age and Qualityof life domain scores were expressed using mean and standarddeviation. Results: Sixty-six women were included in thestudy. Mean age was 69.6±7.2 years. The prevalence of AnalIncontinence was 28.8% (n=19) and the prevalence of doubleincontinence was 18.1% (n=12). Patients with isolated anddouble anal incontinence had a negative impact on qualityof life, as indicated by the scores of the domains evaluated.Conclusions: The prevalence of anal incontinence was higherthan the prevalence of isolated fecal incontinence or analincontinence found in studies carried out in other populations.The same results were observed for the prevalence of doubleincontinence. We identified negative impact of both conditionson all domains of quality of life