A história obstétrica de gestantes com trombofilias hereditárias / Obstetric history of pregnant women with hereditary thrombophilias

Introdução: A doença tromboembólica venosa e as complicações obstétricas resultantes do tromboembolismo placentário são as principais causas de morbidade e mortalidade materna e fetal. Pode-se dizer que a gravidez é um fator independente para o desenvolvimento de trombose, já que seu risco é de 5 a 6 vezes maior em mulheres grávidas quando comparadas a não grávidas, sendo mais elevado após o parto. Métodos: Trata-se de uma coorte histórica, onde foram estudadas pacientes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora (expostos=n=70 pacientes) e na Faculdade de Medicina de Barbacena (não expostos=n=74 pacientes). As pacientes foram divididas em dois grupos: Grupo 1 = pacientes com alguma trombofilia identificada (expostos) através das dosagens de proteína S, proteína C, homocisteína, antitrombina III, mutação da MTHFR, mutação da protrombina e do fator V de Leiden; e Grupo 2 = pacientes do serviço de baixo risco obstétrico. Resultados: Houve associação entre trombofilia e aborto prévio, bem como trombofilia e morte fetal prévia (p<0,05). O tipo de trombofilia que foi associada a abortamento prévio foi o déficit da proteína S. A mutação da MTHFR foi associada aos antecedentes de HELLP síndrome (p=0,03; x2 =4,2) e de pré-eclâmpsia (p=0,03; X2 =4,5) quando em homozigotia mutante. A homozigotia para a MTHFR foi também associada às médias de homocisteína, de forma que as homozigotas eram aquelas que apresentavam a maior dosagem de homocisteína (p=0,01; X2 =5,8; X= 27,2 ± 41,2 vs. 12,62 ± 19,0). Conclusão: As trombofilias hereditárias podem estar associadas a mau desfecho obstétrico e devem ser valorizadas na clínica obstétrica. (AU)

Introduction: Venous thromboembolic disease and obstetric complications resulting from placental thromboembolism are the main causes of maternal and fetal morbidity and mortality. Pregnancy is considered an independent factor for the development of thrombosis, as its risk is 5 to 6 times greater in pregnant women when compared to non-pregnant women, being even higher after childbirth. Methods: This historical cohort included patients seen at the Obstetrics Service of Federal University of Juiz de Fora (exposed patients, n = 70) and at the School of Medicine of Barbacena (unexposed patients, n = 74). The patients were divided into two groups: Group 1 consisted of patients with some thrombophilia identified through measurement of protein S, protein C, homocysteine, antithrombin III, MTHFR mutation, prothrombin and factor V Leiden mutations; and Group 2 consisted of patients from the low obstetric risk service. Results: There was an association between thrombophilia and previous abortion, as well as thrombophilia and previous fetal death (p < 0.05). MTHFR mutation was associated with history of HELLP syndrome (p = 0.03; x2 = 4.2) and preeclampsia (p = 0.03; x2 = 4.5) when in homozygous mutation. Homozygous MTHFR was also associated with mean homocysteine levels, so that homozygotes were those with highest homocysteine levels (p = 0.01; x2 = 5.8; x = 27.2 ± 41.2 vs. 12.62 ± 19.0). Conclusions: Hereditary thrombophilias may be associated with poor obstetric outcome and should be valued at clinical obstetrics. (AU)

Concentração de iodo urinário em urina de 24 horas de gestantes e sua associação com bócio tireoidiano materno, aborto e peso neonatal: estudo piloto / Urinary iodine concentration in 24-hour urine of pregnant women and its association with goiter in the mother, abortion and neonatal weight: pilot study

Introdução: A comida tem um papel proeminente na obtenção do iodo e uma das melhores estratégias é a iodização do sal. No Brasil, a Anvisa reduziu as doses de iodo no sal de cozinha desde 2014. Portanto, é importante avaliar a concentração urinária de iodo (CIU) em nossa população. Com base no exposto, propõe-se avaliar a CIU das gestantes, associando-a à frequência de bócio materno, aborto e peso neonatal. Métodos: Trata-se de um estudo observacional com um corte transversal composto por 37 pacientes atendidos no Serviço de Obstetrícia da Faculdade de Medicina de Barbacena e uma clínica particular em Juiz de Fora. A CIU foi verificada em 24 horas de urina. Resultados: A média de CIU foi de 213,6 µg/l de urina, com dose mínima de 29 µg/l e máxima de 437 µg/l. A glândula tireoide foi avaliada durante o exame clínico prénatal (palpação da glândula) e em 24 pacientes (38,1%) foi considerada normal. A palpação da glândula tireoide foi associada à CIU. Houve maior iodúria em gestantes com glândula não palpável (p = 0,004; T = 14,13). Não houve associação entre a CIU e história de aborto ou peso fetal ao nascimento (p > 0,05). Conclusões: Apesar de ser uma amostra pequena da população, identificamos pacientes expostas ao déficit. No entanto, a CIU não parece estar associada ao peso do recém-nascido ou a abortos, mas à dosagem de TSH e ao tamanho da glândula tireoide. Assim, a palpação da glândula tireoide poderia ser usada como uma medida indireta do CIU. (AU)

Introduction: Food has a prominent role in providing iodine and one of the best strategies is salt iodization. The Brazilian Health Regulatory Agency has reduced iodine content in table salt since 2014. Therefore, there is a need for evaluating urinary iodine concentration in our population, especially after the modified recommendations. Based on the above, we sought to assess urinary iodine concentration in pregnant women, associating it with frequency of maternal goiter, abortion and neonatal weight. Methods: This observational, cross-sectional study included 37 patients seen at the Obstetrics Service of Barbacena Medical School and a private clinic in Juiz de Fora, both in the state of Minas Gerais, Brazil. Iodine concentration was determined in 24- hour urine through chromatography. Results: The mean 24-hour urine iodine was 213.6 µg/l, with minimum and maximum measures of 29 µg/l and 437 µg/l, respectively. The thyroid gland was assessed by prenatal clinical examination (palpation of the gland). In 24 patients (38.1%) it was considered normal. Palpation of the thyroid gland was associated with 24-hour urine iodine concentration, although a higher iodine concentration was identified in pregnant women with non-palpable gland (p = 0.004; T = 14.13). There was no association between 24-hour urine iodine concentration and history of abortion or birth weight (p > 0.05). Conclusions: This study, although based on a small sample of the population, was important to identify that even in areas where iodine is considered sufficient there may be patients exposed to iodine deficit. However, urinary iodine concentration does not appear to be associated with birth weight or abortion frequency but is associated with thyroid-stimulating hormone (TSH) level and thyroid gland size, suggesting that clinical evaluation of the thyroid gland is an important element for predicting urinary iodine concentration. Thus, palpation of the thyroid gland could be used as an indirect measure of urinary iodine concentration. (AU)

Frequência de sífilis em gestantes / Frequency of syphilis in pregnant women

O cuidado primário tem um papel importante na prevenção e no tratamento de doenças infecciosas, pois no contexto gestacional algumas dessas doenças podem causar complicações graves ao recém-nascido, levando inclusive à morte fetal. Os autores apresentam um estudo transversal em que participaram 299 gestantes no Serviço Pré-natal em Juiz de Fora e 66 gestantes oriundas do serviço de obstetrícia da Faculdade de Medicina de Barbacena. A idade média foi de 24,60 anos. Houve sífilis em ambos os grupos, mas não houve casos de sífilis congênita. Os autores concluíram que a frequência de sífilis apresentou distribuição uniforme em ambos os serviços e sugerem medidas adequadas de controle e tratamento de gestantes. (AU)

Primary care has an important role in the prevention and treatment of infectious diseases since in the gestational context some of these diseases can cause severe complications to the newborn, including fetal death. This is a cross-sectional study assessing 299 pregnant women who attended the Pre-Natal Service in Juiz de Fora and 66 pregnant women who attended the Obstetrics Service of Barbacena School of Medicine. The average age was 24.60 years old. There was syphilis in both groups, but there were no cases of congenital syphilis. The authors concluded that the frequency of syphilis had a uniform distribution among both services and suggest adequate measures of control and treatment of pregnant women. (AU)

Avaliação temporal da frequência da infecção do HIV em gestantes / Temporal evaluation of frequency of HIV infection in pregnant women

Com a evolução da epidemia de AIDS nas últimas décadas, houve um aumento expressivo do número de casos entre heterossexuais. A feminização da epidemia acelerou a disseminação geográfica do vírus da imunodeficiência humana (HIV) em todo o território nacional, determinando também o aumento de crianças infectadas pela transmissão materno-infantil. A frequência da infecção pelo HIV em gestantes atendidas pelo Serviço de Obstetrícia da Universidade Federal de Juiz de Fora, nos períodos de 2009-2015 (grupo 1) foi avaliada e comparada com a frequência da infecção pelo HIV no mesmo serviço no período de 1998-2002 (grupo 2). A comparação dos dados revelou uma menor frequência da infecção pelo HIV no grupo 1. Os autores identificaram queda da frequência da infecção pelo HIV ao longo do tempo, com estabilização nos últimos anos (AU)

There has been a significant increase in the number of cases of AIDS among heterosexuals, due to the dissemination of AIDS epidemic in recent decades. The feminization of the epidemic accelerated the geographical spread of the human immunodeficiency virus (HIV) throughout the Brazilian territory and also led to an increase of children infected by mother-child transmission. The frequency of HIV infection in pregnant women attending the Obstetrics Service of Federal University of Juiz de Fora was evaluated from 2009-2015 (group 1) was evaluated and compared with the frequency of HIV infection in the same department from 1998-2002 (group 2). Intergroup comparison revealed a decrease in the frequency of HIV infection in group 1. The authors found a decrease the frequency of HIV infection, with stabilization in recent years (AU)

Qualidade do pré-natal: uma comparação entre gestantes atendidas na Faculdade de Medicina de Barbacena e na Universidade Federal de Juiz de Fora / Prenatal care quality: a comparison between pregnant women seen at the Medical School of Barbacena and the Federal University of Juiz de Fora

Introdução: A assistência ao pré-natal é fundamental para os resultados perinatais, pois quanto melhor a qualidade do amparo, mais favoráveis são os resultados e menores são as taxas de mortalidade materna e perinatal. Objetivos: Avaliar a qualidade do pré-natal com base no número de consultas e na idade gestacional no início do pré-natal, através da criação de um modelo experimental baseado na assistência clínica e na realização de exames complementares. Métodos: Estudo de corte transversal, em que foram analisados 150 prontuários de gestantes atendidas no Serviço de Obstetrícia da Universidade Federal de Juiz de Fora e 51 prontuários de gestantes atendidas na Unidade Básica de Saúde do bairro Santa Cecília no município de Barbacena/MG. Resultados: Não houve diferenças socioeconômicas, em relação aos aspectos obstétricos, exames complementares, complicações clínicas, obstétricas, nem sorologias para toxoplasmose, sífilis e HIV. Entretanto, o número de consultas, idade gestacional na primeira consulta, exame das mamas, sorologias para rubéola, exame macroscópico dos fluxos genitais, coleta colpocitológica, ganho de peso durante o pré-natal, anemia e a infecção urinária apresentaram diferença significativa. Conclusão: O pré-natal de Barbacena foi considerado adequado em 78,4% dos casos pelo Índice de Kessner modificado por Takeda (IKMT) e adequado intermediário pelo Índice de Acesso e Assistência ao Pré-natal (IAAPN). Já o pré-natal de Juiz de Fora foi considerado adequado em 77,3% pelo IKMT e adequado superior pelo IAAPN (AU)

Introduction: Prenatal care is important for perinatal outcomes, because the better the quality of support, more favorable are the results and lower the maternal and perinatal mortality rates. Objectives: To assess the quality of prenatal care based on the number of medical visits and gestational age at the beginning of prenatal care through the creation of an experimental model based on clinical care and complementary exams. Methods: Cross-sectional study analyzing 150 medical records of pregnant women seen at the Obstetrics Department of the Federal University of Juiz de Fora and 51 medical records of pregnant women seen at the Santa Cecilia Primary Health Care Unit located in the city of Barbacena/MG, Brazil. Results: There were no differences in terms of socioeconomic conditions, obstetric aspects, laboratory tests, clinical and obstetric complications, or serology for toxoplasmosis, syphilis, and HIV. However, the number of medical visits, gestational age at first visit, breast examination, serology for rubella, macroscopic examination of the genital flows, cervical cytology, weight gain during prenatal care, anemia and urinary tract infection showed significant difference. Conclusion: Barbacena's prenatal care was considered adequate in 78.4% of cases by the Kessner index modified by Takeda (KIMT) and appropriate intermediate by the Prenatal Access and Assistance Index (PNAAI); whereas the Juiz de Fora's prenatal care was considered adequate in 77.3% by the KIMT and appropriate superior by the PNAAI (AU)

A utilização da progesterona natural micronizada em gestações gemelares na prevenção do trabalho de parto prematuro / Use of natural micronized progesterone in the prevention of preterm labor in twin pregnancies

Com o objetivo de determinar a eficácia da progesterona natural micronizada em gestações gemelares para a profilaxia do trabalho de parto prematuro, foi avaliada uma coorte histórica de 43 mulheres com gestações gemelares. As gestantes foram divididas em dois grupos: usuárias da progesterona (Grupo 1) e não usuárias da progesterona (Grupo 2). O medicamento foi administrado na dosagem de 200 mcg por via vaginal, a partir de 20 semanas de gestação. Das 43 gestações estudadas, 20 foram tratadas com a progesterona. Não houve associação entre uso da progesterona e época do parto, de forma que o uso da progesterona natural micronizada não impediu o parto prematuro (p = 0,87). Portanto, a progesterona natural micronizada não reduziu a frequência do trabalho de parto prematuro em gestações gemelares...

A historical cohort of 43 women with twin pregnancies were assessed to determine the effectiveness of natural micronized progesterone in twin pregnancies for the prophylaxis of preterm labor. The women were divided into two groups: progesterone users (Group 1) and non-users of progesterone (Group 2). The drug was administered at a dose of 200 mcg vaginally, from 20 weeks of gestation. Of the 43 pregnancies studied, 20 were treated with progesterone. There was no association between use of progesterone and delivery time, so that the use of natural micronized progesterone did not prevent preterm birth (p = 0.87). Therefore, natural micronized progesterone did not reduce the frequency of preterm birth in twin pregnancies...

Estudo piloto – desvio positivo de pacientes hipertensos na cidade de Barbacena, Minas Gerais – Brasil / Pilot profect – positive deviance on hypertensive patients in a midsize city, Minas Gerais – Brazil

A hipertensão arterial sistêmica (HAS) é uma condição clínica multifatorial caracterizada por níveis elevados e sustentados de pressão arterial (PA). 1 O paciente é considerado hipertenso quando a pressão sistólica é ≥ 140 mmHg e a diastólica é ≥ 90 mmHg em três aferições 1-5.Embora o tratamento adequado seja importante para o controle da HAS, a prevenção se destaca, especialmente nos pacientes de risco 5-9...

Spontaneous pneumothorax during pregnancy: case report and literature review

Pneumothorax during pregnancy is a rare and potentially serious complication for both mother and fetus. Due to an increased need for oxygen during pregnancy and delivery, pneumothorax affects fetal oxygen supply, since it causes hypoxia in the mother. The authors describe a case of pneumothorax during pregnancy and conduct a literature review.

Associação entre cultura de secreção vaginal, características sociodemográficas e manifestações clínicas de pacientes com diagnóstico de candidíase vulvovaginal / Association between vaginal secretion culture, socio-demographic characteristics and clinical manifestations of patients with vulvovaginal candidiasis

OBJETIVO: Investigar a etiologia, o perfil epidemiológico de pacientes com candidíase vulvovaginal (CVV) e possíveis fatores predisponentes. MÉTODOS: Secreção vaginal das pacientes foi semeada em ágar Sabouraud e amostras de leveduras foram isoladas e identificadas por Polymerase Chain Reaction (PCR). Dados demográficos, clínicos e fatores predisponentes foram obtidos por meio de questionário. Para análise estatística, foram utilizados os testes t de Student, Fischer e do χ², com auxílio do software Statistical Package for the Social Sciences (SPSS), com nível de significância de 5%. RESULTADOS: Foram avaliadas 69 pacientes, com idade entre 15 e 52 anos, predominando mulheres brancas (79,7%), com escolaridade de nível superior completo (58%), casadas (56,5%) e com vida sexual ativa (97,1%). Dentre elas, 34,8% eram gestantes, 7,2% diabéticas, 1,4% soropositivas para AIDS e 36,2% usavam anticoncepcional oral. Antibioticoterapia recente foi citada por 13% das pacientes, uso de antifúngico por 5,8% e de antitricomonas por 1,4%. Uso de corticosteroides foi relatado por 2,9% das participantes e de antineoplásicos, por 1,4%. Fluxo vaginal e prurido foram as principais queixas apresentadas, respectivamente, por 97,1 e 73,9% das pacientes, seguido de ardência (63,8%) e hiperemia (63,8%). Quando presente, o fluxo foi majoritariamente branco (88,1%) ou grumoso (86,6%). O diagnóstico foi confirmado pela cultura em 55 (79,7%) pacientes, sendo 4 casos de infecção mista. A espécie prevalente foi C. albicans, seguida por um caso de C. glabrata, que foi encontrada em mais duas pacientes em associação com C. albicans. Nas outras duas infecções polimicrobianas, C. lusitaniae foi isolada com C. albicans. CONCLUSÕES: Embora a positividade da cultura tenha sido alta e os dados clínicos de CVV sejam característicos, a sintomatologia não é patognomônica. C. albicans é a espécie prevalente, mas deve-se atentar para a ocorrência de outras espécies na etiologia de CVV, como a emergência de C. lusitaniae.

PURPOSE: To investigate the etiology and the epidemiological profile of patients with vulvovaginal candidiasis (VVC) and predisposing factors. METHODS: Vaginal secretions were streaked in Sabouraud agar and yeast samples were isolated and identified by Polymerase Chain Reaction (PCR). Demographic and clinical data were obtained with a questionnaire. For statistical analysis, the Student's t-test, the χ² and Fischer tests were applied as needed using the Statistical Package for Social Sciences (SPSS) software, with the level of significance set at 5%. RESULTS: Sixty-nine patients aged from 15 to 52 years were evaluated. They were predominantly white (79.7%), with higher education (58%), married (56.5%) and sexually active (97.1%). Among them, 34.8% were pregnant, 7.2% diabetic, 1.4% seropositive for AIDS, and 36.2% were using oral contraceptives. Recent antibiotic therapy was mentioned by 13% of the patients, and antifungal or anti-trichomonas therapy was mentioned by 5.8 and 1.4% of the patients, respectively. Corticosteroid use was reported by 2.9% and antineoplastic by 1.4%. Vaginal discharge and itching were the main complaints (97.1 and 73.9%), followed by burning (63.8%) and erythema (63.8%). When present, the vaginal flow was predominantly white (88.1%) or lumpy (86.6%). The diagnosis was confirmed by culture in 55 (79.7%) patients, with mixed infections in 4 patients. The most prevalent species was C. albicans, followed by C. glabrata (one monoinfection and two mixed infections with C. albicans). C. lusitaniae and C. albicans were also identified in mixed infections (two patients). CONCLUSION: Despite the high culture positivity and clinical data characteristic of VVC, the symptoms were not pathognomonic. C. albicans is the most prevalent species, but other species are also involved in VVC etiology, such as the emergence of C. lusitaniae.

[Association between vaginal secretion culture, socio-demographic characteristics and clinical manifestations of patients with vulvovaginal candidiasis]. / Associação entre cultura de secreção vaginal, características sociodemográficas e manifestações clínicas de pacientes com diagnóstico de candidíase vulvovaginal.

PURPOSE: To investigate the etiology and the epidemiological profile of patients with vulvovaginal candidiasis (VVC) and predisposing factors. METHODS: Vaginal secretions were streaked in Sabouraud agar and yeast samples were isolated and identified by Polymerase Chain Reaction (PCR). Demographic and clinical data were obtained with a questionnaire. For statistical analysis, the Student's t-test, the χ² and Fischer tests were applied as needed using the Statistical Package for Social Sciences (SPSS) software, with the level of significance set at 5%. RESULTS: Sixty-nine patients aged from 15 to 52 years were evaluated. They were predominantly white (79.7%), with higher education (58%), married (56.5%) and sexually active (97.1%). Among them, 34.8% were pregnant, 7.2% diabetic, 1.4% seropositive for AIDS, and 36.2% were using oral contraceptives. Recent antibiotic therapy was mentioned by 13% of the patients, and antifungal or anti-trichomonas therapy was mentioned by 5.8 and 1.4% of the patients, respectively. Corticosteroid use was reported by 2.9% and antineoplastic by 1.4%. Vaginal discharge and itching were the main complaints (97.1 and 73.9%), followed by burning (63.8%) and erythema (63.8%). When present, the vaginal flow was predominantly white (88.1%) or lumpy (86.6%). The diagnosis was confirmed by culture in 55 (79.7%) patients, with mixed infections in 4 patients. The most prevalent species was C. albicans, followed by C. glabrata (one monoinfection and two mixed infections with C. albicans). C. lusitaniae and C. albicans were also identified in mixed infections (two patients). CONCLUSION: Despite the high culture positivity and clinical data characteristic of VVC, the symptoms were not pathognomonic. C. albicans is the most prevalent species, but other species are also involved in VVC etiology, such as the emergence of C. lusitaniae.

Pregnancy after kidney transplantation: when is the best time? / Gravidez após transplante renal: qual o momento ideal?

The authors report a case of a patient underwent kidney transplantation that went through an unplanned pregnancy, at 41 years old, as well as the implications for both mother and fetus.

Os autores relatam o caso de uma paciente submetida à transplante renal que evoluiu com uma gravidez não planejada, aos 41 anos de idade, bem como suas implicações para o binômio mãe e feto.

Langerhans cell density in cervical intraepithelial neoplasia associated with human papillomavirus infection in HIV-infected and HIV-noninfected Brazilian women.

OBJECTIVE: Local immunity plays an important role in the cervical defense mechanisms that prevent the development of cervical intraepithelial neoplasia. The objective of this study was to determine the involvement of local immunity by evaluating Langerhans cell (LC) density in cervical biopsies of human immunodeficiency virus (HIV)-positive and HIV-negative women. MATERIALS AND METHODS: A cross-sectional study was developed by including HIV-positive and HIV-negative women. All patients presented human papillomavirus DNA from the uterine cervix, which was detected by polymerase chain reaction or hybrid capture II. Cervical biopsies were assessed for LC density and cervical intraepithelial neoplasia. Langerhans cells were identified by immunohistochemistry using anti-CD1a and anti-S100 antibodies. Associations among cervical LC density, the type of cervical lesion, CD4 lymphocyte count, and HIV viral load were analyzed using logistic regression (SPSS, version 12.0). RESULTS: Seventy-seven women (40 seropositive and 37 seronegative) were enrolled. The mean ± SD LC density identified with the anti-CD1a antibody was 0.80 ± 0.7 cells versus 2.6 ± 1.6 cells (P < 0.0001), whereas the mean ± SD LC density identified by the anti-S100 antibody was 1.3 ± 1.0 cells versus 3.6 ± 1.7 cells (P < 0.0001) among the HIV-positive and HIV-negative women, respectively. There were no associations between LC density and HIV viral load, CD4 lymphocyte count, or human papillomavirus genotype (P > 0.05). In a logistic regression model, HIV infection was the only factor independently associated with a decrease in LC density. CONCLUSIONS: Human immunodeficiency virus infection was found to be an independent factor that explains the decrease in local immunity in the uterine cervix, which could allow the development of cervical lesions. This effect was not associated with CD4 lymphocyte count or HIV viral load.

Espiralização, estenose e trombose do cordão umbilical e morte fetal / Hypercoiling, stricture, and thrombosis of the umbilical cord and fetal death

Anormalidades do cordão umbilical são inúmeras, desde nós falsos, que não tem significado clínico, até alterações que determinam a morte fetal intraútero. Aqui apresentamos o caso de uma paciente que foi acompanhada em regime de pré-natal de baixo risco, com queixa de parada súbita da movimentação fetal.

Umbilical cord abnormalities are numerous, ranging from false knots, which have no clinical significance, to changes that often lead to fetal death. As prenatal ultrasound becomes increasingly sophisticated, many of these conditions are now diagnosed in uterus. We describe the case of a patient that progressed from a low-risk pre-natal condition, with a complaint of sudden cessation of fetal movement, to a diagnosis of fetal death.

Aspectos ginecológicos e frequência de infecções do trato genital inferior em pacientes adolescentes e adultas: existem diferenças? / Gynecological aspects and frequency of lower genital tract infections in teenagers and adult patients: are there any differences?

Introdução: As adolescentes merecem atenção especial em saúde pública, pois ao iniciar atividade sexual se expõem aos riscos das DSTs, da gravidez indesejada, do câncer cervical e de outras doenças inflamatórias pélvicas. Objetivos: Avaliar os aspectos ginecológicos e a frequência de infecções do trato genital inferior em adolescentes. Métodos: Trata-se de um estudo de caso-controle, onde foram estudadas pacientes adolescentes (n=68) e adultas (n=112) atendidas em uma clínica privada, que presta atendimento em ginecologia e obstetrícia. Excluíram-se aquelas que apresentavam qualquer tipo problema que impossibilitasse a realização dos exames necessários (sangramento genital, uso de cremes ou gel vaginal ou relação sexual em intervalo inferior a 72 horas da consulta médica) e as que não assinaram o Termo de Consentimento Livre e Esclarecido (TCLE). As pacientes foram submetidas à anamnese e exame físico, com coleta de material para a realização de citologia, exame a fresco e pesquisa do DNA do Papilomavírus humano (HPV), pela técnica de captura híbrida II. Quando necessário realizou-se a biópsia de colo uterino, guiada pela colposcopia. No teste de significância estatística das diferenças observadas na análise, utilizou-se o teste do qui-quadrado e/ou o teste T de Student, dependendo da natureza dos dados comparados. O nível de significância adotado na análise foi de 5%. Resultados: A frequência de infecção pelo HPV diagnosticada pela captura híbrida foi de 47,3% para as pacientes adultas e de 35,3% para as adolescentes (p=0,42). A frequência de neoplasia intraepitelial de alto grau foi mais frequente em pacientes adultas, mas as adolescentes apresentaram 19% de neoplasia intraepitelial cervical diagnosticada pela histopatologia. Conclusão: Identificou-se percentual elevado de neoplasia intraepitelial cervical em adolescentes, o que pode estar associado ao comportamento de risco deste grupo, com trocas frequentes de parceiros e prática do sexo sem proteção.

Background: Adolescents deserve special attention in public health, because when they start sexual activity these are individuals exposed to the risks of STDs, unwanted pregnancies, cervical cancer and other pelvic inflammatory diseases. Aim: To evaluate the frequency of gynecological and lower genital tract infections in adolescents. Methods: This is a case-control study where patients were studied, both adolescents (n = 68) and adults (n=112) attended a private clinic. We excluded those who had any problems that hinder the achievement of the necessary examinations (vaginal bleeding, use of creams or gels or vaginal intercourse at an interval less than 72 hours of medical consultation) and that did not sign the informed consent. The patients underwent history and physical examination, with collection of material for the Pap smear and research DNAHPV, the technique of hybrid capture II. When appropriate a cervix biopsy was done guided by colposcopy. Statistical analysis were performed considering p<0.05. Results: The frequency of HPV infection diagnosed by hybrid capture was 47.3% for adult patients and 35.3% for girls (p=0.42). The frequency of intraepithelial neoplasia of high degree was more frequent in adult patients, but 19% of adolescents had cervical intraepithelial neoplasia diagnosed by histopathology. Conclusion: We identified a high percentage of cervical intraepithelial neoplasia in adolescents, which may be associated with a risky behavior in this group, with frequent partners changes and practice of unprotected sex.

Avaliação clínica, mamográfica e frequência de doenças mamárias em pacientes de um serviço privado de saúde / Clinical and mammographic evaluation and frequency of breast disease in patients of a private health care facility

Introdução: O câncer de mama é a neoplasia maligna de maior incidência na população feminina, apresentando crescimento contínuo na última década. A mamografia de rastreamento é considerada o teste mais sensível para a detecção precoce do câncer de mama, mesmo que dependente do seu padrão de qualidade, o que inclui competência profissional e equipamentos adequados. Objetivos: Avaliar a frequência de doenças mamárias e o rastreio mamográfico utilizado no serviço privado de saúde. Métodos: Realizou-se um estudo com corte transversal com 3193 de pacientes que foram atendidas em um serviço privado de Saúde da Mulher, no período de janeiro de 1988 a janeiro de 2010, sendo excluídas as pacientes que não permitiram que seus dados fossem estudados, as que já haviam tratado previamente de um câncer de mama e as pacientes com prontuários incompletos. Resultados: Foram revisados 3076 prontuários, com identificação de 117 pacientes com alterações mamográficas e ou alterações clínicas mamárias. A média de idade das pacientes avaliadas foi de 45,01+13,32 anos. A história familiar de câncer de mama foi identificada por 15,40% das pacientes (n=18) e 27 pacientes (23,1%) relataram tratamento mamário prévio. Verificou-se que a idade foi o fator mais importante no determinismo do câncer de mama (p<0,001; X2=64,68) e que quanto maior o número de mamografias realizadas ao longo da vida, menor a freqüência de diagnóstico de câncer invasor da mama (p<0,05). Conclusões: Concluem os autores que as políticas de saúde devem levar em consideração o rastreio mamográfico como um elemento importante para o diagnóstico precoce do câncer de mama.

Background: Breast cancer is the most common malignant neoplasm among women. This type of cancer has been continuously growing over the past decade. Screening mammography is considered the most sensitive test for the early detection of breast cancer, although its accuracy depends on quality factors such as professional competence and adequate equipment. Aims: To evaluate the frequency of breast diseases and to investigate the types of breast screening used in a private health care facility. Methods: We conducted a cross-sectional study involving 3,193 patients seen at a private women’s health care facility between January 1988 and January 2010. We excluded from the study the patients who did not allow the use of their data, as well as those who had been previously treated for breast cancer and the ones whose medical records were incomplete. Results: We reviewed 3,076 medical records. One-hundred and seventeen patients had abnormal mammographic or clinical results. The mean age of the patients was 45.01 + 13.32 years. Family history of breast cancer was reported by 15.40% of patients (n=18), and 27 patients (23.1%) reported previous treatment of breast disease. We found that age was the most important factor for the detection of breast cancer (p<0.001, X2=64.68) and that the greater the number of mammograms performed throughout life, the lower the frequency of a diagnosis of invasive breast cancer (p<0.05). Conclusions: We concluded that the health policies should consider screening mammograms as an important factor that contributes to the early diagnosis of breast câncer.

Aspectos ginecológicos e obstétricos de pacientes atendidas nos serviços público e privado de saúde: há diferenças? / Gynecological and obstetrics aspects of patients treated in public and private health services: are there any differences?

OBJETIVO: Avaliar os aspectos epidemiológicos e clínicos de pacientes ginecológicas atendidas nas redes privada e pública de saúde. MÉTODOS: Estudo de corte transversal, no qual foram estudados prontuários de 243 pacientes (122 pacientes no serviço público e 121 no privado), de janeiro de 2007 a janeiro de 2008. Excluíram-se os prontuários de pacientes grávidas, com sangramento genital, histórico de uso de cremes ou géis vaginais em intervalos inferiores há 15 dias e pacientes que tiveram relação sexual em prazo inferior a cinco dias da consulta avaliada. A análise dos dados foi realizada com recursos de processamento estatístico do software Stata, versão 9.2, considerando-se o nível de significância de 5 por cento. RESULTADOS: A média de idade das pacientes foi de 27±12 anos entre pacientes da rede pública, e de 25,9±10,4 anos na rede particular, não havendo diferença estatística entre estas médias (F=0,5 e p=0,4). As pacientes da rede pública apresentaram escolaridade mais baixa (p<0,001), eram preferencialmente do lar (p<0,001), iniciaram vida sexual mais precocemente, tiveram maior número de parceiros (p<0,001), de gestações (p<0,001) e de partos (p=0,004) e utilizavam principalmente a camisinha como método contraceptivo (p=0,013). Não houve diferença estatística em relação aos antecedentes de doenças sexualmente transmissíveis, ao diagnóstico de candidíase, vaginose bacteriana, tricomoníase ou neoplasia. CONCLUSÕES: As pacientes da rede pública de saúde apresentam maior número de gestações e partos. São, em geral, donas de casa, com baixa escolaridade, iniciam vida sexual mais precocemente e com maior número de parceiros. Entretanto, não houve diferença entre os grupos quando se avaliaram doenças mamárias, infecções ginecológicas ou neoplasias de colo uterino, o que sugere que o nível socioeconômico não é o único elemento no determinismo da doença e, por isso, outras variáveis devem ser avaliadas.

PURPOSE: To evaluate the epidemiological and clinical aspects of gynecological patients seeking care in the private and public health networks. METHODS: In this cross-sectional study we analyzed the records of 243 patients (122 public service patients and 121 private service ones), from January 2007 to January 2008. We excluded records of pregnant patients with vaginal bleeding, history of using vaginal creams or gels at intervals of less than 15 days and patients who had sexual intercourse within less than five days before their visit and with incomplete clinical data. Data were analyzed statistically using the Stata software, version 9.2, with a 5 percent level of significance. RESULTS: The mean age of the patients attending the public health service was 27±12 years-old and 25.9±10.4 years-old for patients attending the private health service, with no statistical difference between means (F=0.5 and p=0.4). Patients attending the public health service had lower education (p<0.001), they were preferentially housewives (p<0.001), began sexual life early, had a greater number of partners (p<0.001), of pregnancies (p<0.001) and of deliveries (p=0.004), and mainly used the condom as a contraceptive method (p=0.013). There was no statistical difference between groups regarding the history of sexual transmitted diseases, diagnosis of candidiasis, bacterial vaginosis, trichomoniasis, or neoplasia. CONCLUSIONS: Patients attending the public health service have a higher number of pregnancies and births. They are usually housewives with low educational level, their sex life begins early, and they have more partners. However, there was no difference between groups when evaluating breast diseases, gynecological infections, or cancer of the cervix, which suggests that socioeconomic status is not the only element in the determination of the disease and, therefore, other variables should be evaluated.

[Screening of infection by human immunodeficiency virus at the time of delivery]. / Rastreio da infecção pelo vírus da imunodeficiência humana no momento do parto.

PURPOSE: to evaluate the frequency of HIV tests performed during prenatal care and rapid tests ordered for pregnant women admitted at the time of delivery. METHOD: this was a cross-sectional study with 711 pregnant women at delivery during the period from January to July 2010. Women admitted for clinical control and those that did not allow their clinical data to be included in the study were excluded. The χ² test or the Fisher's Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5%. RESULTS: the mean age of the patients was 25.77 ±6.7 years and the maximum and minimum age was 44 and 12 years, respectively. The average gestational age at the time of attendance was 38.41 ±6.7 weeks. Of these patients, 96.3% (n=685) had prenatal care and 11.1% (n=79) received prenatal care at our facility. The average number of prenatal care visits was 6.85 ±2.88, but 28.1% had less than six visits. We identified 10 HIV-positive pregnant women (1.4%) and two patients were known to be HIV positive. The others (n=8) were screened at birth and therefore did not receive ARV prophylaxis during the prenatal period. Three patients were admitted during the expulsion period and also did not receive intrapartum antibiotic prophylaxis. However, all newborns were evaluated, with lactation being suppressed and artificial milk being used. CONCLUSIONS: despite the measures established by the Ministry of Health, there are still flaws in the approach to these patients. Only with the participation of managers and professionals involved in care it will be possible to correct the direct actions that enable the effective prevention of vertical transmission of HIV.

[Hormonal contraception: a comparison between patients of the private and public health network]. / Contracepção hormonal: uma comparação entre pacientes das redes pública e privada de saúde.

The aim of this paper is to assess the profile of patients using hormonal contraceptives in the public health network and a comparison with the private health service, as well as the frequency of side effects and adherence to treatment. A cross-sectional study was conducted with 240 patients, namely 120 patients from the private health service and 120 patients from the public health network. The most commonly prescribed hormonal dosage on the private group (36.7%) was 15 or 20 micrograms of ethinyl estradiol (EE), associated with gestodene, desogestrel or levonorgestrel. On the other hand, the prescribed hormonal dosage in the public group was a combination of 30 micrograms of EE associated with gestodene, levonorgestrel or desogestrel (48.3%). There was no difference between the frequency of side effects in both groups surveyed (p>0.05). Meanwhile, adherence to treatment was higher in patients of the private group. The authors concluded that the most widely used contraceptive method was a low oral dose of ethinyl estradiol and there is no difference between the frequency of side effects. However, adherence to treatment was higher in the private group, which may be associated with social and cultural aspects of the patients surveyed.

Prevenção da doença perinatal pelo estreptococo do grupo B: atualização baseada em algoritmos / Prevention of perinatal group B streptococcal disease: algorithm-based update

A infecção pelo estreptococo β-hemolítico do grupo B (EGB) ou Streptococcus agalactiae persiste como uma causa líder de morbimortalidade perinatal. A antibioticoprofilaxia da infecção pelo EGB, baseada no rastreio universal em gestações de 35 a 37 semanas, é mais efetiva do que a estratégia baseada em fatores de risco. A seleção do antibiótico deve se basear na suscetibilidade da cepa do EGB e na história materna de alergia ao medicamento. A penicilina G, administrada por via endovenosa (≥4 horas), continua sendo a droga de escolha para a profilaxia intraparto, enquanto a ampicilina é uma alternativa aceitável. A cefazolina é recomendada para gestantes alérgicas à penicilina, as quais apresentam baixo risco de anafilaxia, enquanto a clindamicina e a eritromicina são indicadas para os casos com alto risco de anafilaxia. A vancomicina deve ser utilizada nas gestantes alérgicas à penicilina, quando houver resistência à clindamicina e à eritromicina ou quando a sensibilidade a essas drogas for desconhecida. No entanto, devido à persistência da morbimortalidade perinatal e ao surgimento de novos dados relevantes nas áreas de epidemiologia, obstetrícia, neonatologia, microbiologia, biologia molecular e farmacologia, em 2010, o Centers of Disease Control and Prevention (CDC) publicou uma terceira revisão das suas diretrizes sobre a doença causada pelo EGB. Este artigo de atualização propõe-se a divulgar de forma comentada e sintética, baseada prioritariamente em algoritmos, as recentes diretrizes do CDC sobre o tema

Group B streptococcus (GBS) or Streptococcus agalactiae remains as a leading cause of perinatal morbidity and mortality. The antibiotic prophylaxis of GBS infection, based on universal screening in pregnancies from 35 to 37 weeks, is more effective than a strategy based on risk factors. The choice of antibiotic should be based on the susceptibility of the strain of GBS and on the maternal history of allergy to the medicine. Penicillin G, administered intravenously (≥4 hours), remains the drug of choice for intrapartum prophylaxis, while ampicillin is an acceptable alternative. Cefazolin is recommended for pregnant women allergic to penicillin, who present low risk of anaphylaxis, while clindamycin and erythromycin are recommended for cases with high risk of anaphylaxis. Vancomycin should be used in pregnant women allergic to penicillin when there is resistance to erythromycin and clindamycin, or the sensitivity to these drugs is unknown. However, due to the persistence of perinatal morbidity and mortality and the emergence of new relevant data in the s of epidemiology, obstetrics, neonatology, microbiology, molecular biology and pharmacology, in 2010, the Centers for Disease Control and Prevention (CDC) published a third revision of the guidelines disease caused by GBS. This update article aims at disseminating the synthetic form - primarily based on algorithms - and commenting on these recent CDC guidelines

Contracepção hormonal: uma comparação entre pacientes das redes pública e privada de saúde / Hormonal contraception: a comparison between patients of the private and public health network

O objetivo deste artigo é avaliar o perfil de pacientes usuárias de contraceptivos hormonais no setor público e fazer a comparação com o serviço privado de saúde, bem como verificar a frequência de efeitos colaterais e a aderência ao tratamento. Realizou-se um estudo de corte transversal com 240 pacientes, sendo 120 da rede privada e 120 da rede pública de saúde. No grupo privado, a dosagem hormonal mais frequentemente prescrita foi a de 15 ou 20 microgramas de etinil-estradiol (EE), associados a gestodeno, desogestrel ou levonogestrel (36,7 por cento). No grupo público, a combinação de 30 microgramas de EE associados a gestodeno, levonogestrel ou desogestrel (48,3 por cento) foi a principal medicação contraceptiva prescrita. Não houve diferença entre a frequência dos efeitos colaterais nos dois grupos pesquisados (p>0,05). A aderência ao tratamento foi maior nas pacientes do grupo privado (p<0,05). Concluiu-se que o método contraceptivo mais utilizado foi o oral com baixa dosagem de EE, não havendo diferença entre a frequência dos efeitos colaterais. A aderência ao tratamento foi maior no grupo privado, o que pode estar associado ao fator sociocultural das pacientes estudadas.

The aim of this paper is to assess the profile of patients using hormonal contraceptives in the public health network and a comparison with the private health service, as well as the frequency of side effects and adherence to treatment. A cross-sectional study was conducted with 240 patients, namely 120 patients from the private health service and 120 patients from the public health network. The most commonly prescribed hormonal dosage on the private group (36.7 percent) was 15 or 20 micrograms of ethinyl estradiol (EE), associated with gestodene, desogestrel or levonorgestrel. On the other hand, the prescribed hormonal dosage in the public group was a combination of 30 micrograms of EE associated with gestodene, levonorgestrel or desogestrel (48.3 percent). There was no difference between the frequency of side effects in both groups surveyed (p>0.05). Meanwhile, adherence to treatment was higher in patients of the private group. The authors concluded that the most widely used contraceptive method was a low oral dose of ethinyl estradiol and there is no difference between the frequency of side effects. However, adherence to treatment was higher in the private group, which may be associated with social and cultural aspects of the patients surveyed.