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1.
Rev Bras Ginecol Obstet ; 45(10): e584-e593, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37944925

RESUMO

OBJECTIVE: To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C < -1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). MATERIALS AND METHODS: After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. RESULTS: There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p < 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p = 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. CONCLUSION: High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.


OBJETIVO: Avaliar a eficácia e os resultados do tratamento cirúrgico para prolapso de órgãos pélvicos (POP) nos estágios III e IV, por meio da técnica de fixação do ligamento sacroespinal (FLSE) ou suspensão do ligamento útero-sacro (SLUS), ao comparar os índices de cura anatômicos, subjetivos, e os parâmetros de qualidade de vida (por meio do questionário Prolapse Quality of Life [P-QoL] validado para a língua portuguesa) sob duas definições: prolapso genital Ba, Bp e C < −1 (estágio I) e Ba, Bp e C ≤ 0 (estágio II). MATERIAIS E MéTODOS: Após aprovação do Comitê de Ética (CAAE 0833/06) e registro no ClinicalTrials.gov (NCT01347021), 51 pacientes foram randomizadas em dois grupos: grupo SLUS (N = 26) e (2) grupo FLSE (N = 25), com seguimento de 6 e 12 meses. RESULTADOS: Houve melhora significativa nas pontuações no P-QoL e nas medidas anatômicas de todos os compartimentos em ambos os grupos após 12 meses (p < 0,001). As taxas de cura anatômica nos grupos SLUS e FLSE , considerando o estágio 1, foram de 34,6% e 40% (anterior), respectivamente; de 100% em ambos os grupos (apical); e de 73,1% e 92% (posterior), respectivamente. As taxas de resultados adversos foram de 42% (N = 11) e 36% (N = 11), respectivamente, nos grupos SLUS e FLSE (p = 0,654), e elas foram sangramento excessivo, perfuração da bexiga (intraoperatória) ou dor glútea, e infecção urinária (pós-operatória), entre outras, sem diferenças entre os grupos. CONCLUSãO: Altas taxas de cura em todos os compartimentos foram observadas segundo critério anatômico (estágio I), sem diferença quanto às pontuações no P-QoL e às complicações tanto com SLUS quanto com FLSE para o tratamento cirúrgico de POP acentuado.


Assuntos
Prolapso de Órgão Pélvico , Infecções Urinárias , Feminino , Humanos , Qualidade de Vida , Prolapso de Órgão Pélvico/cirurgia , Útero , Ligamentos/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos
2.
Rev. bras. ginecol. obstet ; 45(10): 584-593, 2023. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1529880

RESUMO

Abstract Objective To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C< −1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). Materials and Methods After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT 01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. Results There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p< 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p= 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. Conclusion High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.


Resumo Objetivo Avaliar a eficácia e os resultados do tratamento cirúrgico para prolapso de órgãos pélvicos (POP) nos estágios III e IV, por meio da técnica de fixação do ligamento sacroespinal (FLSE) ou suspensão do ligamento útero-sacro (SLUS), ao comparar os índices de cura anatômicos, subjetivos, e os parâmetros de qualidade de vida (por meio do questionário Prolapse Quality of Life [P-QoL] validado para a língua portuguesa) sob duas definições: prolapso genital Ba, Bp e C< −1 (estágio I) e Ba, Bp e C ≤ 0 (estágio II). Materiais e Métodos Após aprovação do Comitê de Ética (CAAE 0833/06) e registro no ClinicalTrials.gov (NCT 01347021), 51 pacientes foram randomizadas em dois grupos: grupo SLUS (N = 26) e (2) grupo FLSE (N = 25), com seguimento de 6 e 12 meses. Resultados Houve melhora significativa nas pontuações no P-QoL e nas medidas anatômicas de todos os compartimentos em ambos os grupos após 12 meses (p< 0,001). As taxas de cura anatômica nos grupos SLUS e FLSE , considerando o estágio 1, foram de 34,6% e 40% (anterior), respectivamente; de 100% em ambos os grupos (apical); e de 73,1% e 92% (posterior), respectivamente. As taxas de resultados adversos foram de 42% (N = 11) e 36% (N = 11), respectivamente, nos grupos SLUS e FLSE (p= 0,654), e elas foram sangramento excessivo, perfuração da bexiga (intraoperatória) ou dor glútea, e infecção urinária (pós-operatória), entre outras, sem diferenças entre os grupos. Conclusão Altas taxas de cura em todos os compartimentos foram observadas segundo critério anatômico (estágio I), sem diferença quanto às pontuações no P-QoL e às complicações tanto com SLUS quanto com FLSE para o tratamento cirúrgico de POP acentuado.


Assuntos
Humanos , Procedimentos de Cirurgia Plástica , Prolapso de Órgão Pélvico/cirurgia , Distúrbios do Assoalho Pélvico , Medidas de Resultados Relatados pelo Paciente , Questionário de Saúde do Paciente
3.
Rev. bras. ginecol. obstet ; 44(12): 1110-1116, Dec. 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1431609

RESUMO

Abstract Objective The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). Methods A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. Results There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). Conclusion The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.


Resumo Objetivo O objetivo deste estudo foi avaliar o uso de moldes dilatadores vaginais, confeccionados com impressão tridimensional (3D), para tratamento conservador através da dilatação vaginal em pacientes com agenesia vaginal (AV). Métodos Foram selecionadas 16 pacientes com diagnóstico de AV (síndrome de Mayer-Rokitansky-Küster-Hauser, síndrome de insensibilidade androgênica total e agenesia cervicovaginal), da Universidade Federal de São Paulo. A produção dos dispositivos foi realizada em uma impressora 3D e, como matéria-prima, foi utilizado o filamento polimérico do poliácido lático (PLA). Um tratamento personalizado foi proposto e desenvolvido para cada paciente. Resultados Quatorze pacientes atingiram um comprimento vaginal final (CVF) de 6 cm ou mais. A média inicial do CVF (DP) foi de 1,81 (1,05) e a média final do CVF (DP) 6,37 (0,94); a diferença (IC 95%) foi de 4,56 (5,27-3,84) e o tamanho do efeito (IC 95%) foi de 4,58 (2,88-6,28). Conclusão Os moldes de impressão 3D para dilatação vaginal obtiveram sucesso em 87,5% das pacientes. Como impacto secundário, não apresentaram efeitos adversos importantes e ofereceram uma estratégia econômica, acessível e reprodutível para o tratamento da AV.


Assuntos
Humanos , Feminino , Vagina/anatomia & histologia , Impressão Tridimensional
4.
Rev Bras Ginecol Obstet ; 44(12): 1110-1116, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36138536

RESUMO

OBJECTIVE: The aim of this study was to evaluate the use of vaginal molds, made with three-dimensional (3D) printing, for conservative treatment through vaginal dilation in patients with vaginal agenesis (VA). METHODS: A total of 16 patients with a diagnosis of VA (Mayer-Rokitansky-Küster-Hauser syndrome, total androgen insensitivity syndrome, and cervicovaginal agenesis) from the Federal University of São Paulo were selected. Device production was performed in a 3D printer, and the polymeric filament of the lactic polyacid (PLA) was used as raw material. A personalized treatment was proposed and developed for each patient. RESULTS: There were 14 patients who reached a final vaginal length of 6 cm or more. The initial total vaginal length (TVL) mean (SD) was 1.81(1.05) and the final TVL mean (SD) was 6.37 (0.94); the difference, analyzed as 95% confidence interval (95% CI) was 4.56 (5.27-3.84) and the effect size (95% CI) was 4.58 (2.88-6.28). CONCLUSION: The 3D printing molds for vaginal dilation were successful in 87.5% of the patients. They did not present any major adverse effects and offered an economical, accessible, and reproducible strategy for the treatment of VA.


OBJETIVO: O objetivo deste estudo foi avaliar o uso de moldes dilatadores vaginais, confeccionados com impressão tridimensional (3D), para tratamento conservador através da dilatação vaginal em pacientes com agenesia vaginal (AV). MéTODOS: Foram selecionadas 16 pacientes com diagnóstico de AV (síndrome de Mayer-Rokitansky-Küster-Hauser, síndrome de insensibilidade androgênica total e agenesia cervicovaginal), da Universidade Federal de São Paulo. A produção dos dispositivos foi realizada em uma impressora 3D e, como matéria-prima, foi utilizado o filamento polimérico do poliácido lático (PLA). Um tratamento personalizado foi proposto e desenvolvido para cada paciente. RESULTADOS: Quatorze pacientes atingiram um comprimento vaginal final (CVF) de 6 cm ou mais. A média inicial do CVF (DP) foi de 1,81 (1,05) e a média final do CVF (DP) 6,37 (0,94); a diferença (IC 95%) foi de 4,56 (5,27­3,84) e o tamanho do efeito (IC 95%) foi de 4,58 (2,88­6,28). CONCLUSãO: Os moldes de impressão 3D para dilatação vaginal obtiveram sucesso em 87,5% das pacientes. Como impacto secundário, não apresentaram efeitos adversos importantes e ofereceram uma estratégia econômica, acessível e reprodutível para o tratamento da AV.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual , Anormalidades Congênitas , Masculino , Feminino , Humanos , Tratamento Conservador , Vagina/anormalidades , Resultado do Tratamento , Transtornos 46, XX do Desenvolvimento Sexual/terapia , Ductos Paramesonéfricos/anormalidades , Anormalidades Congênitas/terapia
5.
J Endocr Soc ; 6(7): bvac061, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35611322

RESUMO

Background: Uterine leiomyomas are benign monoclonal tumors originating from the myometrium. Little information exists concerning metabolomics and the presence of leiomyomas. Objective: The present study evaluated circulating metabolites in the plasma and their correlation with the presence and size of leiomyomas. Study Design: Cross-sectional observational study, including women divided into 3 groups: 37 with leiomyomas and uterus >500 cm3, 17 with leiomyomas and uterus ≤150 cm3, and 21 leiomyoma-free. Patients underwent peripheral blood collection using untargeted metabolic assessment by gas chromatography coupled to mass spectrometer. Results: There was no statistical difference between patients' anthropometric and demographic features and laboratory tests. Statistical differences in uterus volume (P < 0.0001) were found. Forty-six metabolites were identified (35% amino acids and derivatives, 22% fatty acids, and 18% carbohydrates). Statistically significant metabolic distinction (P < 0.05, false discovery rate< 0.05) was observed for 14 metabolites. Most amino acids (L-isoleucine, L-valine, and pyroglutamic acid) were significantly reduced in plasma levels of patients with large leiomyomas. The only exception was L-glutamine, with a significant increase. Fatty acids (arachidonic acid, alfa-tocopherol, palmitic acid, and stearic acid) were similarly reduced in large leiomyomas patients, except for alpha-linolenic acid, which increased. For carbohydrates (myo-inositol, D-threitol, and D-ribose), there was a decrease in the plasma of patients with leiomyomas. Conclusion: There are different plasma metabolites levels of amino acids, fatty acids, and carbohydrates among patients with leiomyomas, most of them reduced, but some significantly increased in large leiomyomas, compared to leiomyoma-free patients.

6.
Neurourol Urodyn ; 41(3): 830-840, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35114028

RESUMO

INTRODUCTION AND HYPOTHESIS: Hip osteoarthritis (OA) compromises functioning. Total hip replacement (THR) is the indicated treatment and may improve urinary incontinence (UI) and symptoms of overactive bladder (OAB). OBJECTIVES: Assess UI, OAB symptoms, and quality of life (QoL) impact in preoperative and postoperative periods of women submitted to THR and investigate associated factors. METHODS: A prospective cohort was conducted with 183 women submitted to THR. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) and SF-12 questionnaires were administered pre- and 3 and 6 months after surgery. RESULTS: Significant improvements were found in UI and QoL 3- and 6-month postoperatively in the overall sample and in the subgroup with preoperative UI. The multivariate regression revealed that the preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI 6-month postoperatively. The factors the best predicted the occurrence of UI 6-month following THR were the preoperative ICIQ-OAB scores and preoperative UI. Each unit of increase in the ICIQ-OAB increases the chances of UI by 26.9% and preoperative UI increases the chances of postoperative UI by 18.7-fold. A weak but significant negative correlation was found between the ICIQ-SF score and the SF-12 score. CONCLUSION: Significant improvements in UI, OAB and QoL were found at 3- and 6-month postoperatively. Preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI at 6 months after surgery. We found significant association between urinary symptoms and THR, but this association is partially explained by current literature.


Assuntos
Artroplastia de Quadril , Bexiga Urinária Hiperativa , Incontinência Urinária , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Bexiga Urinária Hiperativa/diagnóstico
7.
Int Urogynecol J ; 33(11): 2993-3004, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35015091

RESUMO

INTRODUCTION AND HYPOTHESIS: This study aimed to estimate the incidence of fecal incontinence (FI) and identify risk factors in a cohort of older individuals. METHODS: In 2006, individuals aged ≥ 60 years were selected from the SABE study. The dependent variable was FI in 2010. FI was assessed using the question: "In the last 12 months, have you ever lost control of bowel movements or stools?" Incidence was measured in units of per 1000 person-years. Multivariate analysis was used to assess risk factors for FI. RESULTS: This study was the first to examine the incidence of FI in older Brazilian individuals. In total, 1413 individuals were included; mean age was 74.5 years, and 864 (61.8%) participants were women. FI prevalence rates were 4.7% for men and 7.3% for women. Incidence rate of FI was 16.3 and 22.2 per 1000 person-years for men and women, respectively. The risk of FI was greater among women aged ≥ 75 years, with severe symptoms of depression, cancer (other than skin) and chronic obstructive pulmonary disease (COPD). In men, the risk of FI was greater among those with poor literacy (up to 3 years of schooling), an Instrumental Activities of Daily Living (IADL) category of 1-4 and those who self-reported "bad/very bad" health status. CONCLUSIONS: The FI incidence rate was high. The identified risk factors were age ≥ 75 years, with severe symptoms of depression, cancer and COPD (women); having up to 8 years of schooling; IADL category of 1-4 and self-reported health status (men).


Assuntos
Incontinência Fecal , Neoplasias , Doença Pulmonar Obstrutiva Crônica , Atividades Cotidianas , Idoso , Envelhecimento , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Incidência , Masculino , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Fatores de Risco
8.
Eur J Contracept Reprod Health Care ; 27(2): 127-135, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34431421

RESUMO

BACKGROUND: Continuation rates of contraceptive methods in young women vary among studies, and there is scarce data regarding the pregnancy rate in this population. METHODS: Four independently systematic searches were performed in PUBMED, EMBASE, LILACS, and Cochrane databases from inception until January 2021 for oral contraceptive pill (OCP), copper IUD, levonorgestrel intrauterine system (LNG-IUS), and subdermal implant. Inclusion criteria were observational or RCT studies that reported continuation for at least 12 months and/or pregnancy rate of these contraceptives methods in girls aged 22 years old or younger. Two authors extracted data from the study design and the outcomes. Pooled proportions of each method were applied using the inverse variance in all calculations with LOGIT transformation, using the random-effects model. Cochrane collaboration tool and New Castle-Ottawa were used to assess the quality and bias of all included studies. GRADE criteria evaluated the quality of evidence. RESULTS: Continuation rate for OCP was 51% (95%CI 34%-68%), while for cooper IUD was 77% (95%CI 74%-80%), LNG-IUS 84% (95%CI 80%-87%), and implant 85% (95%CI 81%-88%). The pooled estimated pregnancy rate for OCP was 11% (95%CI 6%-20%), while for cooper IUD was 5% (95%CI 3%-7%), LNG-IUS 1.6% (95%CI 1.2%-2.3%), and implant 1.8% (95%CI 0.4%-8.4%). CONCLUSION: Long-acting contraceptive methods presented higher continuation rates and lower pregnancy rates when compared to OCPs.


Assuntos
Anticoncepcionais Femininos , Dispositivos Intrauterinos Medicados , Adulto , Anticoncepção/métodos , Anticoncepcionais Orais Combinados , Feminino , Humanos , Incidência , Levanogestrel , Gravidez , Taxa de Gravidez , Adulto Jovem
9.
Rev Bras Ginecol Obstet ; 43(11): 847-852, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34872143

RESUMO

OBJECTIVE: To compare the prevalence of urinary incontinence (UI) before and during the COVID-19 quarantine in CrossFit women and their relationship with training level. METHODS: A cross-sectional study was performed among 197 women practicing CrossFit. The inclusion criteria were nulliparous women, between 18 and 45 years old, who had trained, before quarantine, in accredited gyms. The exclusion criteria were not following the COVID-19 prevention protocols and having UI on other occasions than just sport. An online questionnaire was emailed containing questions about frequency, duration, and intensity of training and data related to the COVID-19 pandemic. The participants were invited to answer whether they were infected with COVID-19 and what treatment/recommendation they have followed. Whether UI stopped among participants, they were asked about the possible reasons why this happened. The training intensity was categorized as "the same," "decreased" or "increased." RESULTS: The mean age of the participants was 32 years old and most (98.5%) could practice CrossFit during the pandemic. There was a decrease in training intensity in 64% of the respondents. Exercises with their own body weight, such as air squat (98.2%), were the most performed. Urinary incontinence was reported by 32% of the participants before the COVID-19 pandemic, and by only 14% of them during the pandemic (odds ratio [OR] = 0.32 [0.19-0.53]; p < 0.01; univariate analysis). Practitioners reported that the reason possibly related to UI improvement was the reduction of training intensity and not performing doubleunder exercise. CONCLUSION: The reduction in the intensity of CrossFit training during the COVID-19 quarantine decreased the prevalence of UI among female athletes.


OBJETIVO: Comparar a prevalência de incontinência urinária (IU) no CrossFit, antes e durante a quarentena por COVID-19, e sua relação com a intensidade do treinamento. MéTODOS: Estudo observacional com 197 atletas de CrossFit. Os critérios de inclusão foram: nulíparas, 18 a 45 anos, treinando antes da quarentena em academias credenciadas. Os critérios de exclusão foram: não seguir os protocolos de prevenção da COVID-19 e ter IU em outras ocasiões que não apenas no esporte. Utilizou-se um questionário online com perguntas sobre frequência, duração e intensidade do treinamento e dados relacionados à pandemia, além de caso tivessem tido infecção pelo SARS-COV2, qual tratamento/recomendação seguiram. Caso a IU tenha parado entre as participantes, elas foram perguntadas quanto quais as possíveis razões pelas quais isso aconteceu. A intensidade do treinamento foi categorizada como "igual," "diminuída" ou "aumentada ". RESULTADOS: A média de idade foi de 32 anos e a maioria (98,5%) conseguiu praticar CrossFit durante a pandemia. Houve uma diminuição na intensidade do treinamento em 64% das entrevistadas. Exercícios com o próprio peso corporal, como agachamento no ar (98,2%), foram os mais realizados. Incontinência urinária foi relatada por 32% das participantes antes da pandemia e por apenas 14% durante a pandemia (odds ratio [OR] = 0,32 [0,19­0,53]; p < 0,01). As atletas relataram que o motivo possivelmente relacionado à melhora da IU foi a redução da intensidade do treinamento e não realizar o exercício doubleunder. CONCLUSãO: A redução da intensidade do treinamento de CrossFit durante a quarentena por COVID-19 diminuiu a prevalência de IU entre as atletas.


Assuntos
COVID-19 , Incontinência Urinária , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Prevalência , Quarentena , SARS-CoV-2 , Inquéritos e Questionários , Incontinência Urinária/epidemiologia , Incontinência Urinária/prevenção & controle , Adulto Jovem
10.
Rev. bras. ginecol. obstet ; 43(11): 847-852, Nov. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1357076

RESUMO

Abstract Objective To compare the prevalence of urinary incontinence (UI) before and during the COVID-19 quarantine in CrossFit women and their relationship with training level. Methods A cross-sectional study was performed among 197 women practicing CrossFit. The inclusion criteria were nulliparous women, between 18 and 45 years old, who had trained, before quarantine, in accredited gyms. The exclusion criteria were not following the COVID-19 prevention protocols and having UI on other occasions than just sport. An online questionnaire was emailed containing questions about frequency, duration, and intensity of training and data related to the COVID-19 pandemic. The participants were invited to answer whether they were infected with COVID-19 and what treatment/recommendation they have followed. Whether UI stopped among participants, they were asked about the possible reasons why this happened. The training intensity was categorized as "the same," "decreased" or "increased." Results The mean age of the participants was 32 years old and most (98.5%) could practice CrossFit during the pandemic. There was a decrease in training intensity in 64% of the respondents. Exercises with their own body weight, such as air squat (98.2%), were the most performed. Urinary incontinence was reported by 32% of the participants before the COVID-19 pandemic, and by only 14% of them during the pandemic (odds ratio [OR]=0.32 [0.19-0.53]; p<0.01; univariate analysis). Practitioners reported that the reason possibly related to UI improvement was the reduction of training intensity and not performing doubleunder exercise. Conclusion The reduction in the intensity of CrossFit training during the COVID-19 quarantine decreased the prevalence of UI among female athletes.


Resumo Objetivo Comparar a prevalência de incontinência urinária (IU) no CrossFit, antes e durante a quarentena por COVID-19, e sua relação com a intensidade do treinamento. Métodos Estudo observacional com 197 atletas de CrossFit. Os critérios de inclusão foram: nulíparas, 18 a 45 anos, treinando antes da quarentena em academias credenciadas. Os critérios de exclusão foram: não seguir os protocolos de prevenção da COVID-19 e ter IU em outras ocasiões que não apenas no esporte. Utilizou-se um questionário online com perguntas sobre frequência, duração e intensidade do treinamento e dados relacionados à pandemia, além de caso tivessem tido infecção pelo SARS-COV2, qual tratamento/recomendação seguiram. Caso a IU tenha parado entre as participantes, elas foram perguntadas quanto quais as possíveis razões pelas quais isso aconteceu. A intensidade do treinamento foi categorizada como "igual," "diminuída" ou "aumentada ". Resultados A média de idade foi de 32 anos e a maioria (98,5%) conseguiu praticar CrossFit durante a pandemia. Houve uma diminuição na intensidade do treinamento em 64% das entrevistadas. Exercícios com o próprio peso corporal, como agachamento no ar (98,2%), foram os mais realizados. Incontinência urinária foi relatada por 32% das participantes antes da pandemia e por apenas 14% durante a pandemia (odds ratio [OR]=0,32 [0,19-0,53]; p<0,01). As atletas relataram que o motivo possivelmente relacionado à melhora da IU foi a redução da intensidade do treinamento e não realizar o exercício doubleunder. Conclusão A redução da intensidade do treinamento de CrossFit durante a quarentena por COVID-19 diminuiu a prevalência de IU entre as atletas.


Assuntos
Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Incontinência Urinária/prevenção & controle , Incontinência Urinária/epidemiologia , COVID-19 , Quarentena , Prevalência , Estudos Transversais , Inquéritos e Questionários , Pandemias , SARS-CoV-2 , Pessoa de Meia-Idade
11.
Einstein (Sao Paulo) ; 19: eAO6376, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34644746

RESUMO

OBJECTIVE: To evaluate willingness to pay for short- and long-acting reversible contraceptive methods among female Brazilian adolescents and their parents, as well as their perspective on using such methods. METHODS: This is a cross-sectional study of female adolescents aged 13 to 19 years and their parents. We surveyed to estimate their willingness to pay for contraceptive methods. The values are expressed as mean±standard deviation in Brazilian reals (R$). Spearman correlation was employed for socioeconomic status of parents, age of adolescents and their standpoints. The methods types and adolescent and parent perspectives were analyzed by the test χ2. To determine an agreement between pairs and their willingness to pay, we used the Bland-Altman plot. RESULTS: A total of 165 surveys were collected. Short-acting method was significantly more acceptable to pay than the long-action method, by both parents and their daughters. Parents and their daughters are willing to pay out-of-pocket R$ 52,25±22,48 and R$ 51,63±21,24 for short-acting reversible contraception method, and R$ 176,83±130,34 and R$ 174,83±143,64, for long-acting method, respectively. Bland-Altman analysis indicated an agreement on both perspectives and the price they are willing to pay for each contraceptive method. CONCLUSION: Parents and adolescent daughters are more willing to pay for short-acting methods. We showed an agreement between the parent and the daughter for the values paid for each method.


Assuntos
Anticoncepcionais , Pais , Adolescente , Brasil , Estudos Transversais , Feminino , Humanos , Projetos Piloto
12.
Photodiagnosis Photodyn Ther ; 35: 102343, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34038765

RESUMO

Hypericin is considered a potent photosensitizer for use in antitumor and antimicrobial photodynamic therapy (PDT). This review presents the primary biological results obtained with hypericin in photodynamic therapy applications, such as photodynamic cancer treatment, photoinactivation of microorganisms (PDI), tissue scarring, and photo diagnosis. We present a compilation of in vitro results that have been published thus far; for these studies, we highlight the hypericin concentration, light dose, and other experimental conditions to evaluate the efficiency of photodynamic treatment like cell death, cell viability, or cell proliferation. The results indicate that different hypericin phototoxicity levels can be observed according to the specific light dose and concentration. Furthermore, it was shown that cellular localization and cell death mechanisms (apoptosis and necrosis) are dependent on the cell type.


Assuntos
Perileno , Fotoquimioterapia , Antracenos , Apoptose , Sobrevivência Celular , Perileno/análogos & derivados , Perileno/farmacologia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologia , Fármacos Fotossensibilizantes/uso terapêutico
13.
Clinics (Sao Paulo) ; 76: e2145, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503183

RESUMO

OBJECTIVES: Arterial embolization of myomas (AEM) is controversial because of the changes that occur in the extracellular matrix (ECM) of the endometrium and its effect on gestational success in infertile patients desiring reproductive capability. Therefore, we performed this study on the expression of genes in the ECM of the endometrium, such as those coding metalloproteinases (MMP), before and 6 months after embolization of the uterine arteries. METHODS: Seven women with leiomyomas were evaluated, and MMP3 and MMP10 levels were measured. The women underwent pelvic nuclear magnetic resonance (NMR), examination, and endometrial biopsy between the 20th and 24th day of the menstrual cycle, and pre- and post-AEM (after 6 months). For data analysis, the Cq comparative method, also known as the 2-ΔΔCT method, was used to calculate the relative quantities of MMP gene expression among the samples collected. RESULTS: There was a significant decrease by 9.52 times in the expression of MMP3 (p=0.007), and a non-significant change in the expression of MMP10 (p=0.22) in post-AEM-treated women than pre-AEM-treated women. CONCLUSIONS: The results suggest that ECM continues to undergo tissue remodeling 6 months after AEM, at least with regard to MMP3 expression, suggesting that AEM affects the ECM for at least 6 months after the procedure.


Assuntos
Endométrio , Mioma , Matriz Extracelular , Feminino , Humanos , Metaloproteases , Artéria Uterina
14.
Clinics ; 76: e2145, 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1153958

RESUMO

OBJECTIVES: Arterial embolization of myomas (AEM) is controversial because of the changes that occur in the extracellular matrix (ECM) of the endometrium and its effect on gestational success in infertile patients desiring reproductive capability. Therefore, we performed this study on the expression of genes in the ECM of the endometrium, such as those coding metalloproteinases (MMP), before and 6 months after embolization of the uterine arteries. METHODS: Seven women with leiomyomas were evaluated, and MMP3 and MMP10 levels were measured. The women underwent pelvic nuclear magnetic resonance (NMR), examination, and endometrial biopsy between the 20th and 24th day of the menstrual cycle, and pre- and post-AEM (after 6 months). For data analysis, the Cq comparative method, also known as the 2-ΔΔCT method, was used to calculate the relative quantities of MMP gene expression among the samples collected. RESULTS: There was a significant decrease by 9.52 times in the expression of MMP3 (p=0.007), and a non-significant change in the expression of MMP10 (p=0.22) in post-AEM-treated women than pre-AEM-treated women. CONCLUSIONS: The results suggest that ECM continues to undergo tissue remodeling 6 months after AEM, at least with regard to MMP3 expression, suggesting that AEM affects the ECM for at least 6 months after the procedure.


Assuntos
Humanos , Feminino , Endométrio , Mioma , Metaloproteases , Matriz Extracelular , Artéria Uterina
15.
Rev Assoc Med Bras (1992) ; 66(11): 1589-1594, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33295415

RESUMO

Amyotrophic Lateral Sclerosis (ALS) is a fatal disease characterized by muscle weakness, atrophy, fasciculations, and decreased reflexes due to upper and lower motor neurons death. It can be present in both sexes (55-65 years), but with predominance in males. However, in female patients, ALS presents its first symptoms when they are already postmenopausal, when then the incidence ratio of the disease is practically equal between the sexes, which leads to a probable involvement of sex hormones in the development and protection against ALS. The aim of this systematic review, which used the PRISMA consensus and NOS (New Castle-Ottawa Scale) score, was to evaluate the evidence of the action of hormone therapy in women with ALS. The Medline and Cochrane databases were accessed from March 2019 to June 2019, and only full-text articles in Spanish, English, and Portuguese were included. Only four articles matched our inclusion criteria. Postmenopausal women who used exogenous estrogen did not have the same protective factor as women still under the action of endogenous estrogen in the same age group. There was also no increase in the survival of these women.


Assuntos
Esclerose Amiotrófica Lateral , Esclerose Amiotrófica Lateral/tratamento farmacológico , Feminino , Humanos , Masculino
16.
Eur J Contracept Reprod Health Care ; 25(6): 492-501, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33140990

RESUMO

OBJECTIVE: Half of all pregnancies worldwide are unintended, and the rate is even higher in women aged ≤25 years. We sought to identify which method of contraception was the most effective option to prevent unintended pregnancy in young women and adolescents. METHODS: Systematic searches, without language restrictions, were carried out of the PubMed, Embase, Lilacs and Cochrane databases from inception to July 2020. Abstracts and full-text articles of observational studies and randomised controlled trials comparing the use of multiple methods of long-acting reversible contraception (LARC) and short-acting reversible contraception (SARC) in young women and adolescents were screened and reviewed. Risk ratios (RRs) and mean differences with their 95% confidence interval (CI) were derived using a random-effects meta-analytical model. Meta-analyses provided pooled estimates for adverse events, continuation rates and efficacy of LARC methods in young women and adolescents. Nine of the 25 included studies compared LARC with SARC, and 16 compared LARC methods only. RESULTS: At 12 months, young women had better adherence with LARC compared with SARC (n = 1606; RR 1.60; 95% CI 1.21, 2.12; I 2 = 88%), which suggests a better unintended pregnancy prevention outcome for young women. However, more young women chose SARC (n = 2835; RR 0.37; 95% CI 0.17, 0.80; I 2 = 99%). Pregnancy during LARC use was rare. CONCLUSION: LARC methods are the most efficacious in preventing pregnancy, and women should be informed of this if pregnancy prevention is their priority. The evidence, however, is of low quality. PROSPERO REGISTRATION NUMBER: CRD42017055452.


Assuntos
Anticoncepção/métodos , Anticoncepção/estatística & dados numéricos , Anticoncepcionais Femininos/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Adolescente , Anticoncepcionais Femininos/farmacologia , Feminino , Humanos , Dispositivos Intrauterinos Medicados , Contracepção Reversível de Longo Prazo/estatística & dados numéricos , Gravidez , Gravidez não Planejada , Adulto Jovem
17.
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1589-1594, Nov. 2020. graf
Artigo em Inglês | Sec. Est. Saúde SP, LILACS | ID: biblio-1143649

RESUMO

SUMMARY Amyotrophic Lateral Sclerosis (ALS) is a fatal disease characterized by muscle weakness, atrophy, fasciculations, and decreased reflexes due to upper and lower motor neurons death. It can be present in both sexes (55-65 years), but with predominance in males. However, in female patients, ALS presents its first symptoms when they are already postmenopausal, when then the incidence ratio of the disease is practically equal between the sexes, which leads to a probable involvement of sex hormones in the development and protection against ALS. The aim of this systematic review, which used the PRISMA consensus and NOS (New Castle-Ottawa Scale) score, was to evaluate the evidence of the action of hormone therapy in women with ALS. The Medline and Cochrane databases were accessed from March 2019 to June 2019, and only full-text articles in Spanish, English, and Portuguese were included. Only four articles matched our inclusion criteria. Postmenopausal women who used exogenous estrogen did not have the same protective factor as women still under the action of endogenous estrogen in the same age group. There was also no increase in the survival of these women.


Assuntos
Humanos , Masculino , Feminino , Esclerose Amiotrófica Lateral/tratamento farmacológico
18.
Einstein (Sao Paulo) ; 18: eAO5447, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33053017

RESUMO

OBJECTIVE: To investigate the possible genes that may be related to the mechanisms that modulate heparanase-1. METHODS: The analysis was conducted at Universidade Federal de São Paulo, on the data provided by: The Cancer Genome Atlas, University of California Santa Cruz Genome Browser, Kyoto Encyclopedia of Genes and Genomes Pathway Database, Database for Annotation, Visualization and Integrated Discovery Bioinformatics Database and the softwares cBioPortal and Ingenuity Pathway Analysis. RESULTS: Using messenger RNA expression pattern of different molecular subtypes of breast cancer, we proposed that heparinase-1 was co-related with its progression. In addition, genes that were analyzed presented co-expression with heparanase-1. The results that showed that heparanase-1 co-expressed with phosphoinositide 3-kinase adapter protein 1, sialic acid-binding immunoglobulin-like lectin 7, and leukocyte-associated immunoglobulin-like receptor 1 are directed related with immune system evasion during breast cancer progression. Furthermore, cathepsin L was co-expressed with heparanase-1 and transformed inactive heparanase-1 form into active heparanase-1, triggering extracellular matrix remodeling, which contributes to enhanced tumor-host interaction of the tumor. CONCLUSION: The signaling pathway analysis using bioinformatics tools gives supporting evidence of possible mechanisms related to breast cancer development. Evasion genes of the immune system co-expressed with heparanase-1, a enzyme related with tumor progression.


Assuntos
Neoplasias da Mama/genética , Glucuronidase/genética , Simulação por Computador , Humanos
19.
Rev Bras Ginecol Obstet ; 42(8): 468-475, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32559794

RESUMO

OBJECTIVE: To investigate the effects of preoperative fasting abbreviation with a carbohydrate and protein-enriched solution, on postoperative nausea and vomiting (PONV) incidence in gynecological surgery patients, a population naturally at risk for such unpleasant episodes. METHODS: The present prospective double-blind randomized study was performed at The Hospital Municipal e Maternidade Dr. Odelmo Leão Carneiro (HMMOLC, in the Portuguese acronym), in Uberlândia, state of Minas Gerais, Brazil, in partnership with the Gynecology Department of the Universidade Federal de São Paulo (UNIFESP), approved by the Human Research Ethics Committee of UNIFESP and the board of HMMOLC, and included in the Brazil Platform and in the Brazilian Clinical Trial Registry. After signing the consent form, 80 women, who were submitted to gynecological surgery in the period from January to June 2016, were randomized into 2 groups: control group (n = 42) and juice group (n = 38). They received, respectively, 200 mL of inert solution or liquid enriched with carbohydrate and protein 4 hours presurgery. The incidence, frequency and intensity of PONV were studied using the Visual Analogue Scale (VAS), with statistical analysis performed by the software IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). RESULTS: The incidence of nausea and vomiting was lower than in the literature, to this population, with 18.9% (14/74) for the control group and 10.8% (8/74) for the juice group, respectively, with no statistically significant difference between the groups. CONCLUSION: The incidence of nausea and vomiting was lower than in the literature, but it cannot be said that this is due to the abbreviation of fasting. It can provide greater comfort, with the possibility of PONV prevention in patients at risk for these episodes.


OBJETIVO: Investigar os efeitos da abreviação do jejum pré-operatório, por meio de solução enriquecida com carboidrato e proteína, na incidência de náuseas e vômitos no pós-operatório (NVPO) em cirurgias ginecológicas, população naturalmente de risco para esses episódios desagradáveis. MéTODOS: O presente estudo prospectivo randomizado duplo-cego foi realizado no Hospital e Maternidade Municipal Dr. Odelmo Leão Carneiro (HMMOLC), em Uberlândia, estado de Minas Gerais, Brasil, em parceria com o Departamento de Ginecologia da Universidade Federal de São Paulo (UNIFESP), aprovado pelo Comitê de Ética em Pesquisa da UNIFESP, pela diretoria do HMMOLC, registrado na Plataforma Brasil e na plataforma de Registro Brasileiro de Ensaios Clínicos. Após assinatura do termo de consentimento, foram randomizadas 80 mulheres que se submeteram à cirurgia ginecológica, de janeiro a julho de 2016, em 2 grupos: grupo controle (n = 42) e grupo suco (n = 38) que receberam, respectivamente, 200 ml de solução inerte ou 200 ml de líquido contendo carboidrato e proteína, 4 horas pré-cirurgia. Foram estudadas incidência, frequência e intensidade de NVPO por meio da Escala Visual Analógica (EVA), com análise estatística realizada pelo programa IBM SPSS Statistics for Windows, Versão 20.0 (IBM Corp, Armonk, NY, EUA). RESULTADOS: A incidência de náuseas e vômitos foi mais baixa que a esperada na literatura para essa população, com 18,9% (14/74) para o grupo controle e 10,8% (8/74) para o grupo suco, respectivamente, sem diferença estatisticamente significante entre os grupos. CONCLUSãO: A incidência de náuseas e vômitos foi mais baixa do que na literatura; entretanto, não se pode afirmar que foi devido à abreviação de jejum. Essa medida pode trazer maior conforto com a possibilidade de prevenção de NVPO em pacientes de risco para esses eventos.


Assuntos
Jejum , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Náusea e Vômito Pós-Operatórios/epidemiologia , Cuidados Pré-Operatórios/métodos , Adulto , Método Duplo-Cego , Feminino , Humanos , Estudos Prospectivos
20.
J Mol Histol ; 51(4): 353-365, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32488735

RESUMO

Although both estrogen deficiency and diabetes contribute to periodontal tissue deterioration, the combined effects of these conditions on periodontium is unknown. Thus, we analyzed the combined effects of ovariectomy followed by streptozotocin (STZ)-induced diabetes on periodontal tissues of rats. Twenty adult rats were ovariectomized (OVX) or SHAM-operated (SHAM). After 3 weeks, the rats received an intraperitoneal injection of STZ (60 mg/kg/body weight) to induce diabetes or vehicle (blank) solution. The groups were assigned as follows (n = 5): SHAM-vehicle (SHAM), OVX-vehicle (OVX), SHAM + STZ (SHAM-Di), and OVX + STZ (OVX-Di). Seven weeks post-diabetes induction, the rats were euthanized. Blood samples were collected for glucose measurements and maxillae were processed for paraffin embedding. Sections stained with hematoxylin/eosin, Masson's trichrome, and picrosirius-red were used for alveolar bone loss and collagen fiber analysis in the lamina propria. Immunohistochemistry was performed for runt-related transcription factor 2 (Runx2), matrix metalloproteinase 9 (MMP-9), and tryptase detection. Alveolar bone loss and fewer collagen fibers were observed in the OVX-Di group, collagen fibers with irregular organization, and MMP-9 immunoreactivity were more evident in diabetic groups, and MMP-9-positive osteoclasts on alveolar bone surface were noticed in all groups. The OVX-Di group showed lower Runx2 immunoreactivity (osteoblast formation marker), and more tryptase-positive cells (mast cell marker) in the alveolar bone marrow. Our results indicate that estrogen depletion, followed by STZ-induced diabetes, promotes periodontal tissue deterioration that is more evident than both interventions applied alone. Furthermore, our results points to a possible participation of bone-derived mast cells in this process.


Assuntos
Diabetes Mellitus Experimental/metabolismo , Estrogênios/deficiência , Periodonto/metabolismo , Estreptozocina/farmacologia , Perda do Osso Alveolar/metabolismo , Animais , Densidade Óssea/fisiologia , Feminino , Mastócitos/metabolismo , Osteoclastos/metabolismo , Osteócitos/metabolismo , Ovariectomia/métodos , Ligamento Periodontal/metabolismo , Ratos , Ratos Wistar
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