Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.689
Filtrar
1.
Ann Hematol ; 99(6): 1361-1368, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32342133

RESUMO

In everyday gynecological practice, there is an unmet need to manage survivors after allogeneic hematopoietic cell transplantation (allo-HCT). The major gynecological complications include premature ovarian insufficiency (POI), chronic graft-versus-host disease (cGVHD) of the anogenital zone (cGVHDgyn), and secondary neoplasms. Aiming to assess a real-life scale of problems associated with HCT, we performed a detailed analysis of a consecutive series of females after allo-HCT who were referred for a routine gynecological evaluation. The study includes 38 females after allo-HCT in whom gynecological examination with cervical smear and USG were performed, followed by colposcopy according to NCCN guidelines. NIH scoring system was used to classify a grade of cGVHDgyn. The incidence of cGVHD was 71% whereas GVHDgyn was 29%, including 5 patients with score 3 at the time of diagnosis. The other manifestations (frequently noted) included the skin, mucosa, eyes, and liver. Menopause was diagnosed in 93% females, and in 81% of them, POI criteria were fulfilled. Ovarian function resumed in 2 cases. The rate of abnormal cytology was 26%: 4 ASCUS, 1 AGUS, 1 LSIL, 3 HSIL/ASC-H, and one cytological suspicion of cervical cancer. GVHDgyn was documented in 10 patients, and 6 of them had abnormal cervical cytology. Early topical estrogen therapy led to a significant reduction in vaginal dryness (p < 0.05), dyspareunia (p < 0.05), and less frequent cGVHDgyn (p < 0.05). GVHDgyn develops in about 30% of long-term allo-HCT survivors. Topical estrogens and hormonal replacement therapy alleviate symptoms and prevent the occurrence of severe consequences of menopause.


Assuntos
Gerenciamento Clínico , Doenças dos Genitais Femininos/etiologia , Doenças dos Genitais Femininos/terapia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/tendências , Sobreviventes , Adolescente , Adulto , Feminino , Seguimentos , Doenças dos Genitais Femininos/diagnóstico , Humanos , Pessoa de Meia-Idade , Transplante Homólogo/efeitos adversos , Transplante Homólogo/tendências , Adulto Jovem
2.
Int J Gynaecol Obstet ; 149(3): 269-272, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32270477

RESUMO

In the context of the COVID-19 pandemic, patients need to be evaluated within 2-4 weeks in the following cases: cytology result of "squamous cell carcinoma," "atypical glandular cells, favor neoplastic," "endocervical adenocarcinoma in situ," or "adenocarcinoma"; histopathological diagnosis of suspected invasion from cervical/vaginal biopsy, or invasive disease after a cervical excision procedure, vaginal excision, or vulvar biopsy/excision; sudden onset of strongly suggestive symptoms for malignancy. Digital imaging technologies represent an important opportunity during the COVID-19 pandemic to share colposcopic images with reference centers, with the aim of avoiding any concentration of patients. All patients must undergo screening for COVID-19 exposure and should wear a surgical mask. A high-efficiency filter smoke evacuation system is mandatory to remove surgical smoke. Electrosurgical instruments should be set at the lowest possible power and not be used for long continuous periods to reduce the amount of surgical smoke. The following personal protective equipment should be used: sterile fluid-repellant surgical gloves, an underlying pair of gloves, eye protection, FFP3 mask, surgical cap, and gown. The colposcope should be protected by a disposable transparent cover. A protective lens that must be disinfected after each use should be applied. The use of a video colposcope should be preferred.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/normas , Colposcopia/normas , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Doenças dos Genitais Femininos/cirurgia , Controle de Infecções/normas , Pandemias , Pneumonia Viral , Adulto , Biópsia , Consenso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/patologia , Humanos , Itália , Programas de Rastreamento , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Gravidez , Fatores de Tempo
3.
Am Fam Physician ; 101(6): 355-361, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-32163252

RESUMO

Genital ulcers may be located on the vagina, penis, and anorectal or perineal areas and may be infectious or noninfectious. Herpes simplex virus is the most common cause of genital ulcers in the United States. A diagnosis of genital herpes simplex virus infection is made through physical examination and observation of genital lesions. The 2015 Centers for Disease Control and Prevention sexually transmitted disease guidelines provide strategies for the management of patients with genital ulcer disease. Specific testing includes a polymerase chain reaction test for herpes simplex virus; syphilis serology and darkfield microscopy or a direct fluorescent antibody test for Treponema pallidum; and/or culture for Haemophilus ducreyi in settings where chancroid is highly prevalent. Rarely, cases of Epstein-Barr virus may present with genital ulcers. Syphilis and chancroid cause genital ulcers and are mandatory reportable diseases to the local health department. In some cases, no pathogen is identified. It is important to consider noninfectious etiologies such as sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions. Genital ulcers are symptomatic by definition, and the U.S. Preventive Services Task Force recommends screening for syphilis infection for those at risk, early screening for syphilis infection in all pregnant women, and against routine serologic screening for genital herpes simplex virus infection in asymptomatic adolescents and adults, including those who are pregnant.


Assuntos
Gerenciamento Clínico , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Úlcera/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Úlcera/terapia
5.
West Afr J Med ; 37(2): 178-182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150637

RESUMO

Hysteroscopy involves the visualization of the endometrial cavity with the aid of a hysteroscope (Telescope) inserted through the cervix. Hysteroscopy can be performed in an office setting and minor pathologies managed. A distension medium is necessary for proper visualization. These media include gaseous media such as carbon dioxide, used for diagnostic hysteroscopy, and liquid based media such as normal saline and 1.5% glycine, used for both diagnostic and operative hysteroscopy. Complications following hysteroscopy are few. A hysteroscope should become part of the armamentarium of every gynaecologist.


Assuntos
Doenças dos Genitais Femininos/diagnóstico , Histeroscopia/métodos , Útero/diagnóstico por imagem , Assistência Ambulatorial , Dióxido de Carbono , Colo do Útero , Dilatação , Feminino , Glicinérgicos , Humanos , Gravidez , Cloreto de Sódio
7.
Am J Obstet Gynecol ; 222(5): 469.e1-469.e3, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31954699

RESUMO

Medical diagnosis is typically an iterative process guided by integration and synthesis of data into a model of disease. However, facts are not the only inputs into this process. A case of medical mis-diagnosis is presented, in which systematic cognitive bias is considered to have played a role in generating error. Specific cognitive biases are cited, and measures that can be taken to minimize their negative impact are reviewed.


Assuntos
Doenças dos Genitais Femininos/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Incerteza
9.
Eur J Obstet Gynecol Reprod Biol ; 245: 193-197, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31864715

RESUMO

OBJECTIVE: The aim of the presented study is to improve the office hysteroscopy success rate identifying some of the factors associated to an unsuccessful procedure. Moreover it would highlight the importance of an adequate patients follow up after office hysteroscopy failure enlightening the uterine pathologies missed at the first attempt. STUDYDESIGN: This is a retrospective observational study. The Authors reviewed the medical records related to 516 office hysteroscopies performed from January 2016 to November 2018, extrapolating the data from the failed hysteroscopies occurred during this period. After the procedure failure all patients were offered to repeat the hysteroscopy under regional anesthesia in order to identify and treat uterine pathologies. Those patients, who declined to repeat the procedure, received an appropriate follow up. Each failure case is correlated with patient clinical characteristics, indications to hysteroscopy, risk factors presence, hysteroscopy patient compliance, pathology result and patient follow up. RESULTS: The presented study shows an office hysteroscopy failure rate of about 12 %. Severe pain due to cervical stenosis, previous uterine surgery, postmenopausal status and marked uterine ventrifixation/retroflexion, represent the main reason why the procedure was not completed in an office setting. The uterine cavity was subsequently examined in only 26 (42 %) out of 62 patients who reported hysteroscopy failure, mostly repeating the procedure under regional anesthesia (24 cases) or performing vaginal hysterectomy for associated benign gynaecological pathology (2 cases). Endometrial malign pathology (endometrioid carcinoma) was diagnosed in 2 cases of them (7.7 %). Moreover the endometrial cavity remained so far unexplored in 36 (58 %) out of 62 patients, due to the patient refuse to repeat the hysteroscopy under anesthesia. DISCUSSION AND CONCLUSION: Results of the present study suggest that office hysteroscopy should be sussessful at the first attempt due to the patients' refuse, in majority of cases, to repeat the procedure after a failure. To not repeat the hysteroscopy may lead to lose or delay important diagnosis, such as that of endometrial cancer. In this context, to counsel all patients prior the procedure may singnificanly help to identify those who may benefit of pharmacological cervical softening, local anesthetic injection or small caliber hysteroscopes usage, increasing the procedure success rate.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Doenças dos Genitais Femininos/diagnóstico , Histeroscopia/estatística & dados numéricos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento
10.
JAMA Dermatol ; 156(1): 85-91, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31774454

RESUMO

Importance: Contact dermatitis in the anogenital area is associated with sleep disturbance and dyspareunia and can profoundly affect quality of life. The literature on anogenital contact dermatitis and culprit allergens is limited. The last large-scale study on common, relevant allergens in patients with anogenital dermatitis was published in 2008. Objectives: To characterize patients with anogenital dermatitis referred for patch testing by the North American Contact Dermatitis Group, to identify common allergens, and to explore sex-associated differences between anogenital dermatitis and allergens. Design, Setting, and Participants: A retrospective, cross-sectional analysis was conducted of the North American Contact Dermatitis Group database among 28 481 patients who underwent patch testing from January 1, 2005, to December 31, 2016, at outpatient referral clinics in the United States and Canada. Exposure: Patch testing for allergens. Main Outcomes and Measures: Currently relevant allergic patch test reactions in patients with anogenital dermatitis. Results: Of 28 481 patients tested during the study period, 832 patients (336 men and 496 women; mean [SD] age, 50.1 [26.5] years) had anogenital involvement and 449 patients (177 men and 272 women; mean [SD] age, 49.6 [17.4] years) had anogenital dermatitis only. Compared with those without anogenital involvement, there were significantly more male patients in the group with anogenital dermatitis (177 [39.4%] vs 8857 of 27 649 [32.0%]; relative risk, 1.37; 95% CI, 1.14-1.66; P < .001). In the group with anogenital involvement, female patients were significantly less likely than male patients to have allergic contact dermatitis as a final diagnosis (130 [47.8%] vs 107 [60.5%]; relative risk, 0.78; 95% CI, 0.64-0.94; P = .01), whereas a final diagnosis of other dermatoses (eg, lichen planus, lichen sclerosus, or lichen simplex chronicus) was more frequent for female patients than for male patients (67 [24.6%] vs 28 [15.8%]; relative risk, 1.54; 95% CI, 1.02-2.31; P = .03). Of the 449 patients in the group with anogenital involvement only, 227 (50.6%) had 1 or more relevant reaction with patch testing. Allergens that were statistically significantly more common in patients with anogenital involvement compared with those without anogenital involvement included medicaments such as dibucaine (10 of 250 patients tested [4.0%] vs 32 of 17 494 patients tested [0.2%]; relative risk, 22.74; 95% CI, 11.05-46.78; P < .001) and preservatives such as methylchloroisothiazolinone and methylisothiazolinone (30 of 449 patients tested [6.7%] vs 1143 of 27 599 patients tested [4.1%]; relative risk, 1.61; 95% CI, 1.14-2.41; P = .008). A total of 152 patients met the definition for anogenital allergic contact dermatitis, which is defined as anogenital involvement only, allergic contact dermatitis as the only diagnosis, and 1 or more positive reaction of current clinical relevance. Conclusions and Relevance: For patients with anogenital involvement only who were referred for patch testing, male patients were more likely to have allergic contact dermatitis, whereas female patients were more likely to have other dermatoses. Common allergens or sources consisted of those likely to contact the anogenital area. For individuals with anogenital involvement suspected of having allergic contact dermatitis, reactions to preservatives, fragrances, medications (particularly topical anesthetics), and topical corticosteroids should be tested.


Assuntos
Alérgenos/imunologia , Doenças do Ânus/diagnóstico , Dermatite Alérgica de Contato/diagnóstico , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Testes do Emplastro/estatística & dados numéricos , Administração Cutânea , Adulto , Idoso , Anestésicos/efeitos adversos , Doenças do Ânus/epidemiologia , Doenças do Ânus/imunologia , Cosméticos/efeitos adversos , Estudos Transversais , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/imunologia , Feminino , Doenças dos Genitais Femininos/epidemiologia , Doenças dos Genitais Femininos/imunologia , Doenças dos Genitais Masculinos/epidemiologia , Doenças dos Genitais Masculinos/imunologia , Glucocorticoides/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
12.
Medicine (Baltimore) ; 98(38): e17246, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567990

RESUMO

RATIONALE: Uterus-like masses (ULMs) are rare benign lesions that resemble the uterus. PATIENT CONCERNS: Here, we describe the case of a woman with a ULM in the right broad ligament. A 51-year-old woman with a 2-month history of irregular vaginal bleeding was found to have a mass in the right broad ligament. Imaging studies revealed a solid-cystic lesion, suggestive of an endometrial cyst with malignant transformation. INTERVENTIONS: She underwent prompt surgery for the removal of the mass. Intraoperatively, the uterus and ovaries appeared normal, and an 8-cm-long mass was observed in the right broad ligament without any connection to the uterus or ovaries. The mass was successfully excised. DIAGNOSES: Postoperative histopathological examination showed that the cystic mass was filled with a blackish-brownish fluid and that it had thick walls resembling the uterine myometrium. The cyst center was lined by endometrial glands that were positive for cytokeratin as well as estrogen and progesterone receptors, and by stromal cells that were positive for CD10. OUTCOMES: The patient recovered well and has had no further symptoms during 2 years of follow-up. LESSONS: We have reported a case of ULM in the right broad ligament in a Chinese woman. Although ULMs are rare, they should be considered in the differential diagnosis for pelvic masses.


Assuntos
Ligamento Largo , Coristoma/diagnóstico , Doenças dos Genitais Femininos/diagnóstico , Útero , Ligamento Largo/patologia , Ligamento Largo/cirurgia , Coristoma/patologia , Coristoma/cirurgia , Diagnóstico Diferencial , Feminino , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/cirurgia , Humanos , Pessoa de Meia-Idade , Hemorragia Uterina/etiologia
13.
Br J Community Nurs ; 24(Sup10): S19-S22, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31604039

RESUMO

Men, women or children can suffer from oedema (swelling) of the genitalia. When differential diagnosis has excluded acute trauma or pathology and swelling remains, the condition may be diagnosed as genital lymphoedema, a chronic condition that increases the relative risk of cellulitis. Diagnosis of genital oedema is often delayed due to problems with patient and health professional behaviour, in terms of embarrassment, lack of confidence or lack of knowledge. Awareness of this condition and knowledge on how to manage it will go a long way in helping both patients and clinicians overcome the challenges of addressing genital oedema. This article describes the authors' experiences in managing genital oedema. It also briefly discusses a new international project that seeks to identify the knowledge and training that health professionals need to manage this condition more confidently.


Assuntos
Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/enfermagem , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/enfermagem , Pessoal de Saúde/educação , Linfedema/diagnóstico , Linfedema/enfermagem , Diagnóstico Tardio , Feminino , Neoplasias dos Genitais Femininos/cirurgia , Acesso aos Serviços de Saúde , Humanos , Excisão de Linfonodo , Masculino , Pelve , Fatores de Risco , Tempo para o Tratamento , Neoplasias Urológicas/cirurgia
14.
Prog. obstet. ginecol. (Ed. impr.) ; 62(5): 436-442, sept.-oct. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-192125

RESUMO

OBJECTIVE: To assess the perception and personal opinions of gynecologists regarding genitourinary syndrome of menopause (GSM) and to analyze potential differences with those of postmenopausal women. MATERIAL AND METHODS: Spanish gynecologists completed a web-based survey. Each item had four possible answers: < 10%, 10%-50%, 50%-90%, and virtually all women. Results were then compared with those of the Spanish cohort of the REVIVE study. RESULTS: From 633 gynecologists, a third would ask all postmenopausal women about genitourinary syndrome of menopause symptoms and 43.68% would perform a vulvovaginal examination on all postmenopausal women. According to the most frequent answers, 50-90% of women would have genitourinary syndrome of menopause symptoms but < 10% would know that genitourinary syndrome of menopause is a chronic and treatable condition. Up to 90% of women with genitourinary syndrome of menopause would avoid sexual intercourse because of vulvovaginal discomfort or pain. Moreover, 50-90% of women with genitourinary syndrome of menopause would not have any treatment. When comparing results for gynecologists and postmenopausal women, there were some coincidences but also some worrying disparities. CONCLUSIONS: Spanish gynecologists know about genitourinary syndrome of menopause. However, they must be more proactive, to improve the patient-doctor relationship and to be more aware of the sexual life of postmenopausal women. Moreover, many postmenopausal women could benefit from genitourinary syndrome of menopause treatments. Good patient-doctor relationships, and more patient education, are essential


OBJETIVO: evaluar la percepción y las opiniones personales de los ginecólogos sobre el síndrome genitourinario de la menopausia y analizar las posibles diferencias con la percepción de las de las mujeres posmenopáusicas. MATERIAL Y MÉTODOS: los ginecólogos españoles completaron una encuesta en la web. Cada elemento tenía cuatro respuestas posibles: < 10%, 10%-50%, 50%-90% y prácticamente todas las mujeres. Los resultados se compararon entonces con los de la cohorte española del estudio REVIVE. RESULTADOS: de los 633 ginecólogos, un tercio preguntaría a todas las mujeres posmenopáusicas sobre los síntomas del síndrome genitourinario de la menopausia y el 43,68% realizaría un examen vulvovaginal a todas las mujeres posmenopáusicas. Según las respuestas más frecuentes, 50-90% de las mujeres tendrían síntomas del síndrome genitourinario de la menopausia, pero < 10% sabría que el síndrome genitourinario de la menopausia es una condición crónica y con tratamiento. Hasta el 90% de las mujeres con síndrome genitourinario de la menopausia evitarían las relaciones sexuales debido a molestias o dolores vulvovaginales. Además, el 50-90% de las mujeres con síndrome genitourinario de la menopausia no estarían recibiendo ningún tratamiento. Al comparar los resultados de los ginecólogos y los de las mujeres posmenopáusicas hubo algunas coincidencias, pero también algunas discrepancias preocupantes. CONCLUSIONES: los ginecólogos españoles conocen el síndrome genitourinario de la menopausia. Sin embargo, deben ser más proactivos, para mejorar la relación médico-paciente y para ser más conscientes de la vida sexual de las mujeres posmenopáusicas. Además, muchas mujeres posmenopáusicas podrían beneficiarse de los tratamientos del síndrome genitourinario de la menopausia. La buena relación médico-paciente y una mayor educación de la paciente son esenciales


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pós-Menopausa , Relações Médico-Paciente , Exame Ginecológico , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/etiologia , Inquéritos e Questionários , Estudos de Coortes , Atrofia , Espanha
15.
Emerg Med Clin North Am ; 37(4): 771-784, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563207

RESUMO

The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico , Doenças Urológicas/diagnóstico , Emergências , Feminino , Doenças dos Genitais Femininos/terapia , Humanos , Doenças Urológicas/terapia
16.
Emerg Med Clin North Am ; 37(4): 811-819, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563209

RESUMO

Emergency medicine providers may encounter serious GU conditions that need rapid diagnosis and early intervention to avoid severe life- and limb-threatening complications. A fundamental knowledge of several key procedural interventions is incredibly important to optimal patient outcomes.


Assuntos
Serviço Hospitalar de Emergência , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Doenças Urológicas/diagnóstico , Cuidados Críticos/métodos , Feminino , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/terapia , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/terapia , Humanos , Masculino , Doenças Urológicas/patologia , Doenças Urológicas/terapia
17.
Taiwan J Obstet Gynecol ; 58(5): 587-591, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542076

RESUMO

In 2008, we published a review article entitled "Differential diagnosis of gynecologic organ-related diseases in women presenting with ascites" in the Taiwanese Journal of Obstetrics and Gynecololgy. Ascites might be the results of the physiological or pathological status, and the underlying mechanisms varied greatly in the different genders. The diagnostic challenge is frequently found in clinical practice. This review summarizes the recent knowledge and clinical practice for women presenting with ascites. Approach includes history, physical examination, laboratory examination, ultrasound, paracentesis and possible laparoscopy. Accurate and prompt diagnosis not only provides the better care and management but also diminishes the unnecessary psychological stress in women presenting with ascites.


Assuntos
Ascite/diagnóstico , Doenças dos Genitais Femininos/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia/métodos , Paracentese/métodos , Exame Físico/métodos , Ultrassonografia/métodos
18.
Indian J Dermatol Venereol Leprol ; 85(5): 441-447, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389367

RESUMO

Despite adequate treatment of reproductive tract infection, there is persistence of symptoms in some patients. This raises the possibility of existence of other silent microbes with pathogenic potential. Apart from the common sexually transmitted organisms such as Chlamydia trachomatis and Neisseria gonorrhoeae, there are other silent and emerging pathogens, like genital mycoplasma, which have been associated with cervicitis, pelvic inflammatory disease, infertility, and pregnancy-related complications in women. Although these organisms were identified decades ago, they are still overlooked or ignored. There is a need to understand the role played by these organisms in Asian populations and their susceptibility to the standard line of treatment. Data on genital mycoplasma infections in Indian women is heterogeneous, with limited evidence of pathogenicity. Although known for their wide spectrum of reproductive morbidities in western counterparts, these microorganisms are yet to gain the attention of Indian clinicians and microbiologists. There is paucity of adequate information in India regarding these infections, so Indian literature was compiled to get an overview of these pathogens, their association with reproductive morbidities, and their response to treatment. Thus, there is a need to explore genital mycoplasma infections in Indian women, especially in the arena of antimicrobial resistance among genital mycoplasma, which has the potential to become a major problem. A literature search with keywords focusing on "genital mycoplasma", "sexually transmitted infections India", "sexually transmitted mycoplasma", and "characteristic of mycoplasma" was carried out through computerized databases like PubMed, MEDLINE, Embase, and Google Scholar.


Assuntos
Doenças dos Genitais Femininos/epidemiologia , Infecções por Mycoplasma/epidemiologia , Doenças Sexualmente Transmissíveis/epidemiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/fisiologia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/terapia , Humanos , Índia/epidemiologia , Infecções por Mycoplasma/diagnóstico , Infecções por Mycoplasma/terapia , Prevalência , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia , Resultado do Tratamento
20.
J Obstet Gynaecol Can ; 41(8): 1221-1234, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31331610

RESUMO

OBJECTIVE: The primary objective of this document is to clarify the indications for pelvic examination. INTENDED USERS: Physicians, including gynaecologists, obstetricians, family physicians, and emergency physicians; nurses, including registered nurses and nurse practitioners; midwives, including midwives in clinical practice and midwifery trainees; medical trainees, including medical students, residents, and fellows; and all other health care providers who care for women. TARGET POPULATION: This publication provides evidence and expert-based recommendations for pelvic examination in adult women (18 years and older) both with and without gynaecologic symptoms. OUTCOMES: This publication clarifies indications for pelvic examination in the context of recently published national task force statements on the utility of pelvic examination. We aim to ensure that women who have clinical indications for examination receive proper clinical investigation with minimal delays to diagnosis of treatable disease. EVIDENCE: For this committee opinion, relevant studies were identified in PubMed and Medline using the following terms, either alone or in combination, with the search limited to English-language materials and human subjects and no publication date cut-off: pelvic examination, bimanual examination, speculum examination, rectovaginal examination, ovarian cancer screening, asymptomatic women, periodic health examination. The search was performed in May and June 2018. Relevant evidence was selected for inclusion in the following order: meta-analyses, systematic reviews, guidelines and national task force statements, randomized controlled trials, prospective cohort studies, observational studies, non-systematic reviews, case series, and reports. Additional articles were identified by cross-referencing the identified publications. A formal systematic review was not conducted for all topics discussed due to the paucity of evidence and number of different subtopics discussed. The total number of publications included in this review was 66. VALIDATION METHODS: The content and recommendations were drafted and agreed upon by the principal authors. The Boards of the Society of Gynecologic Oncology of Canada (GOC), the College of Family Physicians of Canada (CFPC), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication after review by their respective representative committees. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework (Tables 1 and 2). The Summary of Findings is available upon request. BENEFITS, HARMS, AND COSTS: This committee opinion should benefit all women with and without gynaecologic symptoms who present to gynaecologists and primary care practitioners. It will help guide practitioners in identifying indications for pelvic examination to reduce unnecessary examination with related potential harm while also increasing indicated examination to reduce delays in diagnosis of treatable gynaecologic conditions. GUIDELINE UPDATE: This SOGC Committee Opinion will be automatically reviewed 5 years after publication to determine if all or part of the committee opinion should be updated. However, this review may be performed earlier if new high-impact research is published in the interim. SUMMARY STATEMENTS: 1. National and international statements and guidelines on pelvic examination should not be interpreted to suggest that the pelvic examination is irrelevant or noncontributory to physical assessment or that the pelvic examination in symptomatic women should be omitted. 2. Pelvic examination may include visual inspection, speculum examination, bimanual examination, single digit examination, and/or rectovaginal examination depending on the indication for examination. 3. No study published to date has adequately evaluated any component of the pelvic examination as a screening method for any type of malignant gynaecologic disease, except for the speculum examination for cervical cancer cytology screening. As such, any universal recommendations for or against pelvic examinations for other indications can only be made based on expert opinion and low-quality evidence. 4. In asymptomatic women at average risk for cervical cancer, cervical cytology screening reduces both the incidence of, and mortality from, cervical cancer by detecting pre-invasive, treatable lesions. 5. In asymptomatic women at average risk of malignancy, a visual and bimanual examination at the time of obtaining cervical cytology samples may add value to this screening manoeuvre: Women might not raise certain gynaecologic concerns until the time of pelvic examination; the examination provides an opportunity for patient education and practitioner skill maintenance; and, although inadequately studied to date, there may be positive effects on ovarian and vulvar malignancy that require further investigation. These potential benefits should be weighed against potential harms like patient discomfort and false positives/negatives that may result in inappropriate reassurance or unnecessary investigations/interventions. RECOMMENDATIONS: Symptomatic Women. 1) Any woman with gynaecologic complaints including, but not limited to, vulvar complaints, vaginal discharge, abnormal premenopausal bleeding, postmenopausal bleeding, infertility, pelvic organ prolapse symptoms, urinary incontinence, new and unexplained gastrointestinal symptoms (abdominal pain, increased abdominal size/bloating, and difficulty eating/early satiety), pelvic pain, or dyspareunia should undergo appropriate components of the pelvic examination to identify benign or malignant disease (strong, low). 2) Health care providers may consider discussing the risks and benefits of performing a baseline pelvic examination including visual and bimanual examination prior to prescribing hormonal replacement therapy/menopausal hormonal treatment (weak, very low). Asymptomatic Women. 3) Health care practitioners should perform cervical cytology cancer screening in accordance with provincial/territorial guidelines (strong, strong). 4) There is insufficient evidence to guide recommendations on screening pelvic examination for noncervical gynaecologic malignancy or any benign gynaecologic disease in healthy, asymptomatic women with average risk of malignancy. However, health care practitioners may consider performing a screening pelvic examination including visual, speculum, and bimanual examinations in concert with cervical cytology sampling intervals as recommended by provincial/territorial guidelines. This practice may identify clinically important benign or malignant disease not recognized or reported by the patient (weak, very low). 5) In women over age 70 who no longer require screening with cervical cytology, health care practitioners should consider continuing periodic screening of asymptomatic women for vulvar disease with inspection of the vulva, perineum, and anus to identify benign or malignant disease unrecognized by this population. There is insufficient evidence to guide recommendations on frequency of this examination (weak, low). 6) Women with a personal history of gynaecologic malignancy, a genetic diagnosis that increases gynaecologic malignancy risk, or a history of in utero diethylstilbestrol exposure may benefit from more frequent screening pelvic examinations to identify early primary, recurrent, or metastatic malignancy in the absence of symptoms. Because there is inadequate evidence to define these screening intervals, they should be in accordance with provincial/territorial guidelines and expert opinion (weak, very low). 7. Non-invasive and self-collection screening options for chlamydia and gonorrhea are acceptable in asymptomatic women, but pelvic examination, including visual inspection, speculum examination, and bimanual examination, is required in the presence of symptoms to rule out pelvic inflammatory disease or tubo-ovarian abscess (strong, low). 8) No pelvic examination is required prior to prescription of hormonal contraception in a healthy woman with no gynaecologic symptoms (strong, low).


Assuntos
Exame Ginecológico , Doenças Assintomáticas , Feminino , Doenças dos Genitais Femininos/diagnóstico , Exame Ginecológico/métodos , Humanos , Fatores de Risco , Neoplasias do Colo do Útero/diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...