Artigos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):32-36
DOI 10.1590/S0100-72032005000100007
PURPOSE: to evaluate the prevalence of HIV infection in parturient women from maternity hospitals linked to the Public Health Service in Sergipe state (Brazil) using the rapid test, and to evaluate this strategy to introduce the protocol for adequate management of HIV patients. METHODS: cross-sectional study which included the training of all health personnel and enrollment of every parturient woman admitted to maternity hospitals linked to the Public Health Service of Sergipe in the Northeast of Brazil. They received instructions about HIV perinatal transmission, were asked to undertake the rapid test, independently of their knowledge about their HIV serologic status, and signed the term of free consent. Additional information about antenatal care and obstetric history was obtained. The test used was the DetermineTM - Abbott Laboratories, and we used the Health Ministry protocol for HIV infeccion prophylaxis. A database was created at Epi-Info 2002, and the prevalence was calculated in relation to all tests performed from January 2003 to March 2004. RESULTS: after 9215 performed tests, 39 HIV-seropositive patients (0.42%) were detected. Twenty-three of them (59%) had no previous knowledge about their seropositivity. Two patients that already knew their positive sorology status did not refer this condition to the health persomel. The Health Ministry protocol was used for all positive cases. Antenatal care attendance was high (89%) but only 32.5% of the patients had already been submitted to an HIV serologic test during pregnancy. CONCLUSIONS: HIV prevalence in pregnant women (0.42%) in Sergipe was similar to the average rate in Brazil. A large number of seropositive pregnant women did not know their serologic status at the moment of delivery. This indicates bad antenatal care performance and the necessity to keep using HIV rapid test at the moment of labor and delivery in order to reduce vertical transmission.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):32-36
DOI 10.1590/S0100-72032005000100007
PURPOSE: to evaluate the prevalence of HIV infection in parturient women from maternity hospitals linked to the Public Health Service in Sergipe state (Brazil) using the rapid test, and to evaluate this strategy to introduce the protocol for adequate management of HIV patients. METHODS: cross-sectional study which included the training of all health personnel and enrollment of every parturient woman admitted to maternity hospitals linked to the Public Health Service of Sergipe in the Northeast of Brazil. They received instructions about HIV perinatal transmission, were asked to undertake the rapid test, independently of their knowledge about their HIV serologic status, and signed the term of free consent. Additional information about antenatal care and obstetric history was obtained. The test used was the DetermineTM - Abbott Laboratories, and we used the Health Ministry protocol for HIV infeccion prophylaxis. A database was created at Epi-Info 2002, and the prevalence was calculated in relation to all tests performed from January 2003 to March 2004. RESULTS: after 9215 performed tests, 39 HIV-seropositive patients (0.42%) were detected. Twenty-three of them (59%) had no previous knowledge about their seropositivity. Two patients that already knew their positive sorology status did not refer this condition to the health persomel. The Health Ministry protocol was used for all positive cases. Antenatal care attendance was high (89%) but only 32.5% of the patients had already been submitted to an HIV serologic test during pregnancy. CONCLUSIONS: HIV prevalence in pregnant women (0.42%) in Sergipe was similar to the average rate in Brazil. A large number of seropositive pregnant women did not know their serologic status at the moment of delivery. This indicates bad antenatal care performance and the necessity to keep using HIV rapid test at the moment of labor and delivery in order to reduce vertical transmission.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):1-6
DOI 10.1590/S0100-72032005000100002
PURPOSE: to perform a critical evaluation of the histopathological diagnosis of ductal carcinoma in situ (DCIS) of the breast, through the analysis of interobserver variation related to diagnosis, architectural pattern, nuclear grade, and histological grade. METHODS: eighty-five cases with an initial diagnosis of DCIS were reviewed by the same pathologist, specialist in breast pathology, who selected 15 cases for interobserver analysis. The analysis was carried out by five pathologists and an international expert in breast pathology, who received the same slides and a protocol for classifying the lesions as atypical ductal hyperplasia (ADH), DCIS, or ductal carcinoma in situ with microinvasion (DCIS-MIC). If the diagnosis was DCIS, the pathologists should classify it according to the dominant architectural pattern, nuclear grade, and histological grade. The results were analyzed using percent concordance and the kappa test. RESULTS: there was a great interobserver diagnostic variation. In one case we had all diagnoses, from ADH, DCIS to DCIS-MIC. The kappa test for the comparison among the five observers' and the expert's diagnoses showed minimum interobservers' concordance (<0.40). Regarding DCIS classification related to the dominant architectural pattern and the histological grade, the kappa test values were considered poor among the pathologists. The best results were obtained for the nuclear grading, with a kappa index up to 0.80, considered as good concordance. CONCLUSION: the low index of interobserver concordance in diagnosis and classification of DCIS of the breast indicates the difficulty in using the most common diagnostic criteria of the literature and the need for specific training of non-specialist pathologists in breast pathology for the diagnosis of these lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):1-6
DOI 10.1590/S0100-72032005000100002
PURPOSE: to perform a critical evaluation of the histopathological diagnosis of ductal carcinoma in situ (DCIS) of the breast, through the analysis of interobserver variation related to diagnosis, architectural pattern, nuclear grade, and histological grade. METHODS: eighty-five cases with an initial diagnosis of DCIS were reviewed by the same pathologist, specialist in breast pathology, who selected 15 cases for interobserver analysis. The analysis was carried out by five pathologists and an international expert in breast pathology, who received the same slides and a protocol for classifying the lesions as atypical ductal hyperplasia (ADH), DCIS, or ductal carcinoma in situ with microinvasion (DCIS-MIC). If the diagnosis was DCIS, the pathologists should classify it according to the dominant architectural pattern, nuclear grade, and histological grade. The results were analyzed using percent concordance and the kappa test. RESULTS: there was a great interobserver diagnostic variation. In one case we had all diagnoses, from ADH, DCIS to DCIS-MIC. The kappa test for the comparison among the five observers' and the expert's diagnoses showed minimum interobservers' concordance (<0.40). Regarding DCIS classification related to the dominant architectural pattern and the histological grade, the kappa test values were considered poor among the pathologists. The best results were obtained for the nuclear grading, with a kappa index up to 0.80, considered as good concordance. CONCLUSION: the low index of interobserver concordance in diagnosis and classification of DCIS of the breast indicates the difficulty in using the most common diagnostic criteria of the literature and the need for specific training of non-specialist pathologists in breast pathology for the diagnosis of these lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):12-19
DOI 10.1590/S0100-72032005000100005
PURPOSE: to evaluate and compare results of female pelvic floor surface electromyography in different positions: lying, sitting and standing. METHODS: twenty-six women with the diagnosis of stress urinary incontinence treated with a protocol of exercises to strengthen the pelvic floor muscle were evaluated. Pelvic floor surface electromyography was performed with an intravaginal sensor connected to Myotrac 3G TM equipment, as follows: initial rest of 60 s, five phasic contractions, one 10-s tonic contraction and one 20-s tonic contraction. The amplitudes were obtained from the difference between the final contraction amplitude and the amplitude at rest (in µV). Wilcoxon test was applied for nonparametric data (p value <0.05). RESULTS: the amplitudes of contractions were higher in the lying position, decreasing in the sitting and standing positions. In the lying position, the median values of phasic and tonic contractions were 23.5 (5-73), 18.0 (3-58) and 17.0 (2-48), respectively. In the sitting position, they were 20.0 (2-69), 16.0 (0-58) and 15.5 (1-48). In the standing position they were 16.5 (3-67), 12.5 (2-54) and 13.5 (2-41). All amplitude values were significantly lower in the standing position compared to the lying position (p<0.001, p<0.001 and p=0.003). Similar results were also found in comparison to the sitting position. However, there was no significant difference between the lying and the sitting positions. CONCLUSION: all female pelvic floor contraction amplitudes were lower in the standing position, suggesting that the muscle strength should be intensified in that position.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):12-19
DOI 10.1590/S0100-72032005000100005
PURPOSE: to evaluate and compare results of female pelvic floor surface electromyography in different positions: lying, sitting and standing. METHODS: twenty-six women with the diagnosis of stress urinary incontinence treated with a protocol of exercises to strengthen the pelvic floor muscle were evaluated. Pelvic floor surface electromyography was performed with an intravaginal sensor connected to Myotrac 3G TM equipment, as follows: initial rest of 60 s, five phasic contractions, one 10-s tonic contraction and one 20-s tonic contraction. The amplitudes were obtained from the difference between the final contraction amplitude and the amplitude at rest (in µV). Wilcoxon test was applied for nonparametric data (p value <0.05). RESULTS: the amplitudes of contractions were higher in the lying position, decreasing in the sitting and standing positions. In the lying position, the median values of phasic and tonic contractions were 23.5 (5-73), 18.0 (3-58) and 17.0 (2-48), respectively. In the sitting position, they were 20.0 (2-69), 16.0 (0-58) and 15.5 (1-48). In the standing position they were 16.5 (3-67), 12.5 (2-54) and 13.5 (2-41). All amplitude values were significantly lower in the standing position compared to the lying position (p<0.001, p<0.001 and p=0.003). Similar results were also found in comparison to the sitting position. However, there was no significant difference between the lying and the sitting positions. CONCLUSION: all female pelvic floor contraction amplitudes were lower in the standing position, suggesting that the muscle strength should be intensified in that position.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):7-11
DOI 10.1590/S0100-72032005000100004
PURPOSE: to identify factors associated with climacteric symptoms. METHODS: a cross-sectional study of 254 women aged between 45 and 60 years was carried out at the Climacterium Outpatient Clinic of Caxias do Sul University, RS, from June to October 2002. Women with previous hysterectomy or under hormonal therapy were excluded. The climacteric symptoms were evaluated by means of the Kuppermann index and the attitudes toward menopause by a specific questionnaire. Data were analyzed by Student's t test, analysis of variance (ANOVA) and multiple linear regression analysis. RESULTS: twenty eight percent of the women reported mild climacteric symtoms, whereas 42.3% reported moderate symptoms and 30.7%, intense symptoms. The most prevalent symptoms were: irritability (87.1%), arthralgias/myalgias (77.5%) and melancholy (73.2%), while the most severe were hot flushes in 60.2% of the women, irritability and insomnia. Attitudes toward menopause, skin color and physical activity were predictors of climacteric symptoms. Positive attitudes toward menopause (p=0.01), white color (p=0.02) and the habit of practicing physical activity (0.04) were associated with less intense climacteric symptoms. Negative attitudes toward menopause were associated with worse climacteric symptoms (p<0.01). CONCLUSIONS: in the current study, the climacteric symptoms were influenced by psychosocial factors and physical activity, as well as by climacteric hypoestrogenism.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(1):7-11
DOI 10.1590/S0100-72032005000100004
PURPOSE: to identify factors associated with climacteric symptoms. METHODS: a cross-sectional study of 254 women aged between 45 and 60 years was carried out at the Climacterium Outpatient Clinic of Caxias do Sul University, RS, from June to October 2002. Women with previous hysterectomy or under hormonal therapy were excluded. The climacteric symptoms were evaluated by means of the Kuppermann index and the attitudes toward menopause by a specific questionnaire. Data were analyzed by Student's t test, analysis of variance (ANOVA) and multiple linear regression analysis. RESULTS: twenty eight percent of the women reported mild climacteric symtoms, whereas 42.3% reported moderate symptoms and 30.7%, intense symptoms. The most prevalent symptoms were: irritability (87.1%), arthralgias/myalgias (77.5%) and melancholy (73.2%), while the most severe were hot flushes in 60.2% of the women, irritability and insomnia. Attitudes toward menopause, skin color and physical activity were predictors of climacteric symptoms. Positive attitudes toward menopause (p=0.01), white color (p=0.02) and the habit of practicing physical activity (0.04) were associated with less intense climacteric symptoms. Negative attitudes toward menopause were associated with worse climacteric symptoms (p<0.01). CONCLUSIONS: in the current study, the climacteric symptoms were influenced by psychosocial factors and physical activity, as well as by climacteric hypoestrogenism.