Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(8):374-380
DOI 10.1590/SO100-720320150005394
To identify the impact of urinary incontinence (UI) on quality of life (QoL), to compare the scores of QoL domains in women with stress urinary incontinence (SUI), overactive bladder (OAB) and mixed incontinence (MUI) and to establish the association between the clinical type of UI and the impact on QoL.
Data of 181 incontinent women attended at a public hospital were collected regarding age, body mass index (BMI) and co-morbidities. King's Health Questionnaire (KHQ) was applied and patients were classified into two groups according to the self-assessment of incontinence impact. KHQ scores were compared by the Mann-Whitney test. Depending on their urinary symptoms, women were divided into SUI, OAB and MUI groups and their scores in the KHQ domains were compared by the Kruskal-Wallis and Dunn tests. The odds ratio (OR) of a woman reporting a worse effect of UI on QoL was estimated using the binary logistic model. The control variables were: age, BMI and number of co-morbidities.
A significant difference was found between the two groups of self-assessment of UI impact for all KHQ domains. The MUI group showed worse scores than the SUI group for all domains, and OAB group, for limitation of physical and daily activities. There was a significant difference between the odds of the women in the SUI and MUI groups reporting worse effects of UI on QoL (OR=2.9; p=0.02).
As reported at other reference services, MUI was the most commom type, and urinary loss had a moderate/major impact on QoL, affecting mainly role limitations domain. The adjusted analysis showed that women with MUI had almost three times greater odds of reporting worse impact on QoL than women with SUI.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(8):381-387
DOI 10.1590/SO100-720320150005393
To evaluate the waiting times before obtaining the first colposcopic examination for women with abnormal Papanicolaou smears.
Retrospective cohort study conducted on patients who required a colposcopic examination to clarify an abnormal pap test, between 2002 January and 2008 August, in a metropolitan region of Brazil. The waiting times were defined as: Total Waiting Time (interval between the date of the pap test result and the date of the first colposcopic examination); Partial A Waiting Time (interval between the date of the pap test result and the date of referral); Partial B Waiting Time (interval between the date of referral and the date of the first colposcopic examination). Means, medians, relative and absolute frequencies were calculated. The Kruskal-Wallis test and Pearson's chi-square test were used to determine statistical significance.
A total of 1,544 women with mean of age of 34 years (SD=12.6 years) were analyzed. Most of them had access to colposcopic examination within 30 days (65.8%) or 60 days (92.8%) from referral. Mean Total Waiting Time, Partial A Waiting Time, and Partial B Waiting Time were 94.5 days (SD=96.8 days), 67.8 days (SD=95.3 days) and 29.2 days (SD=35.1 days), respectively.
A large part of the women studied had access to colposcopic examination within 60 days after referral, but Total waiting time was long. Measures to reduce the waiting time for obtaining the first colposcopic examination can help to improve the quality of care in the context of cervical cancer control in the region, and ought to be addressed at the phase between the date of the pap test results and the date of referral to the teaching hospital.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(8):388-392
DOI 10.1590/SO100-720320150005319
To describe the mortality of female breast cancer in Brazil according to color, in the years 2000 and 2010.
A descriptive study in which demographic data were obtained from the Brazilian Institute of Geography and Statistics (IBGE). The breast cancer death information in Brazil was collected from the Ministry of Health through the Mortality Information System (SIM). The crude mortality rates for female breast cancer were calculated according to color and age group, up to 49 years and ≥50 years. The results obtained were distributed into five geographical regions of the country (North, Northeast, Midwest, South and Southeast).
In Brazil, in women aged 50 or more, the highest crude mortality rates of breast cancer in 2000 were 62.6/100,000, 46.0/100,000 and 29.7/100,000 among yellow, white and black women, respectively. In women under 50 years in 2000, the crude mortality ranged from 2.0/100,000 among indigenous women to 6.8/100,000 among white women. After ten years, in women over 50 years, the crude mortality rate among yellow, white and black women was 21.5, 53.2 and 40.4 per 100,000, respectively. In the country's regions, the highest mortality rates of breast cancer were observed in white and black women from the South and Southeast. In the Northeast, mortality rates in black and brown women doubled in 2010.
Breast cancer mortality rates show ethnic and geographical variations. However, it is not possible to exclude the possibility that large variations have occurred as a result of improvement in the quality of information on mortality in the country.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):302-307
DOI 10.1590/S0100-720320150005352
To evaluate the follicular development of female Wistar rats with obesity induced by the cafeteria diet, submitted to the administration of losartan (LOS), an antagonist of the AT1 receptor of Angiotensin II.
At weaning (21 days of age), female Wistar rats were randomly divided, into two groups: control (CTL) that received standard chow and cafeteria (CAF) that received a cafeteria diet, a highly palatable and highly caloric diet. At 70 days of age, at the beginning of the reproductive age, animals of the CAF group were subdivided into two groups (n=15/group): CAF, that received water, and CAF+LOS, that received LOS for 30 days. The CTL group also received water by gavage. At 100 days of age, the animals were euthanized and body weight (BW) as well as the retroperitoneal, perigonadal and subcutaneous fat weights were analyzed. The right ovaries were isolated for counting the number of primary, secondary, antral and mature follicles. Plasma levels of FSH, LH, prolactin and progesterone hormones were analyzed. The results were expressed as mean±standard error of the mean. Data were analyzed statistically by one-way ANOVA followed by the Newman-Keuls post-test (p<0.05).
BW and fat weight, as well as the number of antral follicles, were higher in the CAF group compared to the CTL group. However, FSH and LH levels were lower in CAF animals compared to CTL animals. LOS administration attenuated the reduction of FSH and LH levels. Progesterone and PRL levels were similar among groups.
LOS could improve follicular development in obese females and could be used as an adjunctive drug in the treatment of infertility associated with obesity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):314-318
DOI 10.1590/S0100-720320150005098
To identify the predominant species and the role of sexual partners in the maintenance of recurrent vulvovaginitis by Candida spp.
A prospective study of 830 patients aged 18 to 65 years with yeast vaginitis was performed between August 2007 and March 2012. Patients with diabetes mellitus, AIDS or taking corticosteroids, antibiotics or hormone therapy and immunosuppressed patients, patients using vaginal douches, spermicides or intrauterine devices were excluded from the study. Candida species were identified by phenotypic and genotypic methods. The chi-square test was used to correlate the presence of Candida spp. in male partners with the recurrence of vaginitis.
The fungal agent was isolated from a total of 40 women, 24 with recurrent vaginitis and from 15 of their sexual partners, 10 of whom were asymptomatic while 5 were symptomatic. There was agreement of the species found in the couple in 100% of recurrences. C. albicans (62.4 and 60%), C. glabrata (29.1 and 33.3%) and C. guilliermondii species were identified. Candida tropicalis (4.1%) was isolated from only one patient. Candida albicans was isolated from the remaining 16 women who had uncomplicated vaginitis. C. glabrata was isolated from only two of the asymptomatic partners.
There was a predominance of C. albicans and symptomatic or asymptomatic partners can play an important role as a reservoir and source of transmission of yeast, especially in cases of recurrent vulvovaginitis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):319-324
DOI 10.1590/S0100-720320150005388
To compare body attitudes of pregnant women in various body mass index categories, during different gestational periods and under gestational risk conditions, as well as to analyze the association of the study variables with the body attitudes of pregnant women.
We included 386 pregnant women in all gestational periods, aged 18 to 46 years (mean 29.32±6.04 years ), who attended prenatal care in the public and private sectors of a city in Southeastern Brazil, excluding women with incomplete data. The instruments for assessment were "Body Attitudes Questionnaire", "Critério de Classificação Econômica Brasil", and a sociodemographic questionnaire. In addition, anthropometric and obstetric data were collected. Descriptive, comparative, and correlational statistical analyses were performed.
The body attitudes of pregnant women were similar in all pregnancy trimesters (F=0.39; p=0.9). Negative body attitudes increased gradually among low weight (108.2±12.5), appropriate weight (116.2±16.0), overweight (125.1±14.3), and obese (132.9±16.4) groups, and among pregnancy women with normal (120.0±17.1) and high-risk pregnancies (124.9±16.7). The sociodemographic, economic, and obstetric variables did not influence the variance of body attitudes. The body mass index explained 11.3% of the variance of body attitudes in pregnant women.
Nutritional status and risk conditions showed an association with negative body image and should therefore be evaluated in pregnant women for a better maternal and child health.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):325-332
DOI 10.1590/S0100-720320150005367
To determine the eating behavior of pregnant women assisted by primary health care and to compare it with women at childbearing age in Brazilian capitals.
A cross-sectional study conducted on 256 pregnant women in the second trimester of gestation, selected by drawing lots from those assisted by primary health care units of a municipality in the state of São Paulo in 2009/2010. Eating habits were investigated via a questionnaire adapted from the VIGITEL system, consisting of questions about eating habits in general and the frequency and consumption characteristics of food groups/specific foods. For tis comparison, we used the indicators reported by the VIGITEL system for women at childbearing age in Brazilian capitals in 2010. The analyses involved the presentation of frequency distribution and descriptive statistics with comparisons according to the age group.
Most patients had breakfast every day (86.7%) and 45.7% habitually exchanged a main meal for a snack once or twice a week. A daily consumption of fruit, raw salad and vegetables was not reported by 48.8%, 41.8% and 55.1% of the women, respectively. Fish was reported to never or almost never be consumed by 64.4% of the pregnant women. At least once a week, 69.9% of them reported the consumption of soda, and 86.4% of wafers/cookies. The comparison between the pregnant women and women at childbearing age in capitals showed a close similar prevalence of overweight, and no difference in the regular consumption of fruit and vegetables. Meat containing excess of fat and whole milk were more consumed by pregnant women, with differences reported in all the age groups analyzed. On the other hand, the pregnant women reported a less regular intake of soft drinks.
The actions that need to be performed in prenatal care are various and very important, promoting the consumption of specific foods and providing guidelines about eating behavior, while reinforcing healthy eating habits already present.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):333-338
DOI 10.1590/S0100-720320150005373
To describe the prevalence of malformations found in fetuses with trisomy of chromosomes 13, 18 and 21 by identifying the most frequent within each condition.
A retrospective cross-sectional study with the analysis of trisomy cases of chromosomes 13, 18 and 21 diagnosed through fetal karyotype obtained by amniocentesis/cordocentesis, between October 1994 and May 2014, at a Teaching Hospital in Brazil Southern Region. Malformations identified through morphological ultrasonography were described and, subsequently, confirmed in newborn examinations and/or fetal autopsy. The results were analyzed using Fisher's test and analysis of variance (ANOVA), with a 5% level of significance (p=0.05).
Sixty-nine cases of trisomy were diagnosed among 840 exams; nine were excluded due to outcome outside Hospital de Clínicas de Porto Alegre or incomplete records, remaining 60 cases (nine cases of chromosome 13 trisomy, 26 of chromosome 18, and 25 of chromosome 21). In all three groups, heart disease occurred in most cases; the ventricular septal defect was more prevalent and occurred in 66.7% of the trisomy 13 group. Gastrointestinal abnormalities were more prevalent in the trisomy 18 group, especially omphalocele (38.5%; p<0.01). Genitourinary anomalies were more significantly frequent in the trisomy 13 group (pyelectasis, 55.6% - p<0.01; ambiguous genitalia, 33.3% - p=0.01). Central nervous system defects were identified in all cases of trisomy 13. Facial cracks were significantly more prevalent among fetuses with trisomy 13 (66.7%; p<0.01). Hand and feet malformations significantly differed among the trisomy groups. Hand defects occurred in 50% of trisomy 18 cases, and in 44.4% of all trisomy 13 cases (p<0.01); congenital clubfoot was more common in the trisomy 18 group, being detected in 46.2% of fetuses (p<0.01). The abnormalities were found in 50.9, 27.3 and 21.7% of trisomy 18, 13 and 21 cases respectively.
Many fetal malformations identified at ultrasound are suggestive of trisomy and represent an important tool for etiologic diagnosis and prenatal and pre-conception genetic counseling.