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Summary
Rev Bras Ginecol Obstet. 2013;35(10):436-441
DOI 10.1590/S0100-72032013001000002
PURPOSE: To evaluate the association between central nervous system (CNS) malformations and the C677T-MTHFR mutation in fetal blood. METHODS: A case-control study was conducted to compare the MTHFR-C677T mutation detected in 78 fetuses with CNS malformations and with 100 morphologically normal fetuses. Genomic DNA was extracted and purified from fetal blood using the Wizard® Genomic DNA Purification Kit (Promega Corp., Madison, WI, USA) according to manufacturer's protocol. The polymerase chain reaction (PCR) was used to assay the thermolabile MTHFR-C677T mutation. The γ² and the Fisher's exact tests were used for descriptive analysis and the Wilcoxon test was used for univariate analysis. Logistic regression analysis was performed to identify which variables were predictors of CNS malformation. RESULTS: Cases and controls were similar regarding maternal characteristics such as age and number of deliveries and abortions. The MTHFR-C677T mutation was detected in 20 cases (25.6%) and in 6 controls in its heterozygous form (OR 10.3; 95%CI 3.3-32.2) and in 6 cases (7.7%) and in 1 control in its homozygous form (OR 12.3; 95%CI 1.3-111.1), and the differences were statistically significant. CONCLUSION: The presence of the MTHFR-C677T mutation in fetal blood was consistent with a higher risk of CNS malformations, both in the heterozygous and homozygous forms.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):436-441
DOI 10.1590/S0100-72032013001000002
PURPOSE: To evaluate the association between central nervous system (CNS) malformations and the C677T-MTHFR mutation in fetal blood. METHODS: A case-control study was conducted to compare the MTHFR-C677T mutation detected in 78 fetuses with CNS malformations and with 100 morphologically normal fetuses. Genomic DNA was extracted and purified from fetal blood using the Wizard® Genomic DNA Purification Kit (Promega Corp., Madison, WI, USA) according to manufacturer's protocol. The polymerase chain reaction (PCR) was used to assay the thermolabile MTHFR-C677T mutation. The γ² and the Fisher's exact tests were used for descriptive analysis and the Wilcoxon test was used for univariate analysis. Logistic regression analysis was performed to identify which variables were predictors of CNS malformation. RESULTS: Cases and controls were similar regarding maternal characteristics such as age and number of deliveries and abortions. The MTHFR-C677T mutation was detected in 20 cases (25.6%) and in 6 controls in its heterozygous form (OR 10.3; 95%CI 3.3-32.2) and in 6 cases (7.7%) and in 1 control in its homozygous form (OR 12.3; 95%CI 1.3-111.1), and the differences were statistically significant. CONCLUSION: The presence of the MTHFR-C677T mutation in fetal blood was consistent with a higher risk of CNS malformations, both in the heterozygous and homozygous forms.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):442-446
DOI 10.1590/S0100-72032013001000003
PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186+0.09×gestational week); hyperglycemic renal volume = exp (6.978+0.071×gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):442-446
DOI 10.1590/S0100-72032013001000003
PURPOSE: To measure fetal renal volume in normoglycemic and hyperglycemic pregnancies. METHODS: A longitudinal prospective study was conducted and included 92 hyperglycemic and 339 normoglycemic pregnant women attended at the prenatal service of a hospital from Rio de Janeiro State. Ultrasound examinations were performed to estimate gestational age at baseline and the kidney volume was estimated using the prolate ellipsoid volume equation. RESULTS: Fetal kidney volume growth between normoglycemic and hyperglycemic pregnancies are significantly different. The fetal kidney volume growth in pregnancy is positively correlated with gestational age explained by these predictor equations, by group: normal renal volume = exp (6.186+0.09×gestational week); hyperglycemic renal volume = exp (6.978+0.071×gestational week) and an excessive growth pattern for hyperglycemic pregnancies may be established according to gestational age. CONCLUSION: This is important for early detection of abnormalities in pregnancy, particularly in diabetic mothers.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):447-452
DOI 10.1590/S0100-72032013001000004
PURPOSE: To analyze prenatal care in public and private services. METHODS: A cross-sectional, retrospective and analytic study was conducted based on the audit of files of pregnant women who had given birth at a reference hospital for low risk cases in the area of Campos Gerais - Paraná State, in the first semester of 2011. The Yates chi-squared test or exact Fisher test were used to determine the association between the lack of registration files for pregnant women regarding prenatal assistance in the public and private services, with the level of significance set at p≤0.05. The quality of prenatal care was determined based on the percentile of non-registrations. RESULTS: A total of 500 prenatal files were analyzed. There was a significant attendance of six or more prenatal visits, with a larger proportion in the private service (91.9%). The laboratory and obstetric exams most frequently not registered in the public and in the private services were, respectively: hepatitis B (79.3 and 48.4%), hemoglobin and hematocrit values (35.6 and 21.8%), anti-HIV serology (29.3 and 12.9%), fetal movement (84.3 and 58.9%) and length (60.4 and 88.7%), edema verification (60.9 and 54.8%), and fetal presentation (52.4 and 61.3%). The audit of the files of pregnant women allowed to determine the quality of the prenatal care provided and confirmed differences in assistance according to the place, showing excellent and good quality of private care, and regular public care for ultrasonography and blood type/Rh factor; regular quality of private care and poor quality of public care for urine tests and weight. For the other types of laboratory and obstetric exams and vaccines, the quality was poor or very poor in both types of services. CONCLUSION: The differences between the services showed that there is a need for actions aiming at the improvement of the prenatal care provided by public services.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):447-452
DOI 10.1590/S0100-72032013001000004
PURPOSE: To analyze prenatal care in public and private services. METHODS: A cross-sectional, retrospective and analytic study was conducted based on the audit of files of pregnant women who had given birth at a reference hospital for low risk cases in the area of Campos Gerais - Paraná State, in the first semester of 2011. The Yates chi-squared test or exact Fisher test were used to determine the association between the lack of registration files for pregnant women regarding prenatal assistance in the public and private services, with the level of significance set at p≤0.05. The quality of prenatal care was determined based on the percentile of non-registrations. RESULTS: A total of 500 prenatal files were analyzed. There was a significant attendance of six or more prenatal visits, with a larger proportion in the private service (91.9%). The laboratory and obstetric exams most frequently not registered in the public and in the private services were, respectively: hepatitis B (79.3 and 48.4%), hemoglobin and hematocrit values (35.6 and 21.8%), anti-HIV serology (29.3 and 12.9%), fetal movement (84.3 and 58.9%) and length (60.4 and 88.7%), edema verification (60.9 and 54.8%), and fetal presentation (52.4 and 61.3%). The audit of the files of pregnant women allowed to determine the quality of the prenatal care provided and confirmed differences in assistance according to the place, showing excellent and good quality of private care, and regular public care for ultrasonography and blood type/Rh factor; regular quality of private care and poor quality of public care for urine tests and weight. For the other types of laboratory and obstetric exams and vaccines, the quality was poor or very poor in both types of services. CONCLUSION: The differences between the services showed that there is a need for actions aiming at the improvement of the prenatal care provided by public services.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):453-457
DOI 10.1590/S0100-72032013001000005
PURPOSE: To quantify the number of defense cells and immunoglobulin E (IgE) levels in peripheral blood sampled from women with recurrent vulvovaginal candidiasis. METHODS: A cross-sectional study was conducted on 60 women, 40 with vulvovaginal candidiasis and 20 controls. The defense cells were identified using an impedance system combined with flow cytometry and total and specific IgE was measured by chemiluminescence. The Mann-Whitney test was used for nominal variables and the Spearman test was used to determine the correlation of IgE concentration and eosinophils in peripheral blood. RESULTS: The number of eosinophils in peripheral blood from patients with recurrent vulvovaginal candidiasis, 302.60 (±253.07), was significantly higher compared to control, 175.75 (±109.24) (p=0.037). Serum levels of total and specific IgE were similar in the groups of women with and without recurrent vulvovaginal candidiasis (p=0.361). However, there was a moderate positive correlation between eosinophils and total serum IgE in the candidiasis group (r=0.25). CONCLUSION: Women with recurrent vulvovaginal candidiasis are more likely to have eosinophils in peripheral blood.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):453-457
DOI 10.1590/S0100-72032013001000005
PURPOSE: To quantify the number of defense cells and immunoglobulin E (IgE) levels in peripheral blood sampled from women with recurrent vulvovaginal candidiasis. METHODS: A cross-sectional study was conducted on 60 women, 40 with vulvovaginal candidiasis and 20 controls. The defense cells were identified using an impedance system combined with flow cytometry and total and specific IgE was measured by chemiluminescence. The Mann-Whitney test was used for nominal variables and the Spearman test was used to determine the correlation of IgE concentration and eosinophils in peripheral blood. RESULTS: The number of eosinophils in peripheral blood from patients with recurrent vulvovaginal candidiasis, 302.60 (±253.07), was significantly higher compared to control, 175.75 (±109.24) (p=0.037). Serum levels of total and specific IgE were similar in the groups of women with and without recurrent vulvovaginal candidiasis (p=0.361). However, there was a moderate positive correlation between eosinophils and total serum IgE in the candidiasis group (r=0.25). CONCLUSION: Women with recurrent vulvovaginal candidiasis are more likely to have eosinophils in peripheral blood.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):458-463
DOI 10.1590/S0100-72032013001000006
PURPOSE: To analyze the time between the first symptom and treatment in patients treated for breast cancer in public hospitals in the Federal District. METHODS: This was a cross-sectional analysis. We interviewed 250 women diagnosed with breast cancer treated in six hospitals of the State Department of Health of the Federal District from November 2009 to January 2011. The time intervals studied were the time between the detection of the symptoms and treatment subdivided into intervals until and after the first medical appointment. The variables were: age, menopausal status, color, educational level, average monthly household income, origin, reason for the initial consultation, staging, tumor size, laterality, metastasis to axillary lymph nodes, neoadjuvant chemotherapy, and type of surgery. The Mann-Whtney test was used to assess the association of these variables with the time intervals until treatment. RESULTS: The mean age was 52 years, with a predominance of white women (57.6%), from the Federal District (62.4%), with a family income of up to 2 minimum wages (78%), and up to four years of schooling (52.4%). The staging of the disease ranged from II to IV in 78.8% of the women. The time between the first symptom and treatment was 229 days (median). After detection of the first symptom, 52.9% of the women attended a consultation within 30 days and 88.8% took more than 90 days to start treatment. Women with elementary school education had a greater delay to the start of treatment (p=0.049). CONCLUSIONS: There was a significant delay to start treatment of women with breast cancer in public hospitals of the Federal District, suggesting that efforts should be made to reduce the time needed to schedule medical appointments and to diagnose and treat these patients.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):458-463
DOI 10.1590/S0100-72032013001000006
PURPOSE: To analyze the time between the first symptom and treatment in patients treated for breast cancer in public hospitals in the Federal District. METHODS: This was a cross-sectional analysis. We interviewed 250 women diagnosed with breast cancer treated in six hospitals of the State Department of Health of the Federal District from November 2009 to January 2011. The time intervals studied were the time between the detection of the symptoms and treatment subdivided into intervals until and after the first medical appointment. The variables were: age, menopausal status, color, educational level, average monthly household income, origin, reason for the initial consultation, staging, tumor size, laterality, metastasis to axillary lymph nodes, neoadjuvant chemotherapy, and type of surgery. The Mann-Whtney test was used to assess the association of these variables with the time intervals until treatment. RESULTS: The mean age was 52 years, with a predominance of white women (57.6%), from the Federal District (62.4%), with a family income of up to 2 minimum wages (78%), and up to four years of schooling (52.4%). The staging of the disease ranged from II to IV in 78.8% of the women. The time between the first symptom and treatment was 229 days (median). After detection of the first symptom, 52.9% of the women attended a consultation within 30 days and 88.8% took more than 90 days to start treatment. Women with elementary school education had a greater delay to the start of treatment (p=0.049). CONCLUSIONS: There was a significant delay to start treatment of women with breast cancer in public hospitals of the Federal District, suggesting that efforts should be made to reduce the time needed to schedule medical appointments and to diagnose and treat these patients.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):464-468
DOI 10.1590/S0100-72032013001000007
PURPOSE: To evaluate the sonographic parameters related to morphological characteristics of pelvic adnexal masses by obtaining two-dimensional images by an observer presence, forwarded electronically (via tele-ultrasound) in static and dynamic modes observers do not face (distance) for comparative analyzes inter intraobserver and to the validation of a second opinion. METHODS: From March to August 2010 were selected 50 patients with adnexal mass viewing of the pelvic ultrasound. They were subjected to ultrasound for abdominal and transvaginal routes. The images were captured in static and dynamic modes, electronically forwarded for evaluation of non-presence and two examiners evaluated according to morphological ultrasonographic parameters previously determined. RESULTS: The evaluators did not face in static and dynamic modes obtained almost perfect agreement for all morphological parameters with Kappa values between 0.6 and 0.8. There was no difference between the methods employed, except for the morphological parameter papillary projection in the static mode , in which the agreement was almost perfect ( 0.8 ) while in dynamic mode was substantial (0.6). CONCLUSIONS: The sonographic parameters of the features of adnexal masses pelvic sent by tele-ultrasound are capable of being validated for issuing a second opinion. There were no significant differences in the methodology used in the issue of tele-ultrasound images (static or dynamic) to characterize the composition of pelvic adnexal masses.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):464-468
DOI 10.1590/S0100-72032013001000007
PURPOSE: To evaluate the sonographic parameters related to morphological characteristics of pelvic adnexal masses by obtaining two-dimensional images by an observer presence, forwarded electronically (via tele-ultrasound) in static and dynamic modes observers do not face (distance) for comparative analyzes inter intraobserver and to the validation of a second opinion. METHODS: From March to August 2010 were selected 50 patients with adnexal mass viewing of the pelvic ultrasound. They were subjected to ultrasound for abdominal and transvaginal routes. The images were captured in static and dynamic modes, electronically forwarded for evaluation of non-presence and two examiners evaluated according to morphological ultrasonographic parameters previously determined. RESULTS: The evaluators did not face in static and dynamic modes obtained almost perfect agreement for all morphological parameters with Kappa values between 0.6 and 0.8. There was no difference between the methods employed, except for the morphological parameter papillary projection in the static mode , in which the agreement was almost perfect ( 0.8 ) while in dynamic mode was substantial (0.6). CONCLUSIONS: The sonographic parameters of the features of adnexal masses pelvic sent by tele-ultrasound are capable of being validated for issuing a second opinion. There were no significant differences in the methodology used in the issue of tele-ultrasound images (static or dynamic) to characterize the composition of pelvic adnexal masses.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):469-474
DOI 10.1590/S0100-72032013001000008
PURPOSE: It was to test the validity and reliability of an online version of the Female Sexual Function Index (FSFI). METHODS: An online version of the FSFI was compared to the pen and paper traditional version. Physiotherapy students in three cities were randomly allocated to two groups - G-pp/ol (n=126) and G-ol/pp (n=147). G-pp/ol women replied to th FSFI using the traditional pen and paper method, while G-ol/pp women answered an online version of the same questionnaire. Data were collected ageing after 15 days, when G-pp/ol women answered the online version while G-ol/pp women answered on paper. All data were transferred to SPSS software. Demographic differences between the test two groups were determined by Student's t-test or Fisher exact (95%CI; p>0.05). Association and correlation between the responses of G-pp/ol and G-ol/pp were assessed for each sample by the t-test and Pearson's coefficient. An identical strategy was used for intragroup comparisons. RESULTS: A total of 273 women participated in the study and 28 (10.2%) giving up the second collection. There were no demographic differences between groups. Fifteen of the 19 FSFI questions were associated and correlated between the two groups in both test and the retest. The intragroup analysis revealed that all FSFI questions and scores were associated and weakly correlated for the same group during both test and retest. CONCLUSION: The online version of the FSFI showed acceptable validity and reliability when compared to the paper version, and can justify the choice of this modality, especially in studies involving private questions.
Summary
Rev Bras Ginecol Obstet. 2013;35(10):469-474
DOI 10.1590/S0100-72032013001000008
PURPOSE: It was to test the validity and reliability of an online version of the Female Sexual Function Index (FSFI). METHODS: An online version of the FSFI was compared to the pen and paper traditional version. Physiotherapy students in three cities were randomly allocated to two groups - G-pp/ol (n=126) and G-ol/pp (n=147). G-pp/ol women replied to th FSFI using the traditional pen and paper method, while G-ol/pp women answered an online version of the same questionnaire. Data were collected ageing after 15 days, when G-pp/ol women answered the online version while G-ol/pp women answered on paper. All data were transferred to SPSS software. Demographic differences between the test two groups were determined by Student's t-test or Fisher exact (95%CI; p>0.05). Association and correlation between the responses of G-pp/ol and G-ol/pp were assessed for each sample by the t-test and Pearson's coefficient. An identical strategy was used for intragroup comparisons. RESULTS: A total of 273 women participated in the study and 28 (10.2%) giving up the second collection. There were no demographic differences between groups. Fifteen of the 19 FSFI questions were associated and correlated between the two groups in both test and the retest. The intragroup analysis revealed that all FSFI questions and scores were associated and weakly correlated for the same group during both test and retest. CONCLUSION: The online version of the FSFI showed acceptable validity and reliability when compared to the paper version, and can justify the choice of this modality, especially in studies involving private questions.