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Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):149-151
DOI 10.1590/SO100-720320150005250
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):149-151
DOI 10.1590/SO100-720320150005250
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):152-158
DOI 10.1590/SO100-720320150005282
To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil.
A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria.
The mean age of the women was 52.5 (±4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (±5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values above 8. Depression/anxiety (PR=1.8; 95%CI 1.5-2.2; p<0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p<0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p<0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p<0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p<0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p<0.01), number of normal deliveries >1 (PR 1.2; 95%CI 1.02-1.4; p<0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p<0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p<0.01) was associated with less severe symptoms.
The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce the impact of symptoms on quality of life, and to identify groups of women who are likely to need more care during and beyond menopause.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):152-158
DOI 10.1590/SO100-720320150005282
To determine the average age at the onset of menopause and to investigate menopausal symptoms in women in a metropolitan region in Southeastern Brazil.
A descriptive, exploratory, cross-sectional study was conducted with 749 women (a population-based household survey). The dependent variable was the intensity of menopausal symptoms assessed by th Menopause Rating Scale (MRS). The independent variables were sociodemographic data, health-related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by the χ2 test and Poisson regression using the backward selection criteria.
The mean age of the women was 52.5 (±4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The mean age at the onset of menopause was 46.5 (±5.8) years. The intensity of menopausal symptoms was defined according to the median MRS score and was considered severe for values above 8. Depression/anxiety (PR=1.8; 95%CI 1.5-2.2; p<0.01), rheumatic diseases (PR 1.5; 95%CI 1.2-1.7; p<0.01), self-perception of health as fair/poor/very poor (PR 1.4; 95% CI 1.2-1.7; p<0.01), history of abortion (PR 1.3; 95%CI 1.1-1.4; p<0.01), current or previous treatment for menopausal symptoms (PR 1.2; 95%CI 1.1-1.4; p<0.01), peri- or postmenopausal status (PR 1.4; 95%CI 1.1-1.7; p<0.01), number of normal deliveries >1 (PR 1.2; 95%CI 1.02-1.4; p<0.01) and asthma (PR 1.2; 95%CI 1.01-1.4; p<0.01) were associated with more severe menopausal symptoms. Older age (PR 0.96; 95%CI 0.96-0.97; p<0.01) was associated with less severe symptoms.
The severity of menopausal symptoms was related to a wild range of factors, especially presence of chronic diseases, a larger number of pregnancies, use of hormone therapy, and worse self-rated health. A better understanding of these factors can help to reduce the impact of symptoms on quality of life, and to identify groups of women who are likely to need more care during and beyond menopause.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):159-163
DOI 10.1590/SO100-720320150004973
To analyze the relationship between route of delivery and other aspects of pregnancy and the occurrence of intracranial hemorrhage in newborns of very low weight at a teaching hospital in South Brazil.
A case-control study was conducted. Medical records of all patients who were born weighing ≤1,500 g and who were submitted to transfontanellar ultrasonography were analyzed from January 2011 to September 2014. The cases were newborns with diagnosis of intracranial hemorrhage, while newborns with regular exams were used as controls. Differences between groups were analyzed by the Student t test and by χ2 or Fisher exact tests, and association was determined using the odds ratio with a 95% confidence interval and α=5%.
A total of 222 newborns with birth weight ≤1,500 g were recorded; of these, 113 were submitted to transfontanellar ultrasonography and were included in the study. Sixty-nine (61.1%) newborns were diagnosed with intracranial hemorrhage (cases) and 44 (38.9%) showed no abnormal results (controls). Most cases had grade I hemorrhage (96.8%) originating from the germinative matrix (95.7%). The predominant route of delivery was caesarean section (81.2% of the cases and 72.7% of the controls). Five deaths were recorded (3 cases and 2 controls). Gestational age ranged from 24 to 37 weeks. Median birth weight was 1,205 g (range: 675-1,500 g). The median time of hospitalization was 52 days, ranging from 5 to 163 days.
Grade I intracranial hemorrhage from the germinative matrix was the most frequent. No differences were found between cases and controls for the variables studied. The small number of infants submitted to transfontanellar ultrasonography limited the sample size and the results of the study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):159-163
DOI 10.1590/SO100-720320150004973
To analyze the relationship between route of delivery and other aspects of pregnancy and the occurrence of intracranial hemorrhage in newborns of very low weight at a teaching hospital in South Brazil.
A case-control study was conducted. Medical records of all patients who were born weighing ≤1,500 g and who were submitted to transfontanellar ultrasonography were analyzed from January 2011 to September 2014. The cases were newborns with diagnosis of intracranial hemorrhage, while newborns with regular exams were used as controls. Differences between groups were analyzed by the Student t test and by χ2 or Fisher exact tests, and association was determined using the odds ratio with a 95% confidence interval and α=5%.
A total of 222 newborns with birth weight ≤1,500 g were recorded; of these, 113 were submitted to transfontanellar ultrasonography and were included in the study. Sixty-nine (61.1%) newborns were diagnosed with intracranial hemorrhage (cases) and 44 (38.9%) showed no abnormal results (controls). Most cases had grade I hemorrhage (96.8%) originating from the germinative matrix (95.7%). The predominant route of delivery was caesarean section (81.2% of the cases and 72.7% of the controls). Five deaths were recorded (3 cases and 2 controls). Gestational age ranged from 24 to 37 weeks. Median birth weight was 1,205 g (range: 675-1,500 g). The median time of hospitalization was 52 days, ranging from 5 to 163 days.
Grade I intracranial hemorrhage from the germinative matrix was the most frequent. No differences were found between cases and controls for the variables studied. The small number of infants submitted to transfontanellar ultrasonography limited the sample size and the results of the study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):164-171
DOI 10.1590/SO100-720320150005186
To identify the factors associated with weight retention after pregnancy.
A cohort study was performed with 145 women receiving maternity care at a hospital in Caxias do Sul, Rio Grande do Sul, Brazil, aged 19 to 45 years, between weeks 38 and 42 of pregnancy. The patients were evaluated at one month, three months, and six months after delivery. Student's t-test or one-way analysis of variance (ANOVA) was used to compare groups, as indicated; correlations were assessed with Pearson's and Spearman's tests, as indicated; to identify and evaluate confounders independently associated with total weight loss, a multivariate linear regression analysis was performed and statistical significance was set at p≤0.05.
There was a significant positive association between total weight gain - and a negative association with physical exercise during pregnancy - with total weight loss. Higher parity, inter-pregnancy interval, calorie intake, pre-pregnancy body mass index (BMI), weight gain related to pre-pregnancy BMI, presence and severity of depression, and lack of exclusive breastfeeding were directly associated with lower weight loss. Among nominal variables, level of education and marital status were significantly associated with total weight loss.
In the present study, lower weight retention in the postpartum period was associated with higher educational attainment and with being married. Normal or below-normal pre-pregnancy BMI, physical activity and adequate weight gain during pregnancy, lower parity, exclusive breastfeeding for a longer period, appropriate or low calorie intake, and absence of depression were also determinants of reduced weight retention.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):164-171
DOI 10.1590/SO100-720320150005186
To identify the factors associated with weight retention after pregnancy.
A cohort study was performed with 145 women receiving maternity care at a hospital in Caxias do Sul, Rio Grande do Sul, Brazil, aged 19 to 45 years, between weeks 38 and 42 of pregnancy. The patients were evaluated at one month, three months, and six months after delivery. Student's t-test or one-way analysis of variance (ANOVA) was used to compare groups, as indicated; correlations were assessed with Pearson's and Spearman's tests, as indicated; to identify and evaluate confounders independently associated with total weight loss, a multivariate linear regression analysis was performed and statistical significance was set at p≤0.05.
There was a significant positive association between total weight gain - and a negative association with physical exercise during pregnancy - with total weight loss. Higher parity, inter-pregnancy interval, calorie intake, pre-pregnancy body mass index (BMI), weight gain related to pre-pregnancy BMI, presence and severity of depression, and lack of exclusive breastfeeding were directly associated with lower weight loss. Among nominal variables, level of education and marital status were significantly associated with total weight loss.
In the present study, lower weight retention in the postpartum period was associated with higher educational attainment and with being married. Normal or below-normal pre-pregnancy BMI, physical activity and adequate weight gain during pregnancy, lower parity, exclusive breastfeeding for a longer period, appropriate or low calorie intake, and absence of depression were also determinants of reduced weight retention.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):172-177
DOI 10.1590/SO100-720320150005238
To evaluate the presence of podocyturia in chronic hypertensive pregnant women in the third trimester of pregnancy and its possible association with renal disease.
This was an observational study of a convenience sample of 38 chronic hypertensive pregnant women. The podocytes were labeled by the indirect immunofluorescence technique with anti-podocin and diamidino-phenylindole (DAPI). The count was made on 30 random fields analyzed and corrected according to urinary creatinine (podocytes/mg creatinine). The patients were assigned to two groups: NG (normal glomerular function), up to 100 podocytes, and GP (probable glomerulopathy), more than 100 podocytes. Urinary creatinine was measured by the alkaline picrate method. The variables analyzed were body mass index, gestational age, and systolic and diastolic blood pressure at the time of sample collection. Data were analyzed using the SPSS - version 16.0 (IBM - USA). Statistical analysis was performed by the χ2 test, and significant differences were considered when p<0.05.
The median podocyte count was 20.3 (0.0-98.1) for group GN, and 176.9 (109.1-490.6) for GP. The mean body mass index was 30.2 kg/m2 (SD=5.6), mean gestational age was 35.1 weeks (SD=2.5), median systolic blood pressure was 130.0 mmHg (100.0-160.0) and median diastolic blood pressure was 80.0 mmHg (60.0-110.0). There was no significant correlation between podocyturia and body mass index (p=0.305), gestational age (p=0.392), systolic blood pressure (p=0.540) or diastolic blood pressure (p=0.540).
In this study, there was no podocyturia pattern consistent with the presence of active renal disease, although some of the women studied (15.8%) exhibited a significant loss. We believe that it is premature to recommend the inclusion of the determination of podocyturia in routine prenatal clinical practice in chronically hypertensive pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):172-177
DOI 10.1590/SO100-720320150005238
To evaluate the presence of podocyturia in chronic hypertensive pregnant women in the third trimester of pregnancy and its possible association with renal disease.
This was an observational study of a convenience sample of 38 chronic hypertensive pregnant women. The podocytes were labeled by the indirect immunofluorescence technique with anti-podocin and diamidino-phenylindole (DAPI). The count was made on 30 random fields analyzed and corrected according to urinary creatinine (podocytes/mg creatinine). The patients were assigned to two groups: NG (normal glomerular function), up to 100 podocytes, and GP (probable glomerulopathy), more than 100 podocytes. Urinary creatinine was measured by the alkaline picrate method. The variables analyzed were body mass index, gestational age, and systolic and diastolic blood pressure at the time of sample collection. Data were analyzed using the SPSS - version 16.0 (IBM - USA). Statistical analysis was performed by the χ2 test, and significant differences were considered when p<0.05.
The median podocyte count was 20.3 (0.0-98.1) for group GN, and 176.9 (109.1-490.6) for GP. The mean body mass index was 30.2 kg/m2 (SD=5.6), mean gestational age was 35.1 weeks (SD=2.5), median systolic blood pressure was 130.0 mmHg (100.0-160.0) and median diastolic blood pressure was 80.0 mmHg (60.0-110.0). There was no significant correlation between podocyturia and body mass index (p=0.305), gestational age (p=0.392), systolic blood pressure (p=0.540) or diastolic blood pressure (p=0.540).
In this study, there was no podocyturia pattern consistent with the presence of active renal disease, although some of the women studied (15.8%) exhibited a significant loss. We believe that it is premature to recommend the inclusion of the determination of podocyturia in routine prenatal clinical practice in chronically hypertensive pregnant women.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):178-185
DOI 10.1590/SO100-720320150005184
To conduct a comparative study between two groups of women (HIV positive and negative) analyzing: the prevalence of cervical intraepithelial neoplasia (CIN) and cervical HPV infection; viral risk and relationship with development of CIN; and sociodemographic and behavioral parameters that influence cervical HPV infection and the development of CIN.
A cross-sectional study in which 202 HIV-positive women and 164 HIV-negative women were analyzed to assess the prevalence of CIN and 171 HIV-positive women and 160 HIV-negative women were analyzed to assess the prevalence of cervical HPV infection. The following procedures were performed on the occasion of each medical visit: collection of cervical samples for cytology and polymerase chain reaction (PCR) to detect HPV DNA; colposcopy; standardized questionnaire to collect demographic and behavioral data; and biopsy of all colposcopic changes. Histopathology was the gold standard for the diagnosis of CIN.
The prevalence of CIN was 2.4 and 15.3% (p<0.001) and the prevalence of cervical HPV infection was 37.1 and 55.5% (p=0.002), respectively, among HIV-negative and -positive women. HIV-positive women had a higher risk of HPV infection (35.7 and 23.6%) (p=0.02). HPV 16 was the most prevalent virus type, occurring in 11.3 and 10.2% of HIV-positive and negative women and was also more prevalent among women presenting CIN in both groups. Factors associated fwith the development of CIN were: HIV infection (HT=4.64; 95%CI 2.23-9.65), age (HT=0.95; 95%CI 0.93-0.98 for each year of life) and marital status(HT=0.49; 95%CI 0.30-0.80). Associated factors for HPV infection were: HIV presence (HT=2.72; 95%CI 1.77-4.17), greater number of sexual partners (HT=1.87; 95%CI 1.23-2.84), age (HT=0.97; 95%CI 0.95-0.99 for each year of life) and marital status (HT=0.65; 95%CI 0.42-1.0 for stable union/widows).
The prevalence of CIN and cervical HPV infection was higher in HIV-positive women, who also presented a higher risk of HPV infections and multiple viral types. Type 16 was predominant in both groups and in women with CIN. Older women and women with stable union/widows were less likely to acquire cervical HPV infection and CIN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):178-185
DOI 10.1590/SO100-720320150005184
To conduct a comparative study between two groups of women (HIV positive and negative) analyzing: the prevalence of cervical intraepithelial neoplasia (CIN) and cervical HPV infection; viral risk and relationship with development of CIN; and sociodemographic and behavioral parameters that influence cervical HPV infection and the development of CIN.
A cross-sectional study in which 202 HIV-positive women and 164 HIV-negative women were analyzed to assess the prevalence of CIN and 171 HIV-positive women and 160 HIV-negative women were analyzed to assess the prevalence of cervical HPV infection. The following procedures were performed on the occasion of each medical visit: collection of cervical samples for cytology and polymerase chain reaction (PCR) to detect HPV DNA; colposcopy; standardized questionnaire to collect demographic and behavioral data; and biopsy of all colposcopic changes. Histopathology was the gold standard for the diagnosis of CIN.
The prevalence of CIN was 2.4 and 15.3% (p<0.001) and the prevalence of cervical HPV infection was 37.1 and 55.5% (p=0.002), respectively, among HIV-negative and -positive women. HIV-positive women had a higher risk of HPV infection (35.7 and 23.6%) (p=0.02). HPV 16 was the most prevalent virus type, occurring in 11.3 and 10.2% of HIV-positive and negative women and was also more prevalent among women presenting CIN in both groups. Factors associated fwith the development of CIN were: HIV infection (HT=4.64; 95%CI 2.23-9.65), age (HT=0.95; 95%CI 0.93-0.98 for each year of life) and marital status(HT=0.49; 95%CI 0.30-0.80). Associated factors for HPV infection were: HIV presence (HT=2.72; 95%CI 1.77-4.17), greater number of sexual partners (HT=1.87; 95%CI 1.23-2.84), age (HT=0.97; 95%CI 0.95-0.99 for each year of life) and marital status (HT=0.65; 95%CI 0.42-1.0 for stable union/widows).
The prevalence of CIN and cervical HPV infection was higher in HIV-positive women, who also presented a higher risk of HPV infections and multiple viral types. Type 16 was predominant in both groups and in women with CIN. Older women and women with stable union/widows were less likely to acquire cervical HPV infection and CIN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):186-191
DOI 10.1590/SO100-720320150005252
To evaluate genes differentially expressed in ovaries from lean (wild type) and obese (ob/ob) female mice and cyclic AMP production in both groups.
The expression on messenger RNA levels of 84 genes concerning obesity was analyzed through the PCR array, and cyclic AMP was quantified by the enzyme immunoassay method.
The most downregulated genes in the Obesity Group included adenylate cyclase-activating polypeptide type 1, somatostatin, apolipoprotein A4, pancreatic colipase, and interleukin-1 beta. The mean decrease in expression levels of these genes was around 96, 40, 9, 4.2 and 3.6-fold, respectively. On the other hand, the most upregulated genes in the Obesity Group were receptor (calcitonin) activity-modifying protein 3, peroxisome proliferator activated receptor alpha, calcitonin receptor, and corticotropin-releasing hormone receptor 1. The increase means in the expression levels of such genes were 2.3, 2.7, 4.8 and 6.3-fold, respectively. The ovarian cyclic AMP production was significantly higher in ob/ob female mice (2,229±52 fMol) compared to the Control Group (1,814±45 fMol).
Obese and anovulatory female mice have reduced reproductive hormone levels and altered ovogenesis. Several genes have their expression levels altered when leptin is absent, especially adenylate cyclase-activating polypeptide type 1.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):186-191
DOI 10.1590/SO100-720320150005252
To evaluate genes differentially expressed in ovaries from lean (wild type) and obese (ob/ob) female mice and cyclic AMP production in both groups.
The expression on messenger RNA levels of 84 genes concerning obesity was analyzed through the PCR array, and cyclic AMP was quantified by the enzyme immunoassay method.
The most downregulated genes in the Obesity Group included adenylate cyclase-activating polypeptide type 1, somatostatin, apolipoprotein A4, pancreatic colipase, and interleukin-1 beta. The mean decrease in expression levels of these genes was around 96, 40, 9, 4.2 and 3.6-fold, respectively. On the other hand, the most upregulated genes in the Obesity Group were receptor (calcitonin) activity-modifying protein 3, peroxisome proliferator activated receptor alpha, calcitonin receptor, and corticotropin-releasing hormone receptor 1. The increase means in the expression levels of such genes were 2.3, 2.7, 4.8 and 6.3-fold, respectively. The ovarian cyclic AMP production was significantly higher in ob/ob female mice (2,229±52 fMol) compared to the Control Group (1,814±45 fMol).
Obese and anovulatory female mice have reduced reproductive hormone levels and altered ovogenesis. Several genes have their expression levels altered when leptin is absent, especially adenylate cyclase-activating polypeptide type 1.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):192-196
DOI 10.1590/SO100-720320150005077
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital disorder of the Müllerian ducts in which there is uterus didelphys, obstructed hemivagina and unilateral renal agenesis. The most common presentation is an abdominal mass secondary to hematocolpos, pain and dysmenorrhea. However, in some cases, such as the one we present here, menses are normal due to an obstructed hemivagina, and diagnosis can be delayed. We describe evaluation and surgical management of a 13-year-old girl with this condition who was diagnosed by computed tomography (CT) scan and confirmed by pelvic ultrasound and surgical exploration, as well as a review of the literature.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(4):192-196
DOI 10.1590/SO100-720320150005077
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital disorder of the Müllerian ducts in which there is uterus didelphys, obstructed hemivagina and unilateral renal agenesis. The most common presentation is an abdominal mass secondary to hematocolpos, pain and dysmenorrhea. However, in some cases, such as the one we present here, menses are normal due to an obstructed hemivagina, and diagnosis can be delayed. We describe evaluation and surgical management of a 13-year-old girl with this condition who was diagnosed by computed tomography (CT) scan and confirmed by pelvic ultrasound and surgical exploration, as well as a review of the literature.
