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Revista Brasileira de Ginecologia e Obstetrícia. 01-31-2022;44(3):311-318
, , , , , , The present article presents a literature review concerning the microbiota of breast milk and the influence of epigenetics in the susceptibility to COVID-19.
A literature review.
Breastfeeding transfers microbiota, nutrients, diverse white blood cells, prebiotics, hormones, and antibodies to the baby, which provide short- and longterm immunological protection against several infectious, gastrointestinal, and respiratory illnesses. The little evidence available shows that breast milk very rarely carries the SARS-CoV-2 virus, and even in those cases, it has been discarded as the source of contagion.
The reviewed studies show evidence of a beneficial effect of breastfeeding and highlights its importance on the current pandemic due to the immune reinforcement that it provides. Breastfed individuals showed better clinical response due to the influence on the microbiota and to the nutritional and immune contribution provided by breast milk, compared with those who were not breastfed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 01-31-2022;44(3):311-318
, , , , , , The present article presents a literature review concerning the microbiota of breast milk and the influence of epigenetics in the susceptibility to COVID-19.
A literature review.
Breastfeeding transfers microbiota, nutrients, diverse white blood cells, prebiotics, hormones, and antibodies to the baby, which provide short- and longterm immunological protection against several infectious, gastrointestinal, and respiratory illnesses. The little evidence available shows that breast milk very rarely carries the SARS-CoV-2 virus, and even in those cases, it has been discarded as the source of contagion.
The reviewed studies show evidence of a beneficial effect of breastfeeding and highlights its importance on the current pandemic due to the immune reinforcement that it provides. Breastfed individuals showed better clinical response due to the influence on the microbiota and to the nutritional and immune contribution provided by breast milk, compared with those who were not breastfed.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-08-2021;43(1):14-19
Considering the increased frequency of maternal deaths reported from 2001 to 2005 for Indigenous andmestizo women from the Ecuadorian rural area ofOtavalo,where the Kichwa people has lived for centuries, the objective of the present article is to describehow the efforts of the local health community and hospital workers together with a propitious political environment facilitated the implementation of intercultural childbirth,which is a strategy that respects the Andean childbirth worldview.
We evaluated a 3-year follow-up (2014-16) of the maternal mortality and the childbirth features (4,213 deliveries).
Although the Western-style (lying down position) childbirth was adopted by 80.6% of the pregnant women, 19.4% of bothmestizo and Indigenous women adopted the intercultural delivery (squatting and kneeling positions). Both intercultural (42.2%) and Western-style (57.8%) childbirths were similarly adopted by Kichwa women, whereas Western-style childbirth predominated among mestizo women (94.0%). After the implementation of the intercultural strategy in 2008, a dramatic decrease of maternal deaths has been observed until now in both rural and urban Otavalo regions.
This scenario reveals that the intermingling of cultures and respect for childbirth traditions have decreased maternal mortality in this World Health Organization- awarded program.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-08-2021;43(1):14-19
Considering the increased frequency of maternal deaths reported from 2001 to 2005 for Indigenous andmestizo women from the Ecuadorian rural area ofOtavalo,where the Kichwa people has lived for centuries, the objective of the present article is to describehow the efforts of the local health community and hospital workers together with a propitious political environment facilitated the implementation of intercultural childbirth,which is a strategy that respects the Andean childbirth worldview.
We evaluated a 3-year follow-up (2014-16) of the maternal mortality and the childbirth features (4,213 deliveries).
Although the Western-style (lying down position) childbirth was adopted by 80.6% of the pregnant women, 19.4% of bothmestizo and Indigenous women adopted the intercultural delivery (squatting and kneeling positions). Both intercultural (42.2%) and Western-style (57.8%) childbirths were similarly adopted by Kichwa women, whereas Western-style childbirth predominated among mestizo women (94.0%). After the implementation of the intercultural strategy in 2008, a dramatic decrease of maternal deaths has been observed until now in both rural and urban Otavalo regions.
This scenario reveals that the intermingling of cultures and respect for childbirth traditions have decreased maternal mortality in this World Health Organization- awarded program.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 08-01-2015;37(8):366-373
DOI 10.1590/SO100-720320150005420
To describe associations between pregnancy rates in adolescence and socioeconomic and social responsibility indicators in the municipalities of the State of Minas Gerais, Southeast of Brazil, in the year of 2010.
Ecological study using data from the Brazilian Live Birth Information System (SINASC). The percentage of live births to adolescent mothers (LBAM) for each municipality was calculated based on the quotient between number of born alive infants of mothers aged 10-19 years old and total number of live births in the year of 2010. Fully Bayesian models were used to obtain the percentages of LBAM adjusted for spatial effects and to assess possible associations with socioeconomic and social responsibility indicators.
The crude percentage of LBAM for the total number of live births in the municipalities of Minas Gerais in 2010 ranged from 0 to 46.4%, with median percentage being 19.6% and the first and third quartiles being 15.6 and 23.1%, respectively. This study has demonstrated a close relationship between adolescent pregnancy and socioeconomic indicators. LBAM percentages were found to be higher in municipalities with low population density, low human development index and other low development indicators.
The strong relationship between LBAM percentages and socioeconomic indicators suggests that adolescent pregnancy is more a social than a biological problem. Therefore, programs and actions should go beyond sexual education and information on preventive health methods.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 08-01-2015;37(8):366-373
DOI 10.1590/SO100-720320150005420
To describe associations between pregnancy rates in adolescence and socioeconomic and social responsibility indicators in the municipalities of the State of Minas Gerais, Southeast of Brazil, in the year of 2010.
Ecological study using data from the Brazilian Live Birth Information System (SINASC). The percentage of live births to adolescent mothers (LBAM) for each municipality was calculated based on the quotient between number of born alive infants of mothers aged 10-19 years old and total number of live births in the year of 2010. Fully Bayesian models were used to obtain the percentages of LBAM adjusted for spatial effects and to assess possible associations with socioeconomic and social responsibility indicators.
The crude percentage of LBAM for the total number of live births in the municipalities of Minas Gerais in 2010 ranged from 0 to 46.4%, with median percentage being 19.6% and the first and third quartiles being 15.6 and 23.1%, respectively. This study has demonstrated a close relationship between adolescent pregnancy and socioeconomic indicators. LBAM percentages were found to be higher in municipalities with low population density, low human development index and other low development indicators.
The strong relationship between LBAM percentages and socioeconomic indicators suggests that adolescent pregnancy is more a social than a biological problem. Therefore, programs and actions should go beyond sexual education and information on preventive health methods.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-25-2014;36(4):157-162
DOI 10.1590/S0100-720320140050.0002
It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).
This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).
Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.
These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-25-2014;36(4):157-162
DOI 10.1590/S0100-720320140050.0002
It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS).
This cross-sectional study analyzed 67 BCS, aged 45 -65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI).
Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01 -0.2) for populations at high risk for CVD.
These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-23-2010;32(5):247-253
DOI 10.1590/S0100-72032010000500008
PURPOSE: to compare the quality of life (QL) of women with and without chronic pelvic pain (CPP) and to investigate the factors associated with QL in women with CPP. METHODS: a cross-sectional study was conducted on 30 women with CPP and 20 women without CPP. Sociodemographic and clinical characteristics were evaluated. QL was investigated by applying the SF-36 questionnaire, which contains eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health. These domains can be summarized into two groups: physical component summary (PCS) and mental component summary (MCS). Pain intensity was investigated by applying the visual analogue scale. Linear regression analysis was used to compare QL scores between women with and without CPP and to identify factors associated with the QL of women with CPP. RESULTS: the mean age of women with and without CPP was 35.2±7.5 and 36±9.3 years (p=0.77), respectively. Women with CPP had a lower monthly family income (p=0.04) and a higher prevalence of dysmenorrhea (87 versus 40%; p<0.01) and depression (30 versus 5%; p=0.04) compared to women without CPP. Adjusted analysis for potential confounding variables revealed that women with CPP had lower QL scores in the pain (p<0.01) and social aspects (p<0.01) domains. Depression was negatively associated with the emotional aspects domain (p=0.05) and with the MCS (p=0.03), while pain intensity was negatively related to the pain domain (p<0.01) of the QL of women with CPP. CONCLUSIONS: women with CPP presented a worse QL compared to women without CPP. Depression and pain intensity were negatively related to the QL of women with CPP. Thus, the evaluation and treatment of pain and depressive symptoms must be among the priorities that aim to improve the QL of women with CPP.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-23-2010;32(5):247-253
DOI 10.1590/S0100-72032010000500008
PURPOSE: to compare the quality of life (QL) of women with and without chronic pelvic pain (CPP) and to investigate the factors associated with QL in women with CPP. METHODS: a cross-sectional study was conducted on 30 women with CPP and 20 women without CPP. Sociodemographic and clinical characteristics were evaluated. QL was investigated by applying the SF-36 questionnaire, which contains eight domains: functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health. These domains can be summarized into two groups: physical component summary (PCS) and mental component summary (MCS). Pain intensity was investigated by applying the visual analogue scale. Linear regression analysis was used to compare QL scores between women with and without CPP and to identify factors associated with the QL of women with CPP. RESULTS: the mean age of women with and without CPP was 35.2±7.5 and 36±9.3 years (p=0.77), respectively. Women with CPP had a lower monthly family income (p=0.04) and a higher prevalence of dysmenorrhea (87 versus 40%; p<0.01) and depression (30 versus 5%; p=0.04) compared to women without CPP. Adjusted analysis for potential confounding variables revealed that women with CPP had lower QL scores in the pain (p<0.01) and social aspects (p<0.01) domains. Depression was negatively associated with the emotional aspects domain (p=0.05) and with the MCS (p=0.03), while pain intensity was negatively related to the pain domain (p<0.01) of the QL of women with CPP. CONCLUSIONS: women with CPP presented a worse QL compared to women without CPP. Depression and pain intensity were negatively related to the QL of women with CPP. Thus, the evaluation and treatment of pain and depressive symptoms must be among the priorities that aim to improve the QL of women with CPP.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-18-2005;22(3):129-134
DOI 10.1590/S0100-72032000000300002
Purpose: to compare the performance of cervical canal and vaginal cul-de-sac samples for colpocytology testing, in order to diagnose cervical neoplasia. Methods: three sequential groups were constituted: group 1 - 10,048 women with ectocervix and cul-de-sac samples collected with the use of an Ayre spatula; group 2 - 3,847 women with ectocervix, cul-de-sac and cervical canal samples taken with an Ayre spatula and a cytobrush, and group 3 -- 4,059 women with ectocervix and cervical canal samples, using an Ayre spatula and a cytobrush. ANOVA (analysis of variance) and comparison of proportions were utilized for the statistical analysis. Results: the rates of abnormal tests in groups 2 (2.6%) and 3 (2.4%), including all squamous and glandular lesions, were significantly higher than in group 1 (2.0%). The diagnosis rates of low-grade squamous intraepithelial lesion (LGSIL) were not statistically different between the three groups (1.27, 1.25 and 1.07%). On the other hand, the diagnosis rates of high-grade squamous intraepithelial lesion (HGSIL) were statistically higher in groups 2 (0.81%) and 3 (0.77%) than in group 1 (0.54%). The difference between the rates of the second and the third groups did not present any statistical significance. Conclusions: the cervical canal sampling improves the performance of cytologic testing for the diagnosis of HGSIL, while cul-de-sac sampling does not change significantly the performance in diagnosing cervical neoplasia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-18-2005;22(3):129-134
DOI 10.1590/S0100-72032000000300002
Purpose: to compare the performance of cervical canal and vaginal cul-de-sac samples for colpocytology testing, in order to diagnose cervical neoplasia. Methods: three sequential groups were constituted: group 1 - 10,048 women with ectocervix and cul-de-sac samples collected with the use of an Ayre spatula; group 2 - 3,847 women with ectocervix, cul-de-sac and cervical canal samples taken with an Ayre spatula and a cytobrush, and group 3 -- 4,059 women with ectocervix and cervical canal samples, using an Ayre spatula and a cytobrush. ANOVA (analysis of variance) and comparison of proportions were utilized for the statistical analysis. Results: the rates of abnormal tests in groups 2 (2.6%) and 3 (2.4%), including all squamous and glandular lesions, were significantly higher than in group 1 (2.0%). The diagnosis rates of low-grade squamous intraepithelial lesion (LGSIL) were not statistically different between the three groups (1.27, 1.25 and 1.07%). On the other hand, the diagnosis rates of high-grade squamous intraepithelial lesion (HGSIL) were statistically higher in groups 2 (0.81%) and 3 (0.77%) than in group 1 (0.54%). The difference between the rates of the second and the third groups did not present any statistical significance. Conclusions: the cervical canal sampling improves the performance of cytologic testing for the diagnosis of HGSIL, while cul-de-sac sampling does not change significantly the performance in diagnosing cervical neoplasia.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-10-2005;22(2):65-70
DOI 10.1590/S0100-72032000000200002
Purpose: to evaluate conization by the loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of cervical intraepithelial neoplasms (CIN), the importance of the margins and follow-up of these women. Methods: 95 women who underwent conization by LEEP for CIN and microinvasive carcinoma from January 1996 to December 1997 were evaluated. For statistical analysis, we used the kappa agreement coefficient and the tendency test of Cochran Armitage. Results: among 63 cases who underwent colposcopically directed biopsy before the conization, the cone presented the same grade of lesion in 20 and no residual disease in 8. The cone lesion presented a higher grade in 24 cases and one of them was a microinvasive carcinoma. Among the 25 women who underwent the cone biopsy with a previous biopsy suggestive of cervicitis or CIN 1, 56% had CIN 2 or 3 in the cone. Among the 32 women without previous biopsy, 15 had CIN 2 or 3, and four had microinvasive carcinoma in the cone. Regarding the margins of the cone, 25 cases presented some grade of CIN in the endocervical margins and 2/10 who underwent a second procedure presented residual disease on histological analysis. Among the 70 women with free cone margins, 2/4 who underwent a second procedure had residual disease on histological analysis. Conclusion: conization by LEEP without previous directed biopsy depends on the experience of the colposcopist. The second resection after LEEP for the diagnosis and treatment of CIN depends not only on the presence of disease in the cone margins but also on the follow-up. A second histological analysis is recommended in cases with microinvasive carcinoma and glandular lesion and affected margins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-10-2005;22(2):65-70
DOI 10.1590/S0100-72032000000200002
Purpose: to evaluate conization by the loop electrosurgical excision procedure (LEEP) for the diagnosis and treatment of cervical intraepithelial neoplasms (CIN), the importance of the margins and follow-up of these women. Methods: 95 women who underwent conization by LEEP for CIN and microinvasive carcinoma from January 1996 to December 1997 were evaluated. For statistical analysis, we used the kappa agreement coefficient and the tendency test of Cochran Armitage. Results: among 63 cases who underwent colposcopically directed biopsy before the conization, the cone presented the same grade of lesion in 20 and no residual disease in 8. The cone lesion presented a higher grade in 24 cases and one of them was a microinvasive carcinoma. Among the 25 women who underwent the cone biopsy with a previous biopsy suggestive of cervicitis or CIN 1, 56% had CIN 2 or 3 in the cone. Among the 32 women without previous biopsy, 15 had CIN 2 or 3, and four had microinvasive carcinoma in the cone. Regarding the margins of the cone, 25 cases presented some grade of CIN in the endocervical margins and 2/10 who underwent a second procedure presented residual disease on histological analysis. Among the 70 women with free cone margins, 2/4 who underwent a second procedure had residual disease on histological analysis. Conclusion: conization by LEEP without previous directed biopsy depends on the experience of the colposcopist. The second resection after LEEP for the diagnosis and treatment of CIN depends not only on the presence of disease in the cone margins but also on the follow-up. A second histological analysis is recommended in cases with microinvasive carcinoma and glandular lesion and affected margins.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 05-07-2004;26(2):125-130
DOI 10.1590/S0100-72032004000200007
PURPOSE: to evaluate the efficacy of a physical exercise protocol in the recovery of shoulder movement in women who underwent complete axillary lymph node dissection due to breast carcinoma, comparing free and restricted amplitude movements. METHODS: 59 women who underwent complete axillary lymph node dissection associated with modified mastectomy (46) or quadrantectomy (13) were included in this clinical, prospective and randomized study. On the first day after surgery 30 women were randomized to do the shoulder movement with free amplitude and 29 women had this amplitude restricted to 90º in the first 15 days. Nineteen exercises were done, three sessions per week, for six weeks. Mean (± standard error) deficits of shoulder flexion and abduction were compared, as well as gross and adjusted incidence rates of seroma and dehiscence. RESULTS: 42 days after surgery, flexion and abduction means were similar in the two groups. Both presented a mean flexion deficit (17.2º and 21.6º, respectively), and abduction deficit (19.7º and 26.6º, respectively). The incidence rates of seroma and dehiscence were neither related to exercise nor to the type of surgery, time of drain permanence, number of dissected or compromised lymph nodes, age or obesity. CONCLUSION: early physiotherapy with free movement of the women's shoulder was associated neither with functional capacity nor with postsurgical complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 05-07-2004;26(2):125-130
DOI 10.1590/S0100-72032004000200007
PURPOSE: to evaluate the efficacy of a physical exercise protocol in the recovery of shoulder movement in women who underwent complete axillary lymph node dissection due to breast carcinoma, comparing free and restricted amplitude movements. METHODS: 59 women who underwent complete axillary lymph node dissection associated with modified mastectomy (46) or quadrantectomy (13) were included in this clinical, prospective and randomized study. On the first day after surgery 30 women were randomized to do the shoulder movement with free amplitude and 29 women had this amplitude restricted to 90º in the first 15 days. Nineteen exercises were done, three sessions per week, for six weeks. Mean (± standard error) deficits of shoulder flexion and abduction were compared, as well as gross and adjusted incidence rates of seroma and dehiscence. RESULTS: 42 days after surgery, flexion and abduction means were similar in the two groups. Both presented a mean flexion deficit (17.2º and 21.6º, respectively), and abduction deficit (19.7º and 26.6º, respectively). The incidence rates of seroma and dehiscence were neither related to exercise nor to the type of surgery, time of drain permanence, number of dissected or compromised lymph nodes, age or obesity. CONCLUSION: early physiotherapy with free movement of the women's shoulder was associated neither with functional capacity nor with postsurgical complications.