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Carvalho BTB, Borovac-Pinheiro A, Morais SS, Guida JP, Surita FG. Gestational hypertension as a factor associated with chronic kidney disease: the importance of obstetric history of women undergoing hemodialysis. J Bras Nefrol 2023; 45:294-301. [PMID: 36626329 PMCID: PMC10697153 DOI: 10.1590/2175-8239-jbn-2022-0119en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/09/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Pregnancy-related complications may impact women's reproductive cycle and health through their lives. The objective of this study was to evaluate the sociodemographic, clinical, and obstetric history of women undergoing hemodialysis. METHODS We performed a cross-sectional study in a specialized health facility with four hemodialysis units. Sociodemographic characteristics, clinical and personal history, obstetric and perinatal results of women with pregnancies before hemodialysis were evaluated. Prevalence, bivariate, and logistic regression analyses were performed. RESULTS We included 208 (87.76%) women. Hypertension was the main cause of chronic kidney disease (CKD) (128 women). Rates of adverse perinatal outcomes, including prematurity, low birth weight, miscarriage, fetal death, and neonatal death, were 19.3%, 14.5%, 25.5%, 12.1%, and 5.3%, respectively. Hypertensive syndromes during pregnancy occurred in 37.0% of women, with 12.5% reporting preeclampsia and 1.4% reporting eclampsia. Up to 1 year after birth, 45.2% of women reported hypertension. Hemodialysis due to hypertension was associated with a history of hypertension during pregnancy (OR 2.33, CI 1.27 - 4.24), gestational hypertension (2.41, CI 3.30 - 4.45), and hypertension up to one year after birth (OR 1.98, CI 1.11 - 3.51). Logistic regression showed that gestational hypertension was independently associated with CKD due to hypertension (aOR 2.76, CI 1.45 - 5.24). CONCLUSION Women undergoing hemodialysis due to hypertension were more likely to have gestational hypertension or hypertension up to one year after birth. To delay end-stage renal disease, it is necessary to identify women at risk of kidney failure according to their reproductive history.
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Affiliation(s)
- Beatriz Tenorio Batista Carvalho
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Ginecologia e Obstetrícia, Campinas, SP, Brazil
| | - Anderson Borovac-Pinheiro
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Ginecologia e Obstetrícia, Campinas, SP, Brazil
| | - Sirlei Siani Morais
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Ginecologia e Obstetrícia, Campinas, SP, Brazil
| | - José Paulo Guida
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Ginecologia e Obstetrícia, Campinas, SP, Brazil
| | - Fernanda Garanhani Surita
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas,
Departamento de Ginecologia e Obstetrícia, Campinas, SP, Brazil
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Carvalho BTB, Borovac-Pinheiro A, Morais SS, Guida JP, Surita FG. Hipertensão gestacional como fator associado à doença renal crônica: a importância do histórico obstétrico de mulheres submetidas à hemodiálise. J Bras Nefrol 2023. [DOI: 10.1590/2175-8239-jbn-2022-0119pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Introdução: Complicações relacionadas à gestação podem afetar o ciclo reprodutivo e a saúde das mulheres ao longo de suas vidas. Este estudo visou avaliar histórico sociodemográfico, clínico e obstétrico de mulheres em hemodiálise. Métodos: Realizamos estudo transversal em unidade de saúde especializada com quatro unidades de hemodiálise. Avaliou-se características sociodemográficas, histórico clínico e pessoal, resultados obstétricos e perinatais de mulheres com gestações anteriores à hemodiálise. Foram realizadas análises de prevalência, bivariadas e regressão logística. Resultados: Incluímos 208 (87,76%) mulheres. Hipertensão foi a principal causa de doença renal crônica (DRC) (128 mulheres). Taxas de desfechos perinatais adversos, incluindo prematuridade, baixo peso ao nascer, aborto espontâneo, óbito fetal e neonatal, foram de 19,3%, 14,5%, 25,5%, 12,1% e 5,3%, respectivamente. Síndromes hipertensivas durante a gestação ocorreram em 37,0% das mulheres, com 12,5% relatando pré-eclâmpsia e 1,4% relatando eclampsia. Até 1 ano após o parto, 45,2% das mulheres relataram hipertensão. Hemodiálise devido à hipertensão foi associada ao histórico de hipertensão na gestação (OR 2,33; IC 1,27 - 4,24), hipertensão gestacional (2,41; IC 3,30 - 4,45), e hipertensão até um ano após o parto (OR 1,98; IC 1,11 - 3,51). A regressão logística mostrou que hipertensão gestacional foi independentemente associada à DRC devido à hipertensão (ORa 2,76; IC 1,45 - 5,24). Conclusão: Mulheres submetidas à hemodiálise por hipertensão foram mais propensas a apresentar hipertensão gestacional ou hipertensão até um ano após o parto. Para retardar a doença renal em estágio terminal, deve-se identificar mulheres em risco de insuficiência renal de acordo com sua história reprodutiva.
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Borrelli CB, Morais SS, Barbieri MM, Leme T, Prado JFT, Surita FG. Prepregnancy overweight and obesity as risk factors for birth defects: a cross-sectional study over a 30-year period. J OBSTET GYNAECOL 2022; 42:2905-2911. [PMID: 36000806 DOI: 10.1080/01443615.2022.2112938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Overweight and obesity are public health problems worldwide despite being modifiable conditions. The association between birth defects and pregestational maternal body mass index is not entirely clear. We aimed to assess the prevalence and estimate the risk of birth defects related to pregestational body mass index and other maternal factors. We explored a 30-year time series database in a cross-section study. We analysed 40,217 cases, among them 2.8% had birth defects. Bivariate analysis showed a higher prevalence of birth defects with increased pre-pregnancy body mass index and in extremes of maternal age, white skin colour, and primiparity. Multivariable logistic regression showed a higher chance of birth defects in women with pre-pregnancy overweight/obesity (OR:1.19 [CI95%:1.01-1.41]), maternal age ≥ 40 years (OR:1.68 [CI95%:1.11-2.54]), and white skin colour (OR:1.44 [CI95%:1.19-1.75]). Maternal weight is a modifiable risk factor that must be considered and addressed in preconception counselling to minimise possible deleterious effects on embryogenesis.IMPACT STATEMENTWhat is already known on this subject? Previous studies have linked some maternal factors with birth defects. However, the association with prepregnancy maternal body mass index is not clear.What do the results of this study add? Our findings provide support for the association of prepregnancy maternal overweight and obesity with birth defects and highlight that BMI is a modified risk factor.What are the implications of these findings for clinical practice and/or further research? Maternal body mass index is a modifiable risk factor, highlighting the importance of preconception counselling for the prevention and possible reduction of factors that increase the risk of birth defects.
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Affiliation(s)
- Carolina Bicudo Borrelli
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Mariane M Barbieri
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Thayane Leme
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
| | | | - Fernanda G Surita
- Department of Obstetrics and Gynecology, School of Medical Science, University of Campinas, Campinas, Sao Paulo, Brazil
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Pacagnella RC, Borovac-Pinheiro A, Silveira C, Siani Morais S, Argenton JLP, Souza JP, Weeks AD, Cecatti JG. The golden hour for postpartum hemorrhage: Results from a prospective cohort study. Int J Gynaecol Obstet 2021; 156:450-458. [PMID: 34254311 DOI: 10.1002/ijgo.13823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the predictive capacity of vital signs for the diagnosis of postpartum hemorrhage (PPH). METHODS A prospective cohort study performed at the University of Campinas, Brazil, between February 2015 and March 2016 with women who delivered vaginally. Vital signs and postpartum bleeding were collected over 24 h. Exploratory data analysis was performed plus receiver operating characteristic curve analysis where the areas under the curve was used to determine the best cutoff points for sensitivity, specificity, likelihood ratio, and diagnostic odds ratio. RESULTS For the 270 women recruited, mean blood loss after 120 min was 427.49 ± 335.57 ml, while 84 (31.1%) and 22 (8.1%) women had blood loss ≥500 and ≥1000 ml, respectively. Heart rate cutoff point of 105 bpm measured between 21-40 min after birth identified blood loss ≥1000 ml with 90% specificity. A shock index (SI) of 0.965 at 41-60 min after birth identified blood loss ≥500 and ≥1000 ml within 2 h with approximately 95% specificity. CONCLUSION Shock index and heart rate measured after birth showed high specificity with low sensitivity to identify PPH. In clinical practice, "The rule of 1s" should receive special attention: SI ≥1, or heart rate >100 bpm, or estimated blood loss ≥1 L.
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Affiliation(s)
- Rodolfo C Pacagnella
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Anderson Borovac-Pinheiro
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carla Silveira
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Joao Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, Brazil
| | - Andrew D Weeks
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - José G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Fabro AT, Machado-Rugolo J, Baldavira CM, Prieto TG, Farhat C, Rotea ManGone FR, Batah SS, Cruvinel HR, Aldá MA, Monteiro JS, Pádua AI, Morais SS, Antônio de Oliveira R, Santos MK, Baddini-Martinez JA, Setubal JC, Rainho CA, Yoo HHB, Silva PL, Nagai MA, Capelozzi VL. Circulating Plasma miRNA and Clinical/Hemodynamic Characteristics Provide Additional Predictive Information About Acute Pulmonary Thromboembolism, Chronic Thromboembolic Pulmonary Hypertension and Idiopathic Pulmonary Hypertension. Front Pharmacol 2021; 12:648769. [PMID: 34122072 PMCID: PMC8194827 DOI: 10.3389/fphar.2021.648769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Idiopathic pulmonary artery hypertension (IPAH), chronic thromboembolic pulmonary hypertension (CTEPH), and acute pulmonary embolism (APTE) are life-threatening cardiopulmonary diseases without specific surgical or medical treatment. Although APTE, CTEPH and IPAH are different pulmonary vascular diseases in terms of clinical presentation, prevalence, pathophysiology and prognosis, the identification of their circulating microRNA (miRNAs) might help in recognizing differences in their outcome evolution and clinical forms. The aim of this study was to describe the APTE, CTEPH, and IPAH-associated miRNAs and to predict their target genes. The target genes of the key differentially expressed miRNAs were analyzed, and functional enrichment analyses were carried out. The miRNAs were detected using RT-PCR. Finally, we incorporated plasma circulating miRNAs in baseline and clinical characteristics of the patients to detect differences between APTE and CTEPH in time of evolution, and differences between CTEPH and IPAH in diseases form. We found five top circulating plasma miRNAs in common with APTE, CTEPH and IPAH assembled in one conglomerate. Among them, miR-let-7i-5p expression was upregulated in APTE and IPAH, while miRNA-320a was upregulated in CTEP and IPAH. The network construction for target genes showed 11 genes regulated by let-7i-5p and 20 genes regulated by miR-320a, all of them regulators of pulmonary arterial adventitial fibroblasts, pulmonary artery endothelial cell, and pulmonary artery smooth muscle cells. AR (androgen receptor), a target gene of hsa-let-7i-5p and has-miR-320a, was enriched in pathways in cancer, whereas PRKCA (Protein Kinase C Alpha), also a target gene of hsa-let-7i-5p and has-miR-320a, was enriched in KEGG pathways, such as pathways in cancer, glioma, and PI3K-Akt signaling pathway. We inferred that CTEPH might be the consequence of abnormal remodeling in APTE, while unbalance between the hyperproliferative and apoptosis-resistant phenotype of pulmonary arterial adventitial fibroblasts, pulmonary artery endothelial cell and pulmonary artery smooth muscle cells in pulmonary artery confer differences in IPAH and CTEPH diseases form. We concluded that the incorporation of plasma circulating let-7i-5p and miRNA-320a in baseline and clinical characteristics of the patients reinforces differences between APTE and CTEPH in outcome evolution, as well as differences between CTEPH and IPAH in diseases form.
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Affiliation(s)
- Alexandre Todorovic Fabro
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Juliana Machado-Rugolo
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Health Technology Assessment Center (NATS), Clinical Hospital (HCFMB), Medical School of São Paulo State University (UNESP), Botucatu, Brazil
| | - Camila Machado Baldavira
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Tabatha Gutierrez Prieto
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Cecília Farhat
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Flavia Regina Rotea ManGone
- Laboratory of Molecular Genetics, Center for Translational Research in Oncology, Cancer Institute of São Paulo (ICESP), São Paulo, Brazil
| | - Sabrina Setembre Batah
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Heloísa Resende Cruvinel
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Maiara Almeida Aldá
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Jhonatas Sirino Monteiro
- Bioinformatic Laboratory, Institute of Chemistry, University of São Paulo (USP), São Paulo, Brazil
| | - Adriana Inacio Pádua
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Pathology and Legal Medicine, Respiratory Medicine Laboratory, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - Rogério Antônio de Oliveira
- Department of Biostatistics, Plant Biology, Parasitology and Zoology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Marcel Koenigkam Santos
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - José Antônio Baddini-Martinez
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo (USP), São Paulo, Brazil
| | - João Carlos Setubal
- Bioinformatic Laboratory, Institute of Chemistry, University of São Paulo (USP), São Paulo, Brazil
| | - Claudia Aparecida Rainho
- Department of Chemical and Biological Sciences, Institute of Biosciences, São Paulo State University (UNESP), Botucatu, Brazil
| | - Hugo Hyung Bok Yoo
- Pulmonary Hypertension Care Center, Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Centro de Ciências da Saúde, Rio de Janeiro, Brazil.,National Institute of Science and Technology for Regenerative Medicine, Rio de Janeiro, Brazil
| | - Maria Aparecida Nagai
- Laboratory of Molecular Genetics, Center for Translational Research in Oncology, Cancer Institute of São Paulo (ICESP), São Paulo, Brazil.,Department of Radiology and Oncology, Medical School of São Paulo State University (UNESP), São Paulo, Brazil
| | - Vera Luiza Capelozzi
- Department of Pathology, Laboratory of Histomorphometry and Lung Genomics, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Batah SS, Alda MA, Machado‐Rugulo JR, Felix RG, Nascimento E, Martinez R, de Pádua AI, Bagagli E, Hrycyk MF, Salgado HC, Castania JA, Sbragia L, Santos MK, Baddini‐Martinez JA, Morais SS, Capelozzi VL, Achcar RD, Fabro AT. Pulmonary paracoccidioidomycosis-induced pulmonary hypertension. Clin Transl Med 2020; 10:e213. [PMID: 33252858 PMCID: PMC7678439 DOI: 10.1002/ctm2.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sabrina Setembre Batah
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Maiara Almeida Alda
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | | | - Renato Gonçalves Felix
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Erika Nascimento
- Division of Infectious and Tropical DiseasesInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Roberto Martinez
- Division of Infectious and Tropical DiseasesInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Adriana Ignácio de Pádua
- Pulmonary DivisionInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Eduardo Bagagli
- Institute of Biosciences, Botucatu Medical SchoolSão Paulo State UniversityBotucatuBrazil
| | | | - Hélio Cesar Salgado
- Department of PhysiologyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Jaci Airton Castania
- Department of PhysiologyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Lourenço Sbragia
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Marcel Koenigkam Santos
- Department of Medical Imaging, Hematology and Clinical OncologyRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - José Antônio Baddini‐Martinez
- Pulmonary DivisionInternal Medicine DepartmentRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Sirlei Siani Morais
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
| | - Vera Luiza Capelozzi
- Department of PathologyFaculty of MedicineUniversity of São PauloSão PauloBrazil
| | | | - Alexandre Todorovic Fabro
- Department of Pathology and Legal MedicineRibeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
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Borovac-Pinheiro A, Ribeiro FM, Morais SS, Pacagnella RC. Correction: Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study. PLoS One 2020; 15:e0230530. [PMID: 32163501 PMCID: PMC7067383 DOI: 10.1371/journal.pone.0230530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0217907.].
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Sarian LO, Derchain SFM, Pittal DDR, Andrade LAA, Morais SS, Figueiredo PG. Human Papillomavirus Detection by Hybrid Capture II and Residual or Recurrent High-Grade Squamous Cervical Intraepithelial Neoplasia after Large Loop Excision of the Transformation Zone (LLETZ). Tumori 2019; 91:188-92. [PMID: 15948550 DOI: 10.1177/030089160509100216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The purpose of this study was to assess the association between highly-oncogenic types HPV DNA detection by Hybrid Capture II (HCII) and residual or recurrent high-grade cervical intraepithelial neoplasia (CIN 2 or 3) during the follow-up of women submitted to large loop excision of the transformation zone (LLETZ). Study design In this cohort study, 94 women submitted to LLETZ because of CIN 2 or 3 between March 2001 and September 2002 were followed up twice yearly until September 2003. Follow-up visits consisted of an interview regarding clinical, social and demographic characteristics complemented with gynecological examination with specimen collection for Pap test and HCII and colposcopy. Eighty-one patients attended the first visit (mean 4.8 months, range 3-6) and 75 the second visit (mean 10.9 months, range 7-17 months). McNemar's test to assess the variation of HPV DNA detection following LLETZ, odds ratios (OR) to evaluate the correlation between HPV DNA positivity and residual/recurrent CIN during follow-up, and logistic regression to assess the risk of residual/recurrent CIN were used. Results There was a strong and significant reduction in HPV detection after LLETZ ( P <0.001). HPV DNA detection was correlated with residual/recurrent CIN at the first (OR = 103.4; 95% CI 5.5 to 1961.2) and second (OR = 12.7; 95% CI 1.1 to 345.5) follow-up visits. Multivariate analysis showed HPV persistence as a stand-alone risk factor for residual/recurrent CIN (OR = 50.3; 95% CI 3.8 to 663.1). Conclusions High risk HPV DNA detection decreased substantially after CIN treatment with LLETZ, but HPV persistence was strongly correlated with residual/recurrent CIN.
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Affiliation(s)
- Luís Otávio Sarian
- Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, Brazil.
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Godoy-Miranda AC, Cirelli JF, Pinho-Pompeu M, Paulino DSM, Morais SS, Surita FG. Putting Knowledge into Practice-The Challenge of Acquiring Healthy Habits during Pregnancy. Rev Bras Ginecol Obstet 2019; 41:469-475. [PMID: 31250418 PMCID: PMC10309287 DOI: 10.1055/s-0039-1692633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the knowledge concerning gestational weight gain (GWG), nutrition, and physical exercise (PE) in pregnant women, and how to put them into practice. METHODS A cross-sectional study with 61 pregnant women above 26 weeks of gestation, at the Woman's Hospital, CAISM, University of Campinas. Questionnaires regarding the knowledge of healthy habits (HH) during pregnancy, sociodemographic data, and previous obstetric outcomes were applied. An educational guide with advice on HH during pregnancy and in the postpartum period was offered. RESULTS The average age of women was 28.7 ± 6.23 years, with 85% of them being married; 32% nulliparous; the average body mass index (BMI) before pregnancy was 25.4 ± 9.8 kg/m2, and the mean number of years of schooling was 11.2 ± 3.8. Only 61% of the subjects had received any previous information about GWG during their antenatal care and were aware as to how many pounds they should gain during pregnancy. Among the 61 women, 85% understood that they did not need to "eat for 2" and 99% knew that PE had benefits for their body and was safe for their baby. Half of the women practiced PE prior to pregnancy; however, only 31% continued the practice of PE during the pregnancy. CONCLUSION Despite understanding the need for HH during pregnancy, women still need encouragement to practice PE during pregnancy, as well as more information about GWG.
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Affiliation(s)
- Ana Carolina Godoy-Miranda
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Jessica Fernandes Cirelli
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Maira Pinho-Pompeu
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | | | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, São Paulo, SP, Brazil
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Borovac-Pinheiro A, Ribeiro FM, Morais SS, Pacagnella RC. Shock index and heart rate standard reference values in the immediate postpartum period: A cohort study. PLoS One 2019; 14:e0217907. [PMID: 31185036 PMCID: PMC6559711 DOI: 10.1371/journal.pone.0217907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/22/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To determine Shock Index (SI) reference values in the first two hours of the postpartum period after objectively measuring postpartum bleeding. Materials and methods A complementary analysis using data from a prospective cohort study at Women’s Hospital of the University of Campinas, Brazil, between 1 February 2015 and 31 March 2016. It included women giving birth vaginally unless they had one of these conditions: gestational age below 34 weeks, hypertension, hypo- or hyperthyroidism without treatment, any cardiac disease, infections with fever or sepsis, history of coagulopathy or delivery by C-section. Blood loss was measured by adding the blood volume collected in the drape placed under the women’s buttocks and the weight of gauzes and compresses used (excluding the dry weight). Vital signs were measured every 5–15 min after delivery. Exploratory data analysis was performed to assess the mean, standard deviation, median, and percentiles (5th, 10th, 25th, 50th, 75th, 90th, 95th). To identify variation among the periods after delivery, the mean SI and heart rate (HR) values observed for the following intervals were used in the analysis: 0–20 min, 21–40 min, 41–60 min, 61–90 min and 91–120 min. Results One hundred eighty-six women were included. The mean age ± SD was 24.9 ± 6.1 years and the mean gestational age at birth was 39.2 ± 1.8 weeks. At the puerperal period, the mean SI values ranged from 0.68 ± 0.14 to 0.74 ± 0.15. The percentile distribution ranged from 0.46 (5th percentile) to 1.05 (95th percentile). The mean HR values ranged from 80.8 ± 12.7 bpm to 92.3 ± 14.4 bpm. The percentile distribution ranged from 62.0 bpm (5th percentile) to 117 bpm (95th percentile). Conclusion Reference ranges were established for SI and HR values which showed small variations throughout the postpartum period.
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Affiliation(s)
- Anderson Borovac-Pinheiro
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
- * E-mail:
| | - Filipe Moraes Ribeiro
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
| | - Rodolfo Carvalho Pacagnella
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
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Silva CHD, Morais SS, Sarian LO, Derchain SF. Association of the Karnofsky Performance Scale with the quality of life of Brazilian Women Undergoing Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971102700213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carlos Henrique Debenedito Silva
- SFM Derchain (corresponding author) Department of Obstetrics and Gynecology, Faculty of Medicine, University of Campinas-UNICAMP, Rua Antônio Hossri, 629, Cidade Universitária, 13083–370, Campinas, São Paulo, Brazil
| | - Sirlei Siani Morais
- Scientific Division of Cancer Hospital IV, Brazilian National Cancer Institute-Ministry of Health, Rio de Janeiro, Brazil; SS Morais: Center for Integral Assistance to Women's Health, University of Campinas, Campinas, São Paulo, Brazil
| | - Luis O. Sarian
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Campinas, Campinas, São Paulo, Brazil
| | - Sophie F.M. Derchain
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Campinas, Campinas, São Paulo, Brazil
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Barbieri MM, Bennini JR, Nomura ML, Morais SS, Surita FG. Fetal growth standards in gastroschisis: Reference values for ultrasound measurements. Prenat Diagn 2018; 37:1327-1334. [PMID: 29110317 DOI: 10.1002/pd.5179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The objectives of this study were to create growth curves based on ultrasonography biometric parameters of fetuses with gastroschisis, comparing them with normal growth standards, and to analyze umbilical artery (UA) Doppler velocimetry patterns. METHODS A cohort study of 72 fetuses with gastroschisis, at gestational ages between 14 and 39 weeks was designed. Mean and standard deviation were calculated, with the 5th, 10th, 50th, 90th, and 95th centiles being established for biometric parameters according to gestational age. Curves were obtained, comparing with normal reference via the Mann-Whitney test. UA Doppler velocimetry patterns were obtained. RESULTS A total of 434 examinations were performed, and centiles were established for biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight. A significant difference was observed between the gastroschisis measurements when compared to control, with all curves shifted downwards. Abdominal circumference was the parameter presenting the largest difference. Estimated fetal weight was also lower, with mean difference of 256.3 ± 166.8 g for the 50th centile (P < .0001). UA Doppler velocimetry was normal in 97.5%. CONCLUSIONS Fetuses with gastroschisis show symmetrical growth deficits in the second and third trimesters, with normal UA Doppler velocimetry. These results reinforce the hypothesis that they are constitutionally smaller, yet not restricted because of placental insufficiency.
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Affiliation(s)
- Mariane Massaini Barbieri
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - João Renato Bennini
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Marcelo Luís Nomura
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), School of Medical Sciences, Campinas, São Paulo, Brazil
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de Rezende LF, Franco RL, de Rezende MF, Beletti PO, Morais SS, Gurgel MSC. Two Exercise Schemes in Postoperative Breast Cancer: Comparison of Effects on Shoulder Movement and Lymphatic Disturbance. Tumori 2018; 92:55-61. [PMID: 16683384 DOI: 10.1177/030089160609200109] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS AND BACKGROUND We attempted to determine the best method of performing the exercises in rehabilitation after breast cancer surgery and their influence on postoperative complications. Currently, there are no guidelines for these exercises. The scope of this study was to evaluate the effect of two schemes of physiotherapy exercises (directed or free) on shoulder function and lymphatic disturbance in postoperative rehabilitation. SUBJECTS Sixty women who underwent a modified radical mastectomy or quadrantectomy with axillary dissection were randomized into two groups. METHODS The physiotherapy technique used was kinesiotherapy. The directed group performed physiotherapy following a regimen of 19 exercises. The free group performed the exercises following the biomechanical physiological movements of the shoulder without a previously defined sequence or number of repetitions. RESULTS The averages of the flexion, abduction and external rotational movements of the shoulder showed better recovery with statistical significance in the directed group compared to the free group. There was no significant difference between the groups in lymphatic disturbance. CONCLUSION At the end of 42 days of follow-up, the movements of flexion, extension, abduction and external rotation of the shoulder were better rehabilitated in the directed group. The two schemes of exercises were not different with regard to lymphatic disturbance.
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Affiliation(s)
- Laura Ferreira de Rezende
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMPS), Campinas, SP, Brazil
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Morais SS, Nascimento SL, Godoy-Miranda AC, Kasawara KT, Surita FG. Body Mass Index Changes during Pregnancy and Perinatal Outcomes - A Cross-Sectional Study. Rev Bras Ginecol Obstet 2018; 40:11-19. [PMID: 29253913 PMCID: PMC10467363 DOI: 10.1055/s-0037-1608885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes. METHODS A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequate weight, overweight, and obese. The BMI was calculated at the first and at the last prenatal care visits, and these values were compared. RESULTS An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetal macrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83). CONCLUSION Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.
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Abstract
OBJECTIVE To generate a new body mass index curve of reference values and ranges for body mass index and weight gain during pregnancy and to compare the new curve and weight gain ranges with the currently used references. METHODS A prospective observational study was conducted with a total of 5,656 weight and body mass index measurements in 641 women with single pregnancy who attended their first prenatal visit before 12 weeks. All the women were over 18 years old and had no medical conditions that would influence body mass index. Data were collected using prenatal charts and medical records during hospitalization for childbirth. A linear regression method was used for standard curve smoothing in the general population and for specific curves according to the baseline body mass index classification. Curves were obtained for the 5th, 10th, 50th, 85th, 90th and 95th percentiles. Concordance between the classification of women using the newly generated and currently used curves was evaluated by percentages and kappa coefficients. The weight gain was compared with the reference values of the Institute of Medicine using Student's T test. The data were analyzed using SAS software version 9.2, and the significance level was set at 5%. RESULTS A general reference curve of percentiles of body mass index by gestational age was established. Additionally, four specific curves were generated according to the four baseline body mass index categories. The new general curve offered percentile limits for women according to their initial body mass index and according to the Centers for Disease Control and Prevention limits, showing poor agreement with the currently used curve (48.3%). Women who were overweight or obese when starting prenatal care had higher weight gain than the Institute of Medicine recommendation. CONCLUSIONS The new proposed curve for body mass index during pregnancy showed weak agreement with the currently used curve. The new curve provided more information regarding body mass index increase using percentiles for general and specific groups of body mass index. Overweight pregnant women showed an upward body mass index trend throughout pregnancy that increased more dramatically than those of other groups of pregnant women, and they also presented a major mean difference between weight gain and the Institute of Medicine recommendation.
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Affiliation(s)
- Sirlei Siani Morais
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
- *Corresponding author. E-mail:
| | - Mirena Ide
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
| | - Andrea Moreno Morgan
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
| | - Fernanda Garanhani Surita
- Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade de Campinas (UNICAMP), Campinas, SP, BR
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Nascimento SL, Surita FG, Godoy AC, Kasawara KT, Morais SS. Correction: Physical Activity Patterns and Factors Related to Exercise during Pregnancy: A Cross Sectional Study. PLoS One 2015; 10:e0133564. [PMID: 26176665 PMCID: PMC4503632 DOI: 10.1371/journal.pone.0133564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Nascimento SL, Surita FG, Godoy AC, Kasawara KT, Morais SS. Physical Activity Patterns and Factors Related to Exercise during Pregnancy: A Cross Sectional Study. PLoS One 2015; 10:e0128953. [PMID: 26083416 PMCID: PMC4470997 DOI: 10.1371/journal.pone.0128953] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/01/2015] [Indexed: 12/16/2022] Open
Abstract
Objective To assess the physical activity levels of pregnant women and to examine the characteristics associated with the practice of exercise and the activities of daily living during pregnancy. Methods For this cross-sectional study, 1,279 women were recruited within 72 hours postpartum. They were interviewed about their socio-demographic data and obstetric history and were administered self-report questionnaires about exercise and daily physical activities during pregnancy. Data on the current pregnancy, labor, delivery, and newborn outcomes were collected from participants’ medical records. To analyze factors related to the practice of exercise, we used the student t-test, X², and odds ratio (OR), with a corresponding 95% confident interval (CI), followed by a multiple logistic regression. The significance level was 5%. Results Compared to the pre-pregnancy period, the prevalence of physical activity among participants was lower throughout pregnancy (20.1%) (p = 0.01). Half of the women interrupted practicing physical exercise due to pregnancy. The lowest prevalence of exercise was observed in the first (13.6%) and third trimesters (13.4%). Less than half of women received exercise guidance during prenatal care meetings (47.4%). Walking was the most commonly reported exercise, followed by water aerobics. Factors positively associated with exercise practice were higher educational level (OR= 1.82; CI 95% 1.28–2.60), primiparity (OR=1.49; CI 95% 1.07–2.07), exercising before pregnancy (OR= 6.45; CI 95% 4.64–8.96), and exercise guidance during prenatal care (OR=2.54; CI 95% 1.80–3.57). Mildly intense exercise and domestic activities were most frequently reported among pregnant women. There were no differences in maternal and perinatal outcomes between active and sedentary pregnant women. Conclusion The findings indicate that promoting physical activity remains a priority in public health policy, and women of childbearing age, especially those planning a pregnancy, should be encouraged to adopt an exercise routine or maintain an active lifestyle during pregnancy in order to avoid sedentary- and obesity-associated risks.
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Affiliation(s)
- Simony Lira Nascimento
- Department of Obstetrics and Gynecology, Faculty Medical Sciences, University of Campinas (UNICAMP), Campinas—SP, Brazil
- Department of Physiotherapy, Federal University of Ceara, Fortaleza—CE, Brazil
| | - Fernanda Garanhani Surita
- Department of Obstetrics and Gynecology, Faculty Medical Sciences, University of Campinas (UNICAMP), Campinas—SP, Brazil
- * E-mail:
| | - Ana Carolina Godoy
- Department of Obstetrics and Gynecology, Faculty Medical Sciences, University of Campinas (UNICAMP), Campinas—SP, Brazil
| | - Karina Tamy Kasawara
- Department of Obstetrics and Gynecology, Faculty Medical Sciences, University of Campinas (UNICAMP), Campinas—SP, Brazil
| | - Sirlei Siani Morais
- Department of Obstetrics and Gynecology, Faculty Medical Sciences, University of Campinas (UNICAMP), Campinas—SP, Brazil
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Paulino DSDM, Surita FG, Peres GB, Nascimento SLD, Morais SS. Association between parity, pre-pregnancy body mass index and gestational weight gain. J Matern Fetal Neonatal Med 2015; 29:880-4. [DOI: 10.3109/14767058.2015.1021674] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Godoy CE, Antunes A, Morais SS, Pinto-Neto AM, Costa-Paiva L. Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women. Rev Bras Ginecol Obstet 2014; 35:243-8. [PMID: 23929196 DOI: 10.1590/s0100-72032013000600002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/14/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.
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Affiliation(s)
- Carlos Eduardo Godoy
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas-Unicamp-Campinas (SP), Brasil
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Rett MT, Giraldo PC, Gonçalves AKDS, Eleutério Junior J, Morais SS, DeSantana JM, Gomes do Amaral RL. Short-term physical therapy treatment for female urinary incontinence: a quality of life evaluation. Urol Int 2014; 93:80-3. [PMID: 24525394 DOI: 10.1159/000355703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/17/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urinary incontinence (UI) is a widespread health condition and in some situations conservative treatment has been recommended. The aim of this study was to compare women's quality of life (QoL) before and after short-term physical therapy treatment. METHODS We carried out a clinical trial involving 72 women who received an eight-session intervention based on pelvic floor electrical stimulation (PFES), pelvic floor muscle training (PFMT) and behavioral training. QoL was evaluated by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The Wilcoxon signed-rank test compared the ICIQ-SF scores; the relative changes were calculated by dividing the differences by the initial score, and McNemar's χ(2) compared the questions related to the type of, possible causes of or situations related to UI (p < 0.05). RESULTS There was a significant reduction in the frequency (p < 0.03), amount (p < 0.04) and impact (p < 0.001) of UI on QoL. The total score decreased from 14.6 ± 4.2 to 7.2 ± 4.5 (p < 0.001). All questions regarding the type of, possible causes of or situations related to UI had significantly decreased. Also, 15 women reported the 'never leaked urine' condition (p < 0.001) after treatment. CONCLUSION A short-term physical therapy treatment based on PFES, PFMT and behavioral modifications reduced the frequency, amount and impact of UI and therefore resulted in QoL improvement.
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Affiliation(s)
- Mariana Tirolli Rett
- PT, PhD, Department of Physical Therapy, Federal University of Sergipe (UFS), Aracaju, Brazil
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Herrmann V, Di Sessa RGDG, Ricceto CLZ, Morais SS, Castro EBD, Juliato CR. [Correlation of the International Consultation on Incontinence Questionaire: Urinary Incontinence/Short Form to Urodynamic diagnosis in women with urinary incontinence]. Rev Bras Ginecol Obstet 2014; 35:16-20. [PMID: 23338548 DOI: 10.1590/s0100-72032013000100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/12/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the correlation between the International Consultation on Incontinence Questionnaire - Urinary Incontinence/Short Form (ICIQ-UI/SF) and Urodynamic evaluation (UE) in women with urinary incontinence (UI). METHODS Clinical data, UE and ICIQ-UI/SF scores for 358 patients from private health service were analyzed retrospectively . The correlation between ICIQ-UI/SF and urodynamic parameters was determined by Spearman's test. A ROC curve with the sensitivity and specificity of the ICIQ-UI/SF scores was utilized to establish the value of the questionnaire that would predict an altered urodynamic parameter. The χ(2) test or Fisher's exact test was used to calculate the p-value. The level of significance was 5% and the software used was SAS 9.2. RESULTS Sixty-seven point three percent of the patients presented Stress UI (SUI) according to the UE (urodynamic SUI); those with SUI and Detrusor overactivity (DO) at UE represented 16.2% of the women (SUI+DO), and those with only DO at UE (DO) represented 7.3% of the women. Patients with normal UE represented 9.2% of the women. There was a significant association between ICIQ-UI/SF scores ≥14 and patients with urodynamic SUI, with or without DO. Patients with Valsava Leak Point Pressure (VLPP)≤90 cmH2O presented ICIQ-UI/SF≥15. Spearman's test showed a weak inverse correlation between ICIQ-UI/SF score and VLPP, although it did not show any correlation with maximum cystometric capacity or with bladder volume on first desire to void. CONCLUSION There was an association between ICIQ-UI/SF score and patients with SUI, with or without DO, but no association between the score and patients with DO alone. The lower the VLPP value, the higher the ICIQ-UI/SF score. The ICIQ-UI/SF was not able to distinguish the different types of UI in the studied population.
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Affiliation(s)
- Viviane Herrmann
- Departamento de Tocoginecologia, Centro de Assistência Integral à Saúde da Mulher, Universidade Estadual de Campinas, SP, Brasil
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Alvarenga CA, dos Santos CC, Alvarenga M, Paravidino PI, Morais SS, Brenelli HB, de Carvalho FM. Localization of metastasis within the sentinel lymph node biopsies: a predictor of additional axillary spread of breast cancer? Rev Bras Ginecol Obstet 2014; 35:483-99. [PMID: 24419528 DOI: 10.1590/s0100-72032013001100002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 10/23/2013] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To explore the relationship between morphological characteristics and histologic localization of metastasis within sentinel lymph nodes (SLN) and axillary spread in women with breast cancer. METHODS We selected 119 patients with positive SLN submitted to complete axillary lymph node dissection from July 2002 to March 2007. We retrieved the age of patients and the primary tumor size. In the primary tumor, we evaluated histologic and nuclear grade, and peritumoral vascular invasion (PVI). In SLNs we evaluated the size of metastasis, their localization in the lymph node, number of foci, number of involved lymph nodes, and extranodal extension. RESULTS Fifty-one (42.8%) patients had confirmed additional metastasis in non-sentinel lymph nodes (NLSN). High histologic grade, PVI, intraparenchymatous metastasis, extranodal neoplastic extension and size of metastasis were associated with positive NLSN. SLN metastasis affecting the capsule were associated to low risk incidence of additional metastasis. After multivariate analysis, PVI and metastasis size in the SLN remained as the most important risk factors for additional metastasis. CONCLUSIONS The risk of additional involvement of NSLN is higher in patients with PVI and it increases progressively according the histologic localization in the lymph node, from capsule, where the afferent lymphatic channel arrives, to the opposite side of capsule promoting the extranodal extension. Size of metastasis greater than 6.0 mm presents higher risk of additional lymph node metastasis.
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de Oliveira MMF, de Rezende LF, do Amaral MTP, Pinto e Silva MP, Morais SS, Gurgel MSC. Manual lymphatic drainage versus exercise in the early postoperative period for breast cancer. Physiother Theory Pract 2014; 30:384-9. [PMID: 24410411 DOI: 10.3109/09593985.2013.876695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the effect of active exercise and manual lymphatic drainage (MLD) on postoperative wound healing complications, shoulder range of motion (ROM) and upper limb (UL) perimetry in women undergoing radical mastectomy for breast cancer. METHODS Controlled non-randomized clinical trial with 89 women undergoing breast cancer surgery with axillary lymph node dissection (Brazilian Registry of Clinical Trials: 906). Women were matched for staging, age and body mass index, with 46 women allocated to the exercise group and 43 in the MLD group, receiving 2 weekly sessions during one month. Assessments were performed in the preoperative and 60 d after surgery, including inspection, palpation, goniometry and perimetry. RESULTS No significant difference existed between groups relative to individual and clinical surgical characteristics. The incidence of seroma, number of punctures performed, dehiscence and infection was similar in both groups. A comparison of shoulder ROM and UL perimetry between groups, obtained in the preoperative and postoperative period, did not show any significant difference. CONCLUSION The performance of active exercise or MLD did not demonstrate difference in wound healing complications, shoulder ROM and UL perimetry at 60 d after surgery, suggesting that these techniques may be employed, according to the complaints or symptoms of each woman and physical therapist experience.
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Affiliation(s)
- Mariana Maia Freire de Oliveira
- Physical Therapy Section-Prof. Dr. José Arostodemo Pinotti Women's Hospital-Integral Healthcare Center (CAISM), Universidade Estadual de Campinas (Unicamp) , Campinas , Brazil
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Hartman CA, Juliato CRT, Sarian LO, Toledo MC, Jales RM, Morais SS, Pitta DD, Marussi EF, Derchain S. Ultrasound criteria and CA 125 as predictive variables of ovarian cancer in women with adnexal tumors. Ultrasound Obstet Gynecol 2012; 40:360-366. [PMID: 22648861 DOI: 10.1002/uog.11201] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate the capacity to predict malignancy in women with adnexal tumors using CA 125 measurement and ultrasound criteria. METHODS This was a cross-sectional study including 103 women with a total of 110 adnexal tumors. CA 125 level was measured in a sample of peripheral blood. Lesions were classified by ultrasound, using standardized predetermined criteria, as benign (B) or malignant (M). Those that could not be classified by these criteria were assessed subjectively. Histopathologic examination of surgical specimens was used as the gold standard. RESULTS Of 110 tumors, 79 (71.8%) were benign and 31 (28.2%) were malignant on histopathology. Ultrasound criteria could be applied to 91 (82.7%) tumors, resulting in a sensitivity of 90%, specificity of 87%, positive predictive value (PPV) of 69% and negative predictive value (NPV) of 97%. In tumors not classifiable according to ultrasound criteria, subjective sonographic assessment gave a sensitivity of 67%, specificity of 80%, PPV of 75% and NPV of 73%. At a cut-off point of 37.4 U/mL, CA 125 had a sensitivity of 69%, a specificity of 87.8%, a PPV of 69% and a NPV of 88% for detection of malignancy. When CA 125 was associated with age and ultrasound criteria in a logistic regression model, the sensitivity and specificity increased in the subset of sonographically malignant tumors. CONCLUSION The majority of tumors were correctly classified using ultrasound criteria. CA 125 alone performed worse than did ultrasound in discriminating malignant from benign adnexal tumors. CA 125 measurement contributed to the diagnosis of malignancy, improving overall specificity, only in sonographically malignant tumors.
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Affiliation(s)
- C A Hartman
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas-UNICAMP, Campinas, Brazil
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Cunha-Henriques S, Costa-Paiva L, Pinto-Neto AM, Fonsechi-Carvesan G, Nanni L, Morais SS. Postmenopausal women with osteoporosis and musculoskeletal status: a comparative cross-sectional study. J Clin Med Res 2012; 3:168-76. [PMID: 22121400 PMCID: PMC3194012 DOI: 10.4021/jocmr537w] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2011] [Indexed: 11/25/2022] Open
Abstract
Background With increased life expectancy of the world's population that has taken place in recent decades, there has been growth in the incidence of illnesses of the most advanced ages, including osteoporosis. However, changes in musculoskeletal disorders are not yet so clear. This study proposes to evaluate musculoskeletal alterations in osteoporotic postmenopausal women and healthy and correlate with bone mineral density of the lumbar spine. Methods Randomized, examiner-blinded, comparative cross-sectional study was designed with two groups of women attending the Menopause Clinic in the UNICAMP, 30 women with osteoporosis, while 33 women without osteoporosis comprised the second group. Diagnosis of the presence or absence of osteoporosis was based on bone densitometry performed on the lumbar spine. Volunteers were interviewed and underwent a physical examination with the same examiner, including the muscle strength and amplitude of movement of back flexion and extension, angles of thoracic kyphosis and lumbar lordosis, as well as static and dynamic balance. Results Mean back flexors and extensors strength was significantly lower in women with osteoporosis (P < 0.01). Flexion spinal range of motion was similar in both groups (P = 0.91). However, movement amplitude of spine extension was 20.5o in women with osteoporosis and 28.4o in women without osteoporosis. Thoracic kyphosis angles from T1 to T4 (P < 0.01) and lumbar lordosis angles (P = 0.02) were greater in women with osteoporosis. Seventy-three point three percent of women with osteoporosis and 78.8% of women without osteoporosis had good reply to static balance. Women in both groups had poor results to dynamic balance. No significant differences were observed in static or dynamic balance between women with and without osteoporosis. Vertebral fractures were present in 20% of women with osteoporosis and absent in women without osteoporosis. Conclusions Women with osteoporosis in the study population had poorer musculoskeletal status than women without osteoporosis. Further studies are necessary to evaluate whether correction of these alterations would be related to preventing falls and reducing fracture risk. Keywords Balance; Kyphosis; Mobility; Muscle strength; Osteoporosis; Postmenopausal
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Affiliation(s)
- Sylvia Cunha-Henriques
- Department of Obstetrics and Gynecology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Brazil
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Machado VDSS, Valadares ALR, Costa-Paiva L, Morais SS, Pinto-Neto AM. [Morbidity and associated factors in climacteric women: a population based study in women with 11 or more years of formal education]. Rev Bras Ginecol Obstet 2012; 34:215-20. [PMID: 22584856 DOI: 10.1590/s0100-72032012000500005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/02/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate factors associated with morbidities among Brazilian women aged 40-65 years and with 11 or more years of schooling. METHODS A secondary analysis of a cross-sectional population-based study was conducted, using an anonymous self-report questionnaire completed by 377 women. Were evaluated, with this instrument, some morbidities (hypertension, diabetes, insomnia and depression) and sociodemographic, behavioral, clinical and reproductive factors. The association between morbidities and independent variables was evaluated by the χ² test. Multiple logistic regression analysis with stepwise selection criteria was used to select the major factors associated with morbid conditions. RESULTS In the multiple regression analysis, insomnia was associated with bad/fair self-perception of health (OR=2.3) and nervousness (OR=5.1). Depression was associated with bad/fair self-perception of health (OR=3.7) and bad/poor leisure (OR=2.8). Hypertension was associated with obesity (OR=3.1) and being in postmenopausal (OR=2.6). Diabetes was associated with age above 50 years (OR=3.9) and obesity (OR=12.5). CONCLUSIONS The prevalence of morbidities was high and a worse self-perception of health and obesity were the main factors associated with morbidity.
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Affiliation(s)
- Vanessa de Souza Santos Machado
- Programa de pós-graduação do Departamento de Tocoginecologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil
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Valadares ALR, Carvalho EDD, Costa-Paiva LHD, Morais SS, Pinto-Neto AM. Association between different types of physical activities and quality of life in women aged 60 years or over. Rev Assoc Med Bras (1992) 2012; 57:450-5. [PMID: 21876929 DOI: 10.1590/s0104-42302011000400021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 05/18/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the association between different types of physical activity and quality of life in a sample of women aged 60 or over. SUBJECTS AND METHODS A cross-sectional study was carried out, interviewing 271 women. Of these, 141 were recruited in a menopause outpatient clinic and 130 were recruited in a social leisure center, in Brazil. The instruments used were the International Physical Activity Questionnaire (IPAQ) version 8 and the World Health Organization Quality of Life Questionnaire specific for this age group (WHOQOL-OLD). Each IPAQ section was evaluated by multiple linear regression analysis, considering independent and confounding variables. The significance level was set at 5% and the software used was SAS version 9.1.3. RESULTS The mean age of the patients was 67.4 ± 5.3 years. The mean time devoted to physical activity was 2802.7 ± 1154.9 minutes per week. The total WHOQOL-OLD score was 66.9 ± 11.7. The past, present and future actvities (estimated β = 0.021) and, social participation (estimated β = 0.03) domains had association with IPAQ transportation section. The leisure-time domain of the IPAQ had an inverse and significant relationship with the quality of life score related to present, past and future activities (estimated β = -0.0269). CONCLUSION Quality of life was negatively influenced by leisure, but time spent in this physical activity was the shortest in comparison to other types of physical activities. In this sample, only physical activity for transportation was positively associated with a better quality of life.
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Guerra GV, Cecatti JG, Souza JP, Faúndes A, Morais SS, Gülmezoglu AM, Passini R, Parpinelli MA, Carroli G. Elective induction versus spontaneous labour in Latin America. Bull World Health Organ 2011; 89:657-65. [PMID: 21897486 DOI: 10.2471/blt.08.061226] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 03/30/2011] [Accepted: 06/09/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the frequency of elective induction of labour and its determinants in selected Latin America countries; quantify success in attaining vaginal delivery, and compare rates of caesarean and adverse maternal and perinatal outcomes after elective induction versus spontaneous labour in low-risk pregnancies. METHODS Of 37,444 deliveries in women with low-risk pregnancies, 1847 (4.9%) were electively induced. The factors associated with adverse maternal and perinatal outcomes among cases of spontaneous and induced onset of labour were compared. Odds ratios for factors potentially associated with adverse outcomes were calculated, as were the relative risks of having an adverse maternal or perinatal outcome (both with their 95% confidence intervals). Adjustment using multiple logistic regression models followed these analyses. FINDINGS Of 11,077 cases of induced labour, 1847 (16.7%) were elective. Elective inductions occurred in 4.9% of women with low-risk pregnancies (37,444). Oxytocin was the most common method used (83% of cases), either alone or combined with another. Of induced deliveries, 88.2% were vaginal. The most common maternal adverse events were: (i) a higher postpartum need for uterotonic drugs, (ii) a nearly threefold risk of admission to the intensive care unit; (iii) a fivefold risk of postpartum hysterectomy, and (iv) an increased need for anaesthesia/analgesia. Perinatal outcomes were satisfactory except for a 22% higher risk of delayed breastfeeding (i.e. initiation between 1 hour and 7 days postpartum). CONCLUSION Caution is mandatory when indicating elective labour induction because the increased risk of maternal and perinatal adverse outcomes is not outweighed by clear benefits.
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Affiliation(s)
- Gláucia Virgínia Guerra
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, SP, Brazil
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de Oliveira RR, Morais SS, Sarian LO. [Immediate breast reconstruction effects on quality of life of women with mastectomy]. Rev Bras Ginecol Obstet 2011; 32:602-8. [PMID: 21484029 DOI: 10.1590/s0100-72032010001200007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 12/15/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE to prospectively evaluate the effects of immediate breast reconstruction on the quality of life of women who underwent mastectomy. METHODS 76 women that underwent mastectomy at Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas, in Campinas, São Paulo, Brazil, from August 2007 to December 2008, were included. Two groups were formed: 41 women who underwent mastectomy combined with immediate breast reconstruction (M+RI) and 35 that were subjected to mastectomy alone (M). The quality of life evaluation was assessed with the World Health Organization's questionnaire - Quality of Life (WHOQOL-100). The questionnaire was administered on three occasions: at the time of admission, one month after surgery, and again six months after surgery. The WHOQOL-100 scores were calculated according to analysis' guidelines by the World Health Organization. For comparison of the scores between groups, it was used the Student's t-test, Fisher exact test, chi-square test, and Mann-Whitney test. For the analysis of repeated measures over time, ANOVA and ANOVA for repeated measures were used. RESULTS at all time points evaluated, beginning with the preoperative assessment, the average quality of life scores of the M+IR Group were higher than those of the M Group, primarily in the "physical", "psychological", "level of independence" and "social relationships" domains of the questionnaire. Of the six areas covered by the questionnaire, three ("physical", "social relations", "environment") showed no significant differences between groups. The M+IR Group had a better score (15.5 to 14.9 for the M+IR and 14.3 to 14.2 for M; p=0.04) in the psychological domain. There was a significant reduction in the level of independence in the first month after surgery in both groups, with a significant recovery after six months. CONCLUSIONS the present results suggest that immediate breast reconstruction is significantly beneficial regarding the psychological aspects of quality of life, without affecting the patient's physical functionality.
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Affiliation(s)
- Riza Rute de Oliveira
- Departamento de Tocoginecologia, Universidade Estadual de Campinas, Campinas, SP, Brasil
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Vaz AF, Conde DM, Costa-Paiva L, Morais SS, Esteves SB, Pinto-Neto AM. Quality of life and adverse events after radiotherapy in gynecologic cancer survivors: a cohort study. Arch Gynecol Obstet 2011; 284:1523-31. [PMID: 21442259 DOI: 10.1007/s00404-011-1886-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/10/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate quality of life (QOL) in gynecologic cancer survivors after radiotherapy (RT), investigate the frequency of adverse events and demonstrate an association between these symptoms and QOL. METHODS A prospective cohort study of 95 women aged 21-75 years undergoing RT for gynecologic cancer was carried out. QOL was assessed by the WHOQOL-BREF before, at 4 months, 1 year and 3 years after RT and adverse events were evaluated following RT by the (CTCAE) v 3.0 scale. QOL scores were assessed by the Wilcoxon signed rank test over time. Multiple linear regression analysis was used to identify predictors of QOL. RESULTS The most frequent adverse events were pain (64.2%) and dyspareunia (45.9%). A significant increase in QOL scores was observed in the psychological domain, general health and overall QOL. Pain was negatively associated with the physical, psychological and social relationship domains (p < 0.01); dyspareunia with the physical and social relationship (p < 0.01); decreased sexual interest with the psychological (p < 0.01). Higher family income was positively associated with the psychological domain and general health (p < 0.01). CONCLUSIONS Results suggested that QOL improved after RT in women with gynecologic cancer. Adverse events, such as pain, dyspareunia and decreased sexual interest had a negative impact on QOL.
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Affiliation(s)
- Ana Francisca Vaz
- Department of Gynecology and Obstetrics, Universidade Estadual de Campinas. Rua Alexander Fleeming, 101, Cidade Universitária ''Zeferino Vaz'', Campinas, SP 13083-970, Brazil
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Morais SS, Molozzi J, Viana AL, Viana TH, Callisto M. Diversity of larvae of littoral Chironomidae (Diptera: Insecta) and their role as bioindicators in urban reservoirs of different trophic levels. BRAZ J BIOL 2010; 70:995-1004. [PMID: 21180904 DOI: 10.1590/s1519-69842010000500011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 11/30/2009] [Indexed: 11/22/2022] Open
Abstract
The Chironomidae (Diptera: Insecta) have a high species richness, with species adapted to live under widely different environmental conditions. The study of the taxonomic composition of chironomid larvae and the percentage of occurrence of deformities in mouthparts, mainly in the mentum, are used in biomonitoring programmes in order to obtain information on the levels of organic and chemical pollution of aquatic ecosystems. The objective of this study was to evaluate the abundance of chironomid larvae and to quantify the occurrence of mentum deformities in the specimens collected in three urban reservoirs with different trophic levels. The reservoirs are located in the hydrographic basin of the Paraopeba River, an affluent of the São Francisco River basin (Minas Gerais State, southeastern Brazil). The Serra Azul Reservoir is oligotrophic, the Vargem das Flores Reservoir is mesotrophic, and the Ibirité Reservoir is eutrophic. Along the littoral zone of each reservoir, 30 samples were collected during each sampling campaign. Sampling was carried out every three months for one year, with two sampling campaigns during the wet season and two during the dry season in 2008. Physical and chemical parameters measured in the water column included the water depth, Secchi depth, air and water temperature, electrical conductivity, total dissolved solids, redox potential, dissolved oxygen, pH, turbidity, Total-N, Total-P, P-ortho, and chlorophyll-a. The chironomid larvae were identified to the genus level. The structure of the chironomid assemblages was evaluated based on taxonomic richness (24 genera), density, equitability, and diversity. The potential indicator taxa for each reservoir were established through an Indicator Species Analysis. The values for taxonomic richness (20 taxa), equitability (0.737), and Shannon-Wiener diversity (2.215) were highest in the Serra Azul Reservoir. Fissimentum was the indicator taxon in Serra Azul, the oligotrophic reservoir; whereas Pelomus was the indicator taxon in Vargem das Flores, and Chironomus in Ibirité. The highest percentage of mentum deformities was found during the dry season in Serra Azul (6.9%), while the lowest percentage was found during the wet season in Vargem das Flores (0.8%). The results of this study evidenced significant differences in the taxonomic composition, richness, equitability, and diversity of the chironomid assemblages in these three reservoirs of different trophic levels.
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Affiliation(s)
- S S Morais
- Departamento de Biologia Geral, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Braga AA, D'Ottaviano LH, Braga FS, Morais SS. Extração de terceiros molares retidos sob anestesia local. Avaliação de ansiedade, dor, alterações hemodinâmicas e respiratórias. R Fac Odontol Porto Alegre 2010. [DOI: 10.22456/2177-0018.20097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Trata-se de estudo corte transversal, descritivo com componente analítico, com o objetivo de avaliar a ansiedade dos pacientes no período que precede o procedimento, as alterações hemodinâmicas, respiratórias e dor no intra-operatório em pacientes submetidos à extração de terceiros molares retidos sob anestesia local. Foram incluídos no estudo 42 sujeitos do sexo masculino, hígidos, com idade compreendida entre 18 e 34 anos. A anestesia foi feita com cloridrato de lidocaína a 2% com adrenalina 1:50.000, na dose que variou de 72 a 144mg. Com auxilio de monitor multiparamétrico não-invasivo avaliaram-se os parâmetros: pressão arterial média, freqüência cardíaca, saturação periférica de O2 e frequência respiratória; o grau de ansiedade (escala de ansiedade para cirurgia odontológica) e dor (escala analógica visual). A análise estatística foi realizada por meio dos testes t de Student e Wilcoxon pareado. O nível de significância foi fixado em 5%. O tempo médio máximo de cirurgia foi 60 minutos, período considerado para análise dos resultados. Neste estudo, vinte pacientes apresentavam algum grau de ansiedade. Dor intensa foi referida por sete pacientes nos momentos da osteotomia, odontosecção e luxação que necessitaram de complementação com anestésico local. A análise individual dos parâmetros hemodinâmicos e respiratórios mostrou alterações consideradas clinicamente significativas. Os resultados deste estudo permitem concluir que alterações hemodinâmicas e respiratórias podem ocorrer durante extrações de terceiros molares retidos, especialmente em pacientes ansiosos e com dor. A monitorização é importante na detecção e conseqüentemente prevenção dessas intercorrências, sendo particularmente útil em pacientes em que essas repercussões devam ser evitadas.
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Vale DBAPD, Morais SS, Pimenta AL, Zeferino LC. [Assessment of the cervical cancer screening in the Family Health Strategy in Amparo, São Paulo State, Brazil]. CAD SAUDE PUBLICA 2010; 26:383-90. [PMID: 20396853 DOI: 10.1590/s0102-311x2010000200017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Accepted: 11/14/2009] [Indexed: 11/22/2022] Open
Abstract
Uterine cervical cancer mortality has not been declining. The territorial distribution and registration of families in Brazil's Family Health Strategy help identify women that have performed a Pap smear or that have not had one for more than three years. This study analyzed whether cervical cancer screening in Amparo, São Paulo State, Brazil, made progress in complying with the prevailing guidelines during the seven years of experience with the Strategy. The annual examination rate remained high, with a slight trend towards greater intervals between follow-up tests. Distribution of tests tended to increase in the 40-59-year age bracket and decrease in the over-60 age group, while annual coverage tended to decrease. The proportions of excess tests varied from 61.2% to 65.5%. Concluding, the upgrading of cervical cancer screening was slight, and did not change the opportunistic pattern of follow-up tests. Considering that community health agents can act to increase the coverage of these measures, it is essential to train them for this work.
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Carvalho EDD, Valadares ALR, Costa-Paiva LHD, Pedro AO, Morais SS, Pinto-Neto AM. Atividade física e qualidade de vida em mulheres com 60 anos ou mais: fatores associados. Rev Bras Ginecol Obstet 2010; 32:433-40. [DOI: 10.1590/s0100-72032010000900004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 08/25/2010] [Indexed: 11/22/2022] Open
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Cúneo F, Costa-Paiva L, Pinto-Neto AM, Morais SS, Amaya-Farfan J. Effect of dietary supplementation with collagen hydrolysates on bone metabolism of postmenopausal women with low mineral density. Maturitas 2010; 65:253-7. [DOI: 10.1016/j.maturitas.2009.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 10/01/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
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Pantoja M, Medeiros T, Baccarin MC, Morais SS, Bahamondes L, dos Santos Fernandes AM. Variations in body mass index of users of depot-medroxyprogesterone acetate as a contraceptive. Contraception 2010; 81:107-11. [DOI: 10.1016/j.contraception.2009.07.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 07/14/2009] [Accepted: 07/20/2009] [Indexed: 11/16/2022]
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Guerra GV, Cecatti JG, Souza JP, Faúndes A, Morais SS, Gülmezoglu AM, Parpinelli MA, Passini R, Carroli G. Factors and outcomes associated with the induction of labour in Latin America. BJOG 2010; 116:1762-72. [PMID: 19906020 DOI: 10.1111/j.1471-0528.2009.02348.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the prevalence of labour induction, together with its risk factors and outcomes in Latin America. DESIGN Analysis of the 2005 WHO global survey database. SETTING Eight selected Latin American countries. POPULATION All women who gave birth during the study period in 120 participating institutions. METHODS Bivariate and multivariate analyses. MAIN OUTCOME MEASURES Indications for labour induction per country, success rate per method, risk factors for induction, and maternal and perinatal outcomes. RESULTS Of the 97,095 deliveries included in the survey, 11,077 (11.4%) were induced, with 74.2% occurring in public institutions, 20.9% in social security hospitals and 4.9% in private institutions. Induction rates ranged from 5.1% in Peru to 20.1% in Cuba. The main indications were premature rupture of membranes (25.3%) and elective induction (28.9%). The success rate of vaginal delivery was very similar for oxytocin (69.9%) and misoprostol (74.8%), with an overall success rate of 70.4%. Induced labour was more common in women over 35 years of age. Maternal complications included higher rates of perineal laceration, need for uterotonic agents, hysterectomy, ICU admission, hospital stay>7 days and increased need for anaesthetic/analgesic procedures. Some adverse perinatal outcomes were also higher: low 5-minute Apgar score, very low birthweight, admission to neonatal ICU and delayed initiation of breastfeeding. CONCLUSIONS In Latin America, labour was induced in slightly more than 10% of deliveries; success rates were high irrespective of the method used. Induced labour is, however, associated with poorer maternal and perinatal outcomes than spontaneous labour.
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Affiliation(s)
- G V Guerra
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
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Abstract
OBJECTIVES: to evaluate the vertical position adopted by nulliparous women during labor in terms of pain and satisfaction with the position. METHODS: the study was based on a secondary efficacy analysis of data from 107 nulliparous women enrolled in a randomized controlled trial in which the vertical position adopted during the dilation phase of labor was evaluated. The analysis involved comparing the median percentages of the duration for which women remained in the vertical position for each of the variables studied . The Kruskal-Wallis and Mann-Whitney tests were used to determine the difference s betwee n th e groups. Statistical significance was set at p<0.05. RESULTS: at 4cm of dilation , the women with a pain score < 5 remained longer in the vertical position during labor compared to those with a score > 7 (p=0.02) . At 4 and 6 cm of dilation , the women who reported greater satisfaction remained more than 50 % of the time in the vertical position (p=0.0 2 an d p=0.03 , respectively). CONCLUSIONS: the vertical position helped relieve labor pain and increased comfort and patient satisfaction.
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Silva RB, Costa-Paiva L, Oshima MM, Morais SS, Pinto-Neto AM. Frequência de quedas e associação com parâmetros estabilométricos de equilíbrio em mulheres na pós-menopausa com e sem osteoporose. Rev Bras Ginecol Obstet 2009; 31:496-502. [DOI: 10.1590/s0100-72032009001000005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 09/21/2009] [Indexed: 11/22/2022] Open
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Scarpa KP, Herrmann V, Palma PCR, Riccetto CLZ, Morais SS. [Irritative bladder symptoms after vaginal delivery or c-section]. Rev Assoc Med Bras (1992) 2009; 55:416-20. [PMID: 19750308 DOI: 10.1590/s0104-42302009000400016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 02/16/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study intended to investigate the frequency of irritative bladder symptoms three years after delivery in women previously interviewed in the third trimester of pregnancy and its correlation to mode of delivery, parity, maternal age, birth weight, episiotomy and forceps. METHODS From 340 women previously evaluated at the third trimester of pregnancy, 120 were interviewed three years after delivery, between June and October 2006. Correlation of postpartum irritative bladder symptoms and mode of delivery (exclusively vaginal or c-section), parity, maternal age, birth weight, episiotomy and forceps was analyzed. Associations between irritative bladder symptoms and obstetric parameters were assessed by the Fisher's exact test and Chi-square (p< 0.05). RESULTS The study group consisted of 37.5% primiparous and 62.5% multiparous women. Mode of delivery was exclusively vaginal in 53 women and exclusively c-section in 42. No statistical difference was found between irritative bladder symptoms and mode of delivery and parity. No statistical difference was found between irritative symptoms and maternal age (> 35), birth weight (>or= 4000 g), episiotomy and forceps. CONCLUSION After childbirth, dysfunction of the lower urinary tract, characterized by irritative bladder symptoms, was not associated with mode of delivery, parity, maternal age, birth weight, episiotomy and forceps.
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Affiliation(s)
- Kátia Pary Scarpa
- Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Souza JP, Cecatti JG, Faundes A, Morais SS, Villar J, Carroli G, Gulmezoglu M, Wojdyla D, Zavaleta N, Donner A, Velazco A, Bataglia V, Valladares E, Kublickas M, Acosta A. Maternal near miss and maternal death in the World Health Organization's 2005 global survey on maternal and perinatal health. Bull World Health Organ 2009; 88:113-9. [PMID: 20428368 DOI: 10.2471/blt.08.057828] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 01/15/2009] [Accepted: 06/07/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To develop an indicator of maternal near miss as a proxy for maternal death and to study its association with maternal factors and perinatal outcomes. METHODS In a multicenter cross-sectional study, we collected maternal and perinatal data from the hospital records of a sample of women admitted for delivery over a period of two to three months in 120 hospitals located in eight Latin American countries. We followed a stratified multistage cluster random design. We assessed the intra-hospital occurrence of severe maternal morbidity and the latter's association with maternal characteristics and perinatal outcomes. FINDINGS Of the 97,095 women studied, 2964 (34 per 1000) were at higher risk of dying in association with one or more of the following: being admitted to the intensive care unit (ICU), undergoing a hysterectomy, receiving a blood transfusion, suffering a cardiac or renal complication, or having eclampsia. Being older than 35 years, not having a partner, being a primipara or para > 3, and having had a Caesarean section in the previous pregnancy were factors independently associated with the occurrence of severe maternal morbidity. They were also positively associated with an increased occurrence of low and very low birth weight, stillbirth, early neonatal death, admission to the neonatal ICU, a prolonged maternal postpartum hospital stay and Caesarean section. CONCLUSION Women who survive the serious conditions described could be pragmatically considered cases of maternal near miss. Interventions to reduce maternal and perinatal mortality should target women in these high-risk categories.
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Affiliation(s)
- João Paulo Souza
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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da Silva RB, Costa-Paiva L, Pinto-Neto AM, Braga ADA, Morais SS. Association between habitual physical activity and parameters of physical fitness in postmenopausal women. Climacteric 2009; 8:360-70. [PMID: 16390771 DOI: 10.1080/13697130500345380] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the association between physical activity and the morphological, functional and physiological components of physical fitness in postmenopausal women. METHODS A cross-sectional study of 162 postmenopausal women, 40-65 years of age, who verbally responded to the International Physical Activity Questionnaire applied to evaluate their level of physical activity. Physical fitness was evaluated by measuring body mass index, waist circumference, body fat percentage, maximum oxygen consumption, plasma levels of total and fractional cholesterol, triglycerides and fasting glucose, as well as blood pressure. RESULTS Approximately 83.5% of the women were active, principal physical activities being household chores and transportation walking. Approximately 80% of the women were overweight or obese and presented a waist circumference indicative of high or very high risk for cardiovascular disease, and fat percentage above 33%. Over 50% were found to have low oxygen consumption. There were no significant differences between the groups of active and inactive women with respect to mean body mass index (p = 0.43), percentage of body fat (p = 0.60), hip-to-waist ratio (p = 0.93), waist circumference (p = 0.44), maximum VO2 (p = 0.32), total cholesterol (p = 0.43), fasting glucose (p = 0.73), and systolic (p = 0.79) or diastolic blood pressure (p = 0.48). Adjusted prevalence ratios also showed no significant differences between the groups. CONCLUSIONS Habitual physical activity is not associated with variations in the components that are used to describe physical fitness. It is important to encourage physical activity and provide guidelines to ensure that it is carried out in the quantity, duration and intensity required for improving physical fitness level and obtaining health benefits.
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Affiliation(s)
- R B da Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Universidade Estadual de Campinas, São Paulo, Brazil
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Huguet PR, Morais SS, Osis MJD, Pinto-Neto AM, Gurgel MSC. Qualidade de vida e sexualidade de mulheres tratadas de câncer de mama. Rev Bras Ginecol Obstet 2009; 31:61-7. [DOI: 10.1590/s0100-72032009000200003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 01/16/2009] [Indexed: 11/22/2022] Open
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Pinto e Silva MP, Sarian LO, Morais SS, Pace do Amaral MT, Freire de Oliveira MM, Derchain S. Implications of a Postoperative Rehabilitation Program on Quality of Life in Women with Primary Breast Cancer Treated with Sentinel Lymph Node Biopsy or Complete Axillary Lymph Node Dissection. Ann Surg Oncol 2008; 15:3342-9. [DOI: 10.1245/s10434-008-0161-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 08/23/2008] [Accepted: 08/23/2008] [Indexed: 11/18/2022]
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Carvacho IE, Mello MBD, Morais SS, Silva JLPE. Fatores associados ao acesso anterior à gestação a serviços de saúde por adolescentes gestantes. Rev Saude Publica 2008; 42:886-94. [DOI: 10.1590/s0034-89102008000500014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 04/28/2008] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Analisar os fatores determinantes do acesso de adolescentes gestantes a serviços de atenção primária à saúde, anterior à ocorrência da gestação. MÉTODOS: Estudo transversal baseado em referencial teórico. O acesso a serviços foi analisado em cinco dimensões: geográfico, econômico, administrativo, psicossocial e de informação. Participaram 200 adolescentes primigestas (10 a 19 anos) atendidas em uma unidade básica de saúde do município de Indaiatuba (SP), em 2003. Um questionário com perguntas abertas e fechadas referentes ao acesso ao último serviço de saúde utilizado, anterior à gestação, foi aplicado às participantes no momento de sua primeira consulta de pré-natal. Os dados foram analisados por meio do teste de qui-quadrado de Pearson ou exato de Fisher e por regressão logística múltipla, considerando as cinco dimensões de acesso. RESULTADOS: Mais da metade (63,7%) das adolescentes utilizou algum serviço de saúde para consulta ginecológica. Entre as que nunca consultaram um ginecologista, as justificativas dadas foram falta de informação (43,8%) ou sentimento de medo ou vergonha (37,0%). A principal dificuldade de acesso ao serviço esteve relacionada a barreiras psicossociais, identificadas por 77,0% das adolescentes. CONCLUSÕES: Entre as barreiras de acesso ao serviço de saúde, foram significativas apenas as psicossociais. São necessárias novas estratégias para facilitar o acesso ao serviço de saúde às adolescentes, incluindo ações que diminuam as barreiras de gênero e que se considerem suas características sociodemográficas e o vínculo com seus parceiros.
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Borges JBR, Morais SS, Borges TG, Guarisi R, Maia EMC, Paganotti JC, Barros FS. Perfil das Mulheres no Município de Jundiaí quanto ao Hábito do Auto-Exame das Mamas. Rev Bras Cancerol 2008. [DOI: 10.32635/2176-9745.rbc.2008v54n2.1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objetivo: Estabelecer o perfil das mulheres que freqüentam a saúde pública de Jundiaí, segundo o hábito do autoexame das mamas, e determinar fatores associados. Métodos: Estudo descritivo, exploratório, de corte transversal, aplicado às mulheres, que utilizaram a saúde pública de Jundiaí. Utilizou-se questionário pré-testado. Análise multivariada realizada através de regressão logística com seleção de variáveis stepwise controladas pelo fator escolaridade. Resultados: Com relação ao auto-exame, em um total de 332 mulheres brasileiras com idade superior a 16 anos, 131 (39,82%) o faziam todos os meses e 198 (60,18%) nunca ou raramente o faziam. A maioria que não tinha o hábito de fazer auto-exame possuía menos de 35 anos de idade (47%), e a maioria que o fazia todos os meses tinha mais de 50 anos (43,5%). As mulheres que tinham nível médio/superior e que tiveram doença sexualmente transmissível tiveram mais chance de fazer auto-exame todos os meses, bem como o fato do médico orientar sempre o auto-exame aumentou em 3,3 vezes a chance de fazê-lo em relação a quem nunca teve essa orientação. Associou-se esse resultado ao hábito de fazer mamografia, em que mais de 53% das mulheres que examinavam mensalmente as mamas já haviam feito mamografia, enquanto mais de 56% das mulheres que não tinham o hábito do auto-exame nunca haviam feito esse exame. Conclusões: O auto-exame é conhecido pelas entrevistadas, embora mais da metade dessas não o realize. O fator social e a educação médica em saúde foram fundamentais no hábito desse exame, bem como na prática de mamografia.
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Campos A, Amaral E, Levi JE, Portugal P, Villarroel M, Bezerra KC, Silva MTND, Morais SS. Carga viral vaginal de HIV em mulheres brasileiras infectadas pelo HIV. Rev Assoc Med Bras (1992) 2008; 54:67-71. [DOI: 10.1590/s0104-42302008000100023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 10/11/2007] [Indexed: 11/22/2022] Open
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Freitas RAP, Carvasan GAF, Morais SS, Zeferino LC. Excessive Pap smears due to opportunistic cervical cancer screening. EUR J GYNAECOL ONCOL 2008; 29:479-482. [PMID: 19051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The study aimed to analyze the Pap smears carried out for cervical cancer screening according to Ministry of Health guidelines. All smear tests carried out within the public health system in Campinas in 2003 were analyzed. All tests that did not conform to the guidelines were considered excessive. The guidelines recommend screening once every three years for all women aged 25 to 59 after they have received two negative smears. This study showed that the majority of women initiated screening prior to 25 years of age and the periodicity was predominantly annual, followed by biannual tests. In conclusion, 63.4% of tests were excessive. The screening coverage was 14.76%, but if all the tests had been performed as recommended, the final coverage over three years could have reached 65.4%. Thus it is possible to increase the coverage with the available resources since the screening works like an organized program.
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Affiliation(s)
- R A P Freitas
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas, Cidade Universitária Zeferino Vaz, Campinas, São Paulo, Brazil
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Fernandes T, de Angelo-Andrade LA, Morais SS, Pinto GA, Chagas CA, Maria-Engler SS, Zeferino LC. Stromal cells play a role in cervical cancer progression mediated by MMP-2 protein. EUR J GYNAECOL ONCOL 2008; 29:341-344. [PMID: 18714566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Metalloproteinases, especially metalloproteinase-2 (MMP-2), are known for their role in the degradation of the extracellular matrix. Nevertheless, a thorough understanding of MMP-2 expression in neoplastic lesions of the uterine cervix has yet to be accomplished. This study aimed to analyze the MMP-2 expression in cervical intraepithelial neoplasia III (CIN3) and in cervical squamous cell carcinoma, in tumor cells and adjacent stromal cells. MMP-2 expression was assessed by an immunohistochemical technique. MMP-2 expression was greater in the stromal cells of invasive carcinomas than in CIN3 (p < 0.0001). MMP-2 expression in stromal cells correlates with the clinical stage, gradually increasing as the tumor progresses (p = 0.04). This study corroborates that stromal cells play an important role in tumor invasion and progression, mediated by the progressive enhancement of MMP-2 expression from CIN3 to advanced invasive tumor. The intense MMP-2 expression most probably is associated with poor tumor prognosis.
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Affiliation(s)
- T Fernandes
- Department of Obstetrics and Gynecology, State University of Campinas, Campinas, CP, Brazil
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Vaz AF, Pinto-Neto AM, Conde DM, Costa-Paiva L, Morais SS, Esteves SB. Quality of life of women with gynecologic cancer: associated factors. Arch Gynecol Obstet 2007; 276:583-9. [PMID: 17564721 DOI: 10.1007/s00404-007-0397-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 05/22/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate quality of life (QOL) and identify its associated factors in a cohort of women with gynecologic cancer. METHODS A cross-sectional study was conducted, including 103 women with cervical or endometrial cancer, aged between 18 and 75 years who were receiving their entire treatment at the institution where the investigation was carried out. QOL was measured by the World Health Organization's QOL instrument-abbreviated version (WHOQOL-BREF). Clinical and sociodemographic characteristics, in addition to prevalence of cancer-related symptoms prior to radiotherapy were investigated. Bivariate analysis was performed, applying the Mann-Whitney test. Multivariate analysis was used to identify factors associated with QOL. RESULTS The mean age of the participants was 56.8 +/- 11.6 years. The study included 67 (65%) women with cervical cancer and 36 (35%) women with endometrial cancer. Most participants were at an advanced stage (63.1%). The most common complaints were pain (49.5%) and vaginal bleeding (36.9%). The prevalence of anemia was 22.3%. On multivariate analysis, it was observed that anemia (P = 0.006) and nausea and/or vomiting (P = 0.010) determined impairment in physical domain. Pain negatively influenced physical domain (P = 0.001), overall QOL (P = 0.024), and general health (P = 0.013), while the history of surgery positively affected general health (P = 0.001). CONCLUSION Cancer-related symptoms were factors that most interfered with QOL in women with gynecologic cancer. Therefore, more attention should be focused on identifying these symptoms, adopting measures to minimize their repercussions on QOL.
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Affiliation(s)
- Ana Francisca Vaz
- Department of Gynecology and Obstetrics, Universidade Estadual de Campinas, School of Medicine, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-970, Brazil
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