O papel das duchas higiênicas vaginais sobre a prevalência das infecções genitais em mulheres profissionais do sexo

Orientadores: Paulo César Giraldo, Ana Katherine da Silveira GonçalvesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O uso de duchas vaginais é comum em diferentes povos e culturas. Entre as mulheres que a praticam, a maioria a faz após a menstruação, antes ou após a relação sexual, com a finalidade de evitar o odor desagradável ou para eliminar corrimentos, refrescar a genitália ou prevenir a gravidez. Não está claro na literatura se as duchas poderiam causar problemas às usuárias. Objetivo: Verificar se o uso habitual de duchas vaginais associa-se à infecção genital por Chlamydia trachomatis/ Neisseria gonorrhoeae e Papilomavírus humano (HPV) em mulheres profissionais do sexo. Sujeitos e Métodos: Estudo de corte transversal avaliou 200 mulheres - 111 profissionais do sexo (PS) e 89 não profissionais do sexo (NPS) - assistidas em uma Unidade Básica de Saúde de Campinas, São Paulo, Brasil. Todas as mulheres foram entrevistadas e examinadas por um único pesquisador. A anamnese abordou os antecedentes demográficos, higiênicos, sexuais e médicos, como idade, cor, paridade, escolaridade, tabagismo, estado civil, uso de duchas vaginais, idade da primeira relação sexual, número de parceiros sexuais, número de coitos por semana, práticas sexuais, uso de preservativo e lubrificante. Amostras de células cervicais foram coletadas para testes de captura híbrida objetivando Chlamydia trachomatis/Neisseria gonorrhoaea e HPV. Na análise estatística usou-se o teste exato de Fisher ou X2 para as variáveis discretas, e Mann-Whitney para as variáveis não-paramétricas. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (no 902/2009) e contou com a colaboração da Secretaria de Saúde do Estado de São Paulo e Laboratório Digene. Resultado: Cerca de 40% das mulheres investigadas praticavam duchas vaginais três ou mais vezes por semana (61,7% das PS e somente 14,6% das NPS). A infecção por CT/NG foi positiva em 10,5% do total dos casos, 17 casos (15,3%) em PS e em quatro casos (4,5%) das NPS (p=0,01), porém não houve diferenças significativas entre usuárias de duchas vaginais (14,81%) e não usuárias (7,6%), (p=ns). As PS não usuárias de duchas vaginais tiveram quase o dobro de infecção CT/NG que as NPS usuárias de duchas vaginais (13,9% vs 7,7%). O HPV foi positivo em 40,5% dos casos, sendo 55,8% da PS e em 21,3% das NPS (p=0,001), contudo DNA-HPV não foi significativamente diferente (p=0,47) entre PS usuárias de duchas vaginais (54,4%) e em não usuárias (58,1%). HPV de alto risco foi positivo em 16,2% e 11,6% (p=ns) e o HPV de baixo risco em 23,5% e 30,2% (p=ns) em usuárias e não usuárias de duchas vaginais respectivamente. Os HPV de alto e baixo riscos foram encontrados simultaneamente em 14,7% e 16,2% das usuárias e não usuárias de duchas vaginais, respectivamente (p=ns). Conclusão: O uso de duchas vaginais não se associou às infecções genitais por CT/NG e HPV de alto ou baixo grau nas mulheres estudadas (profissionais do sexo e não profissionais do sexo)Abstract: The use of vaginal douching (VD) is widespread around the world, and is more common than is to be expected. The majority of women douche after menses, before or after sexual intercourse to prevent odor, to alleviate vaginal symptoms, or to prevent pregnancy, however it is not clear in the literature if this habit can cause damages for women. Objective: Establish whether high frequency VD favors Chlamydia trachomatis (CT)/Neisseria gonorrhoeae (NG) and Papilomavírus humano (HPV) infection in female sex workers (SW). Subjects and Methods: A clinical cross-sectional study involving 200 women, 111 SW and 89 non-sex workers (NSW) in a Health Center in Brazil. The subjects were submitted to an interview and examined by a single researcher. A questionnaire was filled out with data that included, medical and demographic history (age, race, parity, education, smoking, marital status), hygiene (use of VD, frequency and the solution used) and sexual behaviour (first sexual relation, number of sexual partners, frequency, sexual practices, homosexual relationships, use of condom and lubricant). Cervical samples were collected for CT and NG testing by hybrid capture 2 assay. Statistical analysis used the Fisher's exact test or qui square for discrete variables and Mann-Whitney test for nonparametric variables. The study was approved by Committee the Ethics in Research (no 902/2009) and received the cooperation of São Paulo Secretariat of Health and Digene laboratory. Results: Approximately 40% of women practiced douche three or more times per week (61.7% of SW and only 14.6% of the NSW). Infection with CT / NG was positive in 10.5% of the total cases, 17 cases (15.3%) in SW and in four cases (4.5%) of the NSW (p = 0.01). However, It was in 14.81% of D and but in and 7.6% of ND (p = ns). SW douchers had almost double CT and NG infections than NSW douchers (13.9% vs 7.7%). HPV infection was detected in 40.5% of cases, 55.8% of SW and 21.3% of NSW of (p = 0.001), despite of DNA HPV was not different (p = 0.47) between SW douchers (54.4%) and non-douchers (58.1%). High-risk DNA-HPV was positive in 16.2% and 11.6% (p = ns) and low-risk DNA-HPV in 23.5% and 30.2% (p = ns) in douchers and non-douchers respectively. High and low risk DNA-HPV were found simultaneously in 14.7% and 16.2% of douchers and non-douchers respectively (p = ns). Conclusion: The use of VD is not a causal factor for cervical CT/NG and High-/low risk HPV infection in women studied (SW and NSW)DoutoradoTocoginecologiaDoutor em Tocoginecologi

Efeitos decorrentes do uso de duchas higienicas sobre a microflora vaginal de mulheres profissionais do sexo

Orientadores: Paulo Cesar Giraldo, Ana Katherine S. GonçalvesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: Verificar se o uso de duchas higiênicas íntimas (DHI) pode interferir na microbiota vaginal de mulheres profissionais do sexo. Sujeitos e Métodos: Estudo de corte transversal realizado durante seis meses verificou o risco de 155 mulheres profissionais do sexo (PS), usuárias e não usuárias de DHI, apresentarem flora vaginal alterada e/ou vaginose bacteriana. As PS foram atendidas em centro de saúde (CS) localizado em zona de prostituição no município de Campinas, São Paulo, e agrupadas em usuárias e não usuárias de duchas higiênicas íntimas para análise da microbiota vaginal. A anamnese determinou os perfis sociodemográfico e sexual destas mulheres que procuraram o CS por diferentes motivos. O conteúdo vaginal foi coletado com swab estéril de Dacron e disposto em duas lâminas de vidro que foram coradas por técnica de Gram. A caracterização da microbiota vaginal pelos critérios de AMSEL adaptado foi realizada por microscopia óptica com lente de imersão. Análises univariável, bivariável com testes de qui-quadrado e exato de Fisher, além de regressão múltipla variável (stepwise) demonstraram o poder de associação entre as variáveis. Resultados: A média de idade, a etnia branca, a escolaridade básica e hábito de fumar encontrados respectivamente nas 94 usuárias e nas 61 não usuárias de DHI foram de 25,5 (± 6,2) vs. 26,0 (± 6,8)anos (p=ns), 48,9% vs. 47,5% (p=ns), 60,6% vs. 45% (p=ns) e 41,5% vs. 49,2% (p=ns) dos casos. Não houve diferença no uso regular de condom com seus parceiros sexuais fixos. Apenas o uso de lubrificantes vaginais foi significativamente maior nas usuárias de DHI (63,8%) que nas não usuárias (36,1%), p=0,0007. As prevalências de flora vaginal alterada, vaginose bacteriana, candidíase, tricomoníase e vaginose citolítica foram de 75,48%; 50,96%; 5,1%; 0,64% e 1,9%, respectivamente. Não houve diferenças significativas destas prevalências quando foram analisados estes achados entre as usuárias e não usuárias de DHI (78,7% vs. 70,5%, ns), (47,9% vs. 55,7%, ns), (5,3% vs. 4,9%, ns), (0 vs. 1,6%, ns) e (1,1% vs. 3,3%, ns). A análise de regressão múltipla tipo stepwise não identificou qualquer risco aumentado de ter flora vaginal alterada ou de vaginose bacteriana em mulheres usuárias de DHI. Conclusão: O uso de DHI não aumentou o risco de flora vaginal alterada e/ou de vaginose bacteriana em mulheres PS. Palavras-chave: profissionais do sexo, duchas higiênicas íntimas, microbiota vaginal, vaginose bacteriana, candidíase vaginalAbstract: Aims: Verify if vaginal douching (VD) can cause vaginal flora imbalance in Female Sex Workers (FSW). Patients and Methods: A cross sectional study, carried out for six months, analysed the risk of vaginal flora imbalance and/or vaginal bacteriosis due to vaginal douching in 155 FSW. The FSW were seen at a public outpatient in a prostitution area in the city of Campinas, the state of São Paulo, Brazil. The vaginal douching (VD) users and non-users made up the two groups for vaginal microbiological analysis. The social-demographic and sexual profile of these women, who were seen for different reasons, was checked by anamnesis. Vaginal content was collected using a sterile Dacron Swab and placed on two glass slides that were stained using Gram technique. Adapted AMSEL criteria characterized the vaginal flora using optic microscope with immersion lens. Univariate, bivariate statistical analyses with X2 and exact Fisher tests apart from multiple variate regression (Stepwise) analysis determined the association between variables. Results: Mean age, white ethnicity, level of schooling and the habit of smoking analysed in the 94 users and 61 non-users of VD respectively were 25.5 (± 6.2) vs. 26.0 (± 6.8) years (p=ns), 48.9% vs. 47.5% (p=ns), 60.6% vs. 45% (p=ns) and 41.5% vs. 49.2% (p=ns) of the cases. There was no difference in the regular use of condoms with their steady sexual partners. Only the use of vaginal lubricant was significantly higher in the VD users (63.8%) than in the non-users (36.1%); p=0.0007. General prevalence of abnormal flora, bacterial vaginosis, candidiasis, trichomoniasis and cytolitic vaginosis was 75.48%, 50.96%, 5.1%, 0.64% and 1.9% respectively. There were no significant differences when analysing the findings between users and non-users of VD (78.7% vs. 70.5%; ns); (47.9% vs. 55.7%; ns); (5.3% vs. 4.9%; ns); (0 vs. 1.6% ns) and (1.1% vs. 3.3%; ns). Stepwise multiple regression analysis did not identify any increased risk of altered vaginal flora or bacterial vaginosis in VD users. Conclusion: The use of VD did not increase the risk of vaginal flora imbalance and/or bacterial vaginosis in FSWMestradoCiencias BiomedicasMestre em Tocoginecologi

Stratification of the phase clouds and statistical effects of the non-Markovity in chaotic time series of human gait for healthy people and Parkinson patients

In this work we develop a new method of diagnosing the nervous system diseases and a new approach in studying human gait dynamics with the help of the theory of discrete non-Markov random processes. The stratification of the phase clouds and the statistical non-Markov effects in the time series of the dynamics of human gait are considered. We carried out the comparative analysis of the data of four age groups of healthy people: children (from 3 to 10 year olds), teenagers (from 11 to 14 year oulds), young people (from 21 up to 29 year oulds), elderly persons (from 71 to 77 year olds) and Parkinson patients. The full data set are analyzed with the help of the phase portraits of the four dynamic variables, the power spectra of the initial time correlation function and the memory functions of junior orders, the three first points in the spectra of the statistical non-Markov parameter. The received results allow to define the predisposition of the probationers to deflections in the central nervous system caused by Parkinson's disease. We have found out distinct differencies between the five submitted groups. On this basis we offer a new method of diagnostics and forecasting Parkinson's disease.Comment: 15 pages, 5 figs, 3 Table

The Prevalence of Urogenital Infections in Pregnant Women Experiencing Preterm and Full-Term Labor

Urogenital infections are extremely prevalent during pregnancy and are an important cause of premature labor. However, the prevalence of urogenital infections during childbirth is not well known. Objective. Identify urogenital infections present at the beginning of labor in both full-term and preterm pregnancies. Study Design. Ninety-four women were admitted to the inpatient maternity clinic of the Federal University of Rio Grande do Norte (UFRN). In total, 49 women in preterm labor and 45 women in full-term labor were included in the study, and samples of urinary, vaginal, and perianal material were collected for microbiological analysis. Results. The prevalences of general infections in the preterm labor group and the full-term labor group were 49.0% and 53.3% (P = 0.8300), respectively. Urogenital infections in the preterm and full-term labor groups included urinary tract infection in 36.7% and 22.2% of women, vaginal candidiasis in 20.4% and 28.9% of women, bacterial vaginosis in 34.7% and 28.9% of women, and group B streptococcus in 6.1% and 15.6% of women, respectively. Conclusions. Urogenital infections were prevalent in women in preterm labor and full-term labor; however, significant differences between the groups were not observed

Genital ulcers in women: clinical, microbiologic and histopathologic characteristics

Female genital ulcer is a disease that affects a large number of women, and its etiologic diagnosis can be difficult. The disease may increase the risk of acquiring HIV. Genital ulcer may be present in sexually transmitted diseases (STD) - syphilis, chancroid, genital herpes, donovanosis, lymphogranuloma venereum and other non-STD disorders (NSTD) - Behçet's syndrome, pemphigus, Crohn's disease, erosive lichen planus and others. This study evaluated the clinical-histopathologic-microbiologic characteristics of female genital ulcers. A cross-sectional descriptive prospective study was conducted during a six-month period to investigate the first 53 women without a definitive diagnosis, seeking medical care for genital ulcers at a genital infections outpatient facility in a university hospital. A detailed and specific history was taken, followed by a dermatologic and gynecologic examination. In addition to collecting material from the lesions for microbiologic study, a biopsy of the ulcer was performed for histopathologic investigation. The average age of the patients was 32.7 years, 56.6% had junior high school education and higher education. The most frequent etiology was herpetic lesion, followed by auto-immune ulcers. At the time of their first consultation, around 60% of the women were using inadequate medication that was inconsistent with the final diagnosis. Histologic diagnosis was conclusive in only 26.4% of the patients (14/53). Cure was obtained in 99% of the cases after proper therapy. The female genital ulcers studied were equally distributed between sexually transmitted and non-sexually transmitted causes. Herpes was the most frequent type of genital ulcer, affecting women indiscriminately, mostly between the ages of 20 and 40 years. The etiologic diagnosis of herpetic ulcers is difficult to make even when various diagnostic methods are applied. It is imperative that NSTD should be included in the differential diagnoses of female genital ulcers. The histopathologic exam is not a diagnostic tool in the majority of cases and should not be considered the gold standard test, being of little value in cases of NSTD and STD ulcers.25426

Reactional changes in short-term levonorgestrel-releasing intrauterine system (lng-ius) use

Objective: To evaluate endocervical and vaginal environment changes in women using a levonorgestrel-releasing intrauterine system (LNG-IUS). Methods: A quasi-experimental study included sixty women who had an LNG-IUS inserted in the Family Planning Clinic of UNICAMP between April and November of 2016. Women in reproductive age, non-pregnant, without the use of antibiotics and contraceptives seeking for LNG-IUS insertion were selected for this study. All women were evaluated with regard to vaginal and endocervical pH, vaginal and endocervical Gram-stained bacterioscopy, and Pap-smear before and two months after LNG-IUS insertion. Clinical aspects such as cervical mucus, vaginal discharge, and cervical ectopy were also observed. Results: After LNG-IUS insertion, there was an increase in the following parameters: endocervical pH>4.5 (p=0.02), endocervical neutrophil amount (p<0.0001), vaginal cytolysis (p=0.04). There was a decrease in vaginal discharge (p=0.01). No statistically significant changes were found in vaginal pH, neutrophils amount in the vaginal mucosa, vaginal discharge appearance, vaginal candidiasis, bacterial vaginosis, vaginal coccobacillary microbiota, cervical mucus appearance, or cervical ectopy size. Conclusions: Short-term LNG-IUS use did not increase vulvovaginal candidiasis or bacterial vaginosis, and led to diminished vaginal discharge. Notwithstanding, this device promoted reactional changes in the vaginal and endocervical environment, without modification on cervical ectopy size.65685786

Freiburg RNA Tools: a web server integrating IntaRNA, ExpaRNA and LocARNA

The Freiburg RNA tools web server integrates three tools for the advanced analysis of RNA in a common web-based user interface. The tools IntaRNA, ExpaRNA and LocARNA support the prediction of RNA–RNA interaction, exact RNA matching and alignment of RNA, respectively. The Freiburg RNA tools web server and the software packages of the stand-alone tools are freely accessible at http://rna.informatik.uni-freiburg.de

Vaginal lipidomics of women with vulvovaginal candidiasis and cytolytic vaginosis: a non-targeted LC-MS pilot study

sem informaçãoTo characterize the lipid profile in vaginal discharge of women with vulvovaginal candidiasis, cytolytic vaginosis, or no vaginal infection or dysbiosis. Design. Cross-sectional study. Setting. Genital Infections Ambulatory, Department of Tocogynecology,138sem informaçãosem informaçãosem informaçãoThe supervision of the laboratory studies by Gustavo Henrique Bueno Duarte at Thomson Mass Spectrometry Laboratory–Campinas State Universit

Time and cell-dependent effects of endocytosis inhibitors on the internalization of biomolecule markers and nanomaterials

Endocytosis is an essential function of cells, with key roles in the internalisation of nutrients, signal molecules and also drugs. Endocytic processes are therefore widely investigated in the context of drug delivery, and inhibitors of endocytic pathways have been used to provide information regarding uptake mechanisms of drug carrier materials. Here we describe studies in which two established inhibitors of clathrin dependent and independent endocytosis, chlorpromazine and methyl‐β‐cyclodextrin respectively, were employed to probe endocytic pathways of three cell lines chosen to represent tumour‐relevant or associated phenotypes: 3 T3 (fibroblasts), HCT 116 (colon cancer) and MGLVA‐1 (gastric cancer). For clathrin mediated endocytosis the data highlight that chlorpromazine inhibition of transferrin internalization, via clathrin dependent endocytosis, is cell and time dependent. We also show that inhibition of uptake is transient with a resumption of transferrin internalization after a maximal inhibition period. The same endocytosis inhibitors were used to probe the internalization of 50 and 100 nm carboxylated polystyrene nanoparticles (C‐PS‐NPs) as model drug delivery carriers. Flow cytometry data indicated that internalisation of C‐PS‐NPs varied considerably with the incubation time of cells with chlorpromazine or methyl‐β‐cyclodextrin, and that the effects were also markedly cell‐line dependent. These data highlight that the effects of endocytosis inhibitors on the internalisation pathways even of relatively simple nanoparticles are complex and interdependent. We suggest that mechanistic investigations of the endocytic processes which govern practical applications of nanoparticles for diagnostic and therapeutic applications should be considered on a cell, time and concentration basis

ENSINO NA SAÚDE: EXPERIÊNCIA INOVADORA DA ODONTOLOGIA

A perspectiva que norteia o presente relato se fundamenta no trabalho desenvolvido entre a Assessoria Pedagógica da Área das Ciências Biológicas e da Saúde e o Curso de Odontologia, da Universidade do Oeste de Santa Catarina (Unoesc) Campus de Joaçaba, mais precisamente com a reestruturação das práticas pedagógicas do curso envolvendo o ensino por competências. O referencial teórico que fundamentou o trabalho foi Bloom (1983), Perrenound (2000) e Werlang (1999). Foi realizado um projeto piloto com o componente curricular de Prevenção Terapêutica dos Tecidos Duros dos Dentes I (PVTTDD I), o qual havia um grande número de reprovações. O componente passou por alterações, com uma proposta pedagógica inovadora para a área da Odontologia, em que o processo de ensino-aprendizagem baseia-se nas habilidades e competências a serem adquiridas pelo acadêmico, em vez de centrá-lo apenas no conteúdo conceitual, exigindo uma organização dos conhecimentos por intermédio de níveis, onde o acadêmico desenvolve competências básicas, intermediárias e globais de acordo com as exigências apresentadas e a capacidade de enfrentar situações e acontecimentos referentes a uma atividade. Neste trabalho foram relatados os resultados de quatro semestres; 2009/02 e 2010/01 tinham o paradigma de repasse de conteúdos e 2010/02 e 2011/01 com a reestruturação pedagógica mencionada. Um indicador interessante foi quanto ao número de reprovações; 2° semestre 2009: 18 alunos reprovaram, 1° semestre 2010: 15 alunos, 2° semestre 2010: 5 alunos e 1º semestre de 2011: apenas 2 acadêmicos. Nos dois primeiros semestres, o número de alunos reprovados era muito superior e o bom desempenho de cada acadêmico em provas teóricas e práticas, a partir do novo método, indica que o trabalho realizado obteve êxito. Atribui-se esta melhora no desempenho da execução das atividades propostas à adesão da equipe docente, ao manual do aluno e à reorganização dos conhecimentos em uma sequência lógica e gradativa