Assessing the Impact of Twin Pregnancies on the Pelvic Floor Using 3-Dimensional Sonography A Pilot Study

Objectives-The purpose of this study was to compare the morphologic characteristics of the pelvic floor musculature between women with twin and singleton pregnancies.Methods-We conducted a cross-sectional case-control study of 40 nulliparous women aged 20 to 38 years to compare women with singleton pregnancies (n = 23) to women with twin pregnancies (n = 17). Biometric measurements of the levator hiatus and the sagittal and coronal diameters were made by transperineal 3-dimensional sonography between the 28th and 38th gestational weeks. Comparisons were statistically assessed by the unpaired Student t test and Mann-Whitney U test.Results-For the women with singleton pregnancies, the mean sagittal diameters at rest, during the Valsalva maneuver, and during pelvic floor contraction were 5.3, 5.7, and 4.5 cm, respectively, and the mean coronal diameters under these conditions were 3.8, 4.1, and 3.6 cm. for the women with twin pregnancies, the corresponding values were as follows: mean sagittal diameters, 5.3, 5.8, and 4.6 cm; and mean coronal diameters, 4.3, 4.3, and 3.8 cm. the differences in coronal diameters were statistically significant at rest (P < .01) and during contraction (P = .04). the mean levator hiatal areas for the women with singleton pregnancies were 14.6, 16.9, and 11.7 cm(2) at rest, during Valsalva, and during contraction, respectively; for the women with twin pregnancies, these values were 16.0, 18.6, and 12.6 cm(2).Conclusions-Hiatal measurements were higher in twin than in singleton pregnancies, with coronal diameters reaching significance at rest and during contraction, suggesting that pelvic support undergoes greater changes during twin pregnancy.Universidade Federal de São Paulo, Dept Obstet, Pelv Floor Sect, BR-05303000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, Pelv Floor Sect, BR-05303000 São Paulo, BrazilWeb of Scienc

Influence of body mass index, body fat percentage and age at menarche on aerobic capacity (VO2 max) of elementary school female students

PURPOSE:To identify and relate body fat percentage (skin fold measures), body mass index (BMI) and age at menarcheto aerobic capacity using the indirect VO2 maximum value (VO2 max) of girls in the second cycle of primary school.METHODS:A total of 197 girls aged 13.0±1.2 years on average, students from two public schools in the city of Atibaia in São Paulo, were evaluated. Anthropometric evaluation of skin folds was performed using the Slaughter protocol for teenage girls, and BMI (kg/m2) was based on Z score (graphic of percentile) according to WHO recommendations. The Léger protocol was used to determine VO2 max. Pearson linear regression and the Student t-test were used for statistical analysis.RESULTS:22.3% of the girls were overweight and 3.5% were obese according to the classification proposed by the WHO; 140 (71.1%) girls reported menarche. The average age at menarche was 12.0±1.0 years and was significantly higher in the group with normal BMI (12.2±0.9 years) than in the overweight or obese groups (11.6±1.0 years). The average indirect VO2 max value was 39.6±3.7 mL/kg/min, ranging from 30.3 to 50.5 mL/kg/min. The advance of chronological age and early age at menarche were positively correlated with lower VO2 max values.CONCLUSIONS:This study showed that 25.8% of the girls had aBMI value above WHO recommendations. Girls with higher BMI and higher body fat percentage had lower VO2 max. The earlier age at menarche and the advance of chronological age were the most important factors for the reduction of aerobic capacity. The ageat menarche was higher in girls with adequate BMI compared tooverweight or obese girls.OBJETIVO:Identificar e relacionar a composição corporal, baseada na porcentagem de gordura corporal e o índice de massa corpórea (IMC), e a idade da menarca, com a capacidade aeróbia, utilizando-se os valores de VO2 máximo indireto, de estudantes do segundo ciclo do ensino fundamental.MÉTODOS:Foram avaliadas 197 meninas com média de idade de 13,0±1,2 anos, estudantes de duas escolas estaduais de Atibaia-SP. Para estimar a porcentagem de gordura corporal, foi realizada uma avaliação de dobras cutâneas utilizando-se o protocolo de Slaughter para meninas adolescentes. Já o índice de massa corpórea (IMC), medido em quilogramas por metro quadrado (kg/m2), seguiu as recomendações da Organização Mundial da Saúde (OMS). Para a avaliação aeróbia, foi utilizado o teste de corrida proposto por Léger, determinando o volume de oxigênio máximo de forma indireta (VO2 máx). Para a análise estatística, foi utilizada a regressão linear de Pearson, o teste t de Student e a análise multivariada.RESULTADOS:22,3% das meninas apresentaram sobrepeso e 3,5% obesidade, de acordo com o IMC. Na amostra estudada, 140 (71,1%) adolescentes relataram a ocorrência de menarca. A média de idade da menarca foi de 12,0±1,0 anos. A média de idade de menarca para o grupo com IMC normal foi significativamente maior (12,2±0,9 anos) do que nas estudantes com sobrepeso ou obesidade (11,6±1,0 anos). A média do VO2 máx indireto foi de 39,6±3,7 mL/kg/min, variando de 30,3 a 50,5 mL/kg/min. O avanço da idade cronológica e a precocidade da menarca correlacionaram-se positivamente com os menores valores de VO2 máx.CONCLUSÕES:Meninas com maiores valores de IMC e percentual de gordura corporal apresentaram menores valores de VO2 máx. A precocidade da menarca e o avanço da idade cronológica foram os fatores mais importantes para a redução da capacidade aeróbia. A idade da menarca foi mais elevada em meninas com IMC adequado quando comparadas com as meninas com sobrepeso ou obesidade.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de GinecologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de OtorrinolaringologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPM, Depto. de GinecologiaUNIFESP, EPM, Depto. de OtorrinolaringologiaUNIFESP, EPMSciEL

Emran Iqbal El-Badawi, Queens and Prophets. How Arabian Noblewomen and Holy Men Shaped Paganism, Christianity and Islam

Emran Iqbal El-Badawi s’est d’abord penché, dans une première partie de sa carrière, sur des points de comparaison entre le Coran et les Évangiles en araméen, arguant que le texte coranique reflète une certaine intertextualité avec le conservatisme des milieux dits judéo-chrétiens . Le présent ouvrage semble ouvrir une seconde phase dans les recherches de M. El‑Badawi, qui se tourne désormais vers l’étude de la place des femmes dans l’Arabie tardo-antique. Queens and Prophets est notamment c..

The Basis of Correctness in the Religious Studies Classroom

What is it that makes a student’s answer correct or incorrect in Religious Studies? In practice, the standards of correctness in the RS classroom are generally applied with relative ease by teachers and students. Nevertheless, they are problematic. We shall argue that correctness does not come from either the students or the teacher believing that what has been said is true. This raises the question: what is correctness, if it does not come down to truth? We propose, and examine, three rival solutions, each of which, to an extent, rationalises a fairly natural response to the problem. The first, the elliptical approach, says that correct contributions have some tacit content: they are elliptical for true sentences about beliefs (e.g. a sentence of the form ‘Christians believe that…’). The second, the imaginative approach, seeks to replace appeals to truth and belief with an appeal to imagination, treating RS as a ‘game of make-believe’ in which teachers and students imaginatively engage with certain worldviews. The third, the institutional approach, locates the root of correctness in the practices of the RS institution, which include making endorsements of some judgements and not others. We show that the first of our proposed approaches encounters a number of significant objections. We find the second of our proposed approaches to be better, but the third is the most attractive, providing a direct, intuitive and comprehensive route through the problem of correctness.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/1467-9752.1216

What do Cochrane systematic reviews say about non-surgical interventions for urinary incontinence in women?

BACKGROUND: Urinary incontinence is a highly prevalent condition that impacts self-esteem and overall quality of life. Many non-surgical treatment options are available, ranging from pharmacological approaches to pelvic exercises. We aimed to summarize the available evidence regarding these non-surgical interventions. DESIGN AND SETTING: Review of systematic reviews, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (EPM-UNIFESP). METHODS: A sensitive search was conducted to identify all Cochrane systematic reviews that fulfilled the inclusion criteria. Titles and abstracts were screened by two authors. RESULTS: We included 20 Cochrane systematic reviews: 4 assessing methods of vesical training, 3 evaluating pharmacological interventions, 4 studying pelvic floor muscle training approaches and 9 aimed at other alternatives (such as urethral injections, weighted vaginal cone use, acupuncture, biostimulation and radiofrequency therapy). The reviews found that the evidence regarding the benefits of these diverse interventions ranged in quality from low to high. CONCLUSIONS: This review included 20 Cochrane systematic reviews that provided evidence (of diverse quality) for non-pharmacological interventions for patients with urinary incontinence. Moderate to high quality of evidence was found favoring the use of pelvic floor muscle training among women with urinary incontinence. To establish solid conclusions for all the other comparisons, further studies of good methodological quality are needed.Univ Fed Sao Paulo Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Dept Gynecol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Discipline Evidence Based Hlth, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo Unifesp, Escola Paulista Med, Dept Gynecol, Sao Paulo, SP, BrazilWeb of Scienc

Relationship between Anxiety and Interleukin 10 in Female Soccer Players with and Without Premenstrual Syndrome (PMS)

Objective To investigate the level of anxiety and its relationship with interleukin (IL)10 (anti inflammatory cytokine that modulates mood swings) in a group of female soccer players. Methods Fifty-two eumenorrheic soccer players were evaluated (age 19.8 +/- 4.7 years). The presence of premenstrual syndrome (PMS) and phases of the menstrual cycle were determined by a daily symptomreport (DSR) kept for 3 consecutivemonths. The concentration of cytokine IL-10 was determined from urine samples collected at four moments: at the follicular and luteal phases of the menstrual cycle, and before (pre) and after (post) the simulated game, and it was quantified by flow cytometry (Luminex xMAP - EMDMillipore, Billerica, MA, USA). The level of anxietywas determined through the BAI anxiety questionnaire answered by all athletes at the same time of the urine collection. The Student t-test, analysis of variance (ANOVA) and Pearson correlation with significance level at 5% were used for data analysis. Results We showed that the prevalence of PMS among female soccer players is similar to that reported in the literature. In addition, we showed that the group withPMS has a higher level of anxiety compared with group without PMS (p = 0.002). Interleukin-10 analysis in players without PMS revealed that there was a significant decrease in the level of this cytokine before the game during the luteal phase when compared with the follicular phase (p < 0.05). The correlation analysis between IL-10 and anxiety showed a negative correlation post-game in the luteal phase in the group without PMS (p = 0.02; r = -0.50) and a positive correlation post-game in the luteal phase in PMS group (p = 0.04; r = 0.36). Conclusion Our results suggest that IL-10 may contribute to reduce anxiety in the group without PMS. This could be attributed to the fact that no IL-10 variation was observed in the group with PMS, which presented higher anxiety symptoms when compared with the group without PMS.Univ Fed Sao Paulo, Escola Paulista Med, Dept Gynecol, Rua Napoleao Barros,608-Vila Clementino, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Otorhinolaryngol, Sao Paulo, SP, BrazilUniv Cruzeiro Sul UNICID, Dept Phys Activ & Sports Sci, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Gynecol, Rua Napoleao Barros,608-Vila Clementino, BR-04024002 Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Otorhinolaryngol, Sao Paulo, SP, BrazilWeb of ScienceFundacao e Amparo a Pesquisa do Estado de Sao Paulo - FAPESPFAPESP: 10/5242

Cellular delivery of small interfering RNA by a non-covalently attached cell-penetrating peptide: quantitative analysis of uptake and biological effect

Cell-penetrating peptides (CPPs) have evolved as promising new tools to deliver nucleic acids into cells. So far, the majority of these delivery systems require a covalent linkage between carrier and cargo. To exploit the higher flexibility of a non-covalent strategy, we focused on the characterisation of a novel carrier peptide termed MPGα, which spontaneously forms complexes with nucleic acids. Using a luciferase-targeted small interfering RNA (siRNA) as cargo, we optimised the conditions for MPGα-mediated transfection of mammalian cells. In this system, reporter gene activity could be inhibited up to 90% with an IC(50) value in the sub-nanomolar range. As a key issue, we addressed the cellular uptake mechanism of MPGα/siRNA complexes applying various approaches. First, transfection of HeLa cells with MPGα/siRNA complexes in the presence of several inhibitors of endocytosis showed a significant reduction of the RNA interference (RNAi) effect. Second, confocal laser microscopy revealed a punctual intracellular pattern rather than a diffuse distribution of fluorescently labelled RNA-cargo. These data provide strong evidence of an endocytotic pathway contributing significantly to the uptake of MPGα/siRNA complexes. Finally, we quantified the intracellular number of siRNA molecules after MPGα-mediated transfection. The amount of siRNA required to induce half maximal RNAi was 10 000 molecules per cell. Together, the combination of methods provided allows for a detailed side by side quantitative analysis of cargo internalisation and related biological effects. Thus, the overall efficiency of a given delivery technique as well as the mechanism of uptake can be assessed

Medical residency in gynecology and obstetrics in times of COVID-19 : recommendations of the National Specialized Commission on Medical Residency of FEBRASGO

* Text prepared by the members of the National Specialized Commission on Medical Residency and endorsed by the Scientific Board and Presidency of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO)

Demanda, demanda máxima y carga instalada

El profesor explica la diferencia entre los conceptos demanda, demanda máxima y carga instalada