Uterine prolapse during pregnancy: A case report

Pelvic organ prolapse (POP) in pregnancy is a rare condition, with potentially serious complications for both mother and fetus. The scope of complications includes urinary retention, premature delivery, fetal demise, and maternal sepsis. In this case report, we present a 35-year-old individual at 30-week gestational age with a stage 2 POP treated conservatively with bed rest in a slight Trendelenburg position, with corticosteroids and symptomatic treatment for pain relief. In this case, an innovative proposal was developed involving outpatient management with biweekly visits in prenatal care after the previously mentioned measures were carried out in 5 days that the pregnant woman was hospitalized. Conservative treatment of these patients throughout pregnancy can result in an uneventful, normal, and spontaneous delivery, as in this case where the patient evolved without complications leading to vaginal delivery occurring at 37 weeks. Early recognition of this condition is crucial and, together with proper management-related complications, such as preterm labor and trauma during delivery, can be avoided

Predictors of residual disease after loop electrosurgical excision procedure

The study aims to evaluate the importance of resection margins in the risk of residual disease (RD) and to investigate other factors that could potentially predict RD before patients engage in follow-up. Eighty-six women with a histologically confirmed diagnosis of cervical intraepithelial neoplasms (CIN) treated by loop electrosurgical excision procedure (LEEP), were included in this retrospective study, between January 2015 and May 2016. Age, smoking habit, menopause status, and LEEP margins were evaluated as possible predictors of RD. The mean age at diagnosis was 35.8 years (range 18-61). The mean follow-up period was 12 months. 11.6% of patients (09/86) were lost in follow-up. 64% of patients (55/86) had clear margins in the specimen and 34.8% of patients had positive surgical margins (30/86). In 1.2% of patients (01/86) the resection margins were uncertain. RD was demonstrated by positive Pap Smear and by colposcopy-guided biopsy in 26.7% of patients (23/86). We found significant differences in the frequency of RD depending on the status of margins: 65.2% of cases with positive margins vs. 24.5% of cases with negative margins (p<0.0001). Multivariate analysis showed that only high-grade squamous intraepithelial lesion (H-SIL) detection in cervical biopsy and status of the LEEP margins were significantly predictive of RD (OR 5.4, 95%CI 1.08-27.7, p<0.05 and OR 7.05, 95%CI 2.1-23.1, p=0.001; respectively). The combination of histological examination of resection margins plus H-SIL detection in cervical biopsy would help to classify LEEP-treated patients into categories of different risk levels of residual disease. DOI: http://dx.doi.org/10.5281/zenodo.117370

Prevalência de fatores de risco para doenças cardiovasculares em crianças e adolescentes do Núcleo de Amparo ao Menor

Introdução: Atualmente, a dislipidemia infanto-juvenil associada a outros agravos não transmissíveis como diabete e obesidade representam um grave problema de saúde pública no Brasil. Objetivos: Investigar a prevalência de dislipidemia, sobrepeso, obesidade e de glicemia alterada em crianças e adolescentes do Núcleo de Amparo ao Menor(NAM) em Natal-RN. Métodos: Estudo transversal realizado com 62 jovens com idade entre 1 e 17 anos inscritos no NAM. Resultados: A média de idade foi de 9,74 anos. A prevalência de hipercolesterolemia foi de 27,41% e a de hipertrigliceridemia de 19,35%. O sobrepeso foi detectado em 16,12% e a obesidade em 3,22%. A glicemia alterada foi detectada em 19,44% dos meninos, em 11,53% das meninas e houve apenas um caso de diabetes. Conclusão: Esses achados demonstram a importância de se diagnosticar precocemente os perfis lipídico e glicêmico, principalmente se estes já apresentarem associação com outros fatores de risco como sobrepeso e obesidade

Prevalência de fatores de risco para doenças cardiovasculares em crianças e adolescentes do Núcleo de Amparo ao Menor

Introdução: Atualmente, a dislipidemia infanto-juvenil associada a outros agravos não transmissíveis como diabete e obesidade representam um grave problema de saúde pública no Brasil. Objetivos: Investigar a prevalência de dislipidemia, sobrepeso, obesidade e de glicemia alterada em crianças e adolescentes do Núcleo de Amparo ao Menor(NAM) em Natal-RN. Métodos: Estudo transversal realizado com 62 jovens com idade entre 1 e 17 anos inscritos no NAM. Resultados: A média de idade foi de 9,74 anos. A prevalência de hipercolesterolemia foi de 27,41% e a de hipertrigliceridemia de 19,35%. O sobrepeso foi detectado em 16,12% e a obesidade em 3,22%. A glicemia alterada foi detectada em 19,44% dos meninos, em 11,53% das meninas e houve apenas um caso de diabetes. Conclusão: Esses achados demonstram a importância de se diagnosticar precocemente os perfis lipídico e glicêmico, principalmente se estes já apresentarem associação com outros fatores de risco como sobrepeso e obesidade

Bioética, assistência médica e justiça social

O Sistema Único de Saúde (SUS) brasileiro garante o acesso universal e integral aos serviços de saúde. Entretanto, na prática, o SUS não tem permitido que os cidadãos desfrutem de uma assistência com equidade, reforçando a dificuldade de se atingir a justiça social em uma sociedade tão desigual e injusta como a brasileira. A ética propõe a equidade como base para resolver as distorções na distribuição da saúde, possibilitando o acesso universal. Este artigo tem como objetivo precípuo discutir como a bioética pode auxiliar para que haja maior equidade na assistência médica em nosso país

Safety, tolerability and side effects of human papillomavirus vaccines: a systematic quantitative review

Recently, many studies have evaluated HPV vaccine safety and adverse effects. Two vaccines have been recently evaluated in randomized controlled trials: the bivalent vaccine for HPV 16 and 18 (Cervarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) and the quadrivalent vaccine for HPV 6, 11, 16, and 18 (Gardasil, Merck and Co., Inc., Whitehouse Station, NJ). We have performed a systematic review of all randomized controlled trials in which HPV vaccines were compared with placebo regarding safety, tolerability and adverse effects. Studies were searched up to March 2013 in the databases: Pubmed, Embase, Scielo and Cancerlit. Odds Ratios (OR) of most incident adverse effects were obtained. Twelve reports, involving 29,540 subjects, were included. In the HPV 16/18 group, the most frequently reported events related to the vaccine were pain (OR 3.29; 95% CI: 3.00–3.60), swelling (OR 3.14; 95% CI: 2.79–3.53) and redness (OR 2.41; 95% CI: 2.17–2.68). For the HPV 6/11/16/18 group the events were pain (OR 2.88; 95% CI: 2.42–3.43) and swelling (OR 2.65; 95% CI: 2.0–3.44). Concerning the HPV 16/18 vaccine, pain was the most common outcome detected. These effects can be due to a possible VLP-related inflammation process. Fatigue was the most relevant general effect observed followed by fever, gastrointestinal symptoms, and headache. In the HPV 6/11/16/18 group, only general symptoms, pain and swelling were observed. Pain and swelling were the most frequent. Comparing HPV 16/18 to HPV 6/11/16/18 vaccines, the former presented more adverse effects, perhaps because there are many more trials evaluating the bivalent vaccine. Other studies are needed to clarify this issue. Keywords: HPV, Vaccines, Adverse effect

Prevalence of complications associated with the use of a peripherally inserted central catheter in newborns: A systematic review protocol.

BackgroundThe improper handling of a peripherally inserted central catheter (PICC) in newborns (NBs) may result in mechanical and infectious complications.AimThe aim of this systematic review (SR) is to estimate the prevalence of complications associated with the use of PICC in NBs.MethodsWe will utilize PubMed, Embase, CENTRAL, Web of Science, Scopus, Cochrane Library, CINAHL, and Google Scholar for the databases search. There will be no restrictions on the search for languages, and observational studies will be selected wherein the prevalence rate of complications associated with the use of PICC in NBs has been presented or can be calculated. The systematic review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two reviewers will independently select studies and assess their eligibility using predefined criteria. Using standardized forms, two other reviewers will independently extract data from each included study, and the random-effects pooled prevalence will be calculated in the meta-analysis with the respective 95% confidence intervals. The methodological quality of the studies will be assessed using the modified Newcastle-Ottawa Scale. Review Manager V.5.3.5 will be used for the qualitative and quantitative synthesis. A protocol was developed and published on PROSPERO (Registration number CRD42020211983).Expected resultsThis SR will show the prevalence of complications caused by the inadequate management of PICC in NBs, which is information considered important for clinical practice improvement

Use of dating sites and applications by women and their risk of sexually transmitted infections: a systematic review and meta-analysis protocol

Introduction The use of social networks has been increasing worldwide. Mobile websites and applications (apps) allow people to network more quickly and have more partners for sex. This can facilitate risky sexual behaviours, such as having multiple partners and unprotected sex, which can lead to a higher incidence of sexually transmitted infections. This systematic review/meta-analysis will assess the effects of the use of dating sites and apps by women on their level of engagement in risky sexual behaviours and their incidence of sexually transmitted infections.Methods and analysis The Cochrane Central Controlled Trials Registry, ClinicalTrials.gov, MEDLINE, Embase, SciELO, Web of Science, Scopus and Cumulative Index to Nursing & Allied Health Literature will be searched for cross-sectional studies, clinical trials and observational studies published between January 1990 and July 2020. This systematic review and meta-analysis will include studies investigating the use of mobile apps by women, risky sexual behaviour and sexually transmitted infections. The outcome will be an increase in new cases of sexually transmitted infections and HIV among women using dating sites and apps. Three independent reviewers will select the studies and extract data from the original articles. The risk of bias will be assessed using the Cochrane risk of bias tool and Risk Of Bias in Non-randomized Studies of Interventions. Data synthesis will be performed using Review Manager software (RevMan V.5.2.3). To assess heterogeneity, we will compute the I2 statistic. In addition, a quantitative synthesis will be carried out if the included studies are sufficiently homogeneous.Ethics and dissemination This study will be a review of the published data, and thus ethical approval is not required. The findings of this systematic review will be published in a peer-reviewed journal.PROSPERO registration number CRD42019120494

Safety of Human Papillomavirus 9-Valent Vaccine: A Meta-Analysis of Randomized Trials

Vaccination against human papillomavirus (HPV) has been progressively implemented in most developed countries for approximately 10 years. In order to increase the protection of the vaccines, a 9-valent vaccine (HPV9) was developed, which provides protection against nine types of the virus. Studies evaluating its safety are rare. Thus, we performed a meta-analysis of three clinical trials assessing adverse effects on women randomly vaccinated with HPV9 or tetravalent vaccine (HPV4), with the objective of analyzing whether the HPV9 is as safe as HPV4. An electronic data search was performed through the PubMed, Embase, Scopus, Web of Science, and SciELO databases. The studies selected 27,465 women who received one of the two vaccines. Pain (OR 1.72; 95% CI 1.62–1.82) and erythema (OR 1.29; 95% CI 1.21–1.36) occurred significantly more in the HPV9 group. However, there was no significant difference between the groups for the following adverse effects: headache (OR 1.07; 95% CI 0.99–1.15), dizziness (OR 1.09; 95% CI 0.93–1.27), and fatigue (OR 1.09; 95% CI 0.91–1.30), and the occurrence of serious events related to vaccination was similarly rare among those vaccinated. Therefore, our findings demonstrate that HPV9 in female patients is as safe as the tetravalent vaccine