Rastreamento do câncer do colo uterino

Esta webaula teve como objetivo apresentar o protocolo de rastreamento do câncer do colo uterino do Ministério da Saúde-2016 e as condutas diante dos possíveis laudos do exame citopatológico

Treatment of Anterior Vaginal Wall Prolapse Using Transvaginal Anterior Mesh With Apical Fixation: A Prospective Multicenter Study With up to 2 Years of Follow-up

Purpose To evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach. Methods This was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months. Results Ninety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P<0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%–90% for every time point (P<0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%). Conclusions This midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications

QUALIDADE DE VIDA DOS MÉDICOS RESIDENTES: ESTUDO DE CASO DE UM HOSPITAL DE ENSINO FEDERAL

O ingresso nos cursos de medicina provoca mudanças no estilo de vida dos acadêmicos, em função de vários fatores estressantes, dentre eles a intensa dedicação aos estudos. O objetivo deste estudo foi analisar a qualidade de vida dos médicos-residentes de um hospital de ensino federal, no estado de Minas Gerais. O método de pesquisa adotado foi o levantamento de dados (survey), por meio do questionário WHOQOL-Bref, com uma amostra de 254 residentes. Para a análise dos dados recorreu-se à estatística descritiva. Os resultados apontam percepções quanto a qualidade de vida global e geral da saúde de não estar satisfeito nem insatisfeito com a condição. Os domínios Físico e Meio Ambiente foram aqueles que apresentaram as facetas com médias mais baixas, exigindo especial atenção para com os fatores sono e repouso, sentimentos negativos, recursos financeiros, lazer e qualidade do ambiente físico, que articulados podem afetar a disposição e a capacidade para o trabalho, favorecendo os sentimentos de desânimo, ansiedade, mau humor e até depressão. A ausência de monitoramento do estado emocional pode incorrer em maior risco para estados depressivos, consumo álcool e disfunções conjugais

Disfun??es de assoalho p?lvico em atletas.

Disfun??es do assoalho p?lvico s?o condi??es que acometem mulheres em idades variadas, por?m aquelas que se encontram no per?odo do climat?rio, assim como as mult?paras, s?o as mais suscet?veis. Entretanto, h? relatos na literatura de jovens nul?paras que apresentam sintomas de disfun??es nesta regi?o, tais como a incontin?ncia urin?ria e a anal durante a pr?tica de esportes. Essas condi??es podem levar ao abandono da atividade f?sica e comprometer a qualidade de vida. Com o intuito de conhecer a ocorr?ncia das disfun??es do assoalho p?lvico e seus fatores etiol?gicos em atletas jovens e nul?paras, foi feita uma revis?o da literatura. Foram consultadas as bases de dados BVS e PubMed nos ?ltimos dez anos. Os resultados dos estudos revisados indicaram alta preval?ncia de disfun??es do assoalho p?lvico entre atletas, muitas delas nul?paras. A incontin?ncia urin?ria ? a disfun??o do assoalho p?lvico mais documentada e acomete principalmente atletas que praticam atividades consideradas de alto impacto, como trampolim e paraquedismo. As condi??es que desencadeiam as disfun??es do assoalho p?lvico em mulheres jovens e nul?paras ainda n?o est?o completamente elucidadas, altera??es extr?nsecas ou gen?ticas do tecido conjuntivo frouxo e atividades que envolvem longos saltos s?o as hip?teses mais frequentes. Apenas um estudo foi encontrado documentando a preval?ncia das disfun??es do assoalho p?lvico entre atletas envolvendo os sistemas intestinal e sexual, al?m do urin?rio.Pelvic floor dysfunctions are conditions that affect women in various ages, however those in the climacteric period, as well as the multiparous are more susceptible to it. However, there are studies in the scientific literature reporting the occurrence of urinary incontinence during sports among young and nuliparous women. Such conditions can lead to a withdrawn from physical activity compromising the quality of life. A literature review in PubMed and in VHL databases, within the last ten years, was done in order to understand the occurrence of symptoms suggestive of pelvic floor dysfunctions other than urinary incontinence, such as anorectal or sexual dysfunction, and their etiological factors in young and nulliparous athletes. Results indicated a high prevalence of urinary incontinence among athletes, who were engaged in high-impact activities such as trampoline, and skydiving. The conditions that contribute to the urinary incontinence etiology in young and nulliparous women are still not fully understood, extrinsic or genetic changes in loose connective tissue and activities involving long jumps are the most common hypotheses to this condition. Other than urinary tract symptoms, it was found only one study documenting pelvic floor disorders involving the intestinal and sexual systems in such population

Quality of life in women with vulvar cancer submitted to surgical treatment: a comparative study

Objectives: To investigate the occurrence and severity of lymphoedema of the lower extremities (LLE), quality of life (QoL), and urinary and sexual dysfunction in women with vulvar cancer submitted to surgical treatment.Study design: Twenty-eight patients with vulvar cancer submitted to vulvectomy and inguinofemoral lymphadenectomy and 28 healthy, age-matched women (control group) were evaluated. The occurrence and severity of LLE were determined by Miller's Clinical Evaluation. QoL, urinary function and sexual function were assessed by the EORTC QLQ-C30, SF-ICIQ and FSFI questionnaires, respectively. The differences between groups and correlations were assessed using Student's r-test, Chi-squared test, Mann-Whitney U-test and Spearman's rho test.Results: The groups were similar in terms of marital status, educational status, menopausal status, hormone therapy and height. The occurrence and severity of LLE were higher in women with vulvar cancer compared with the control group (p < 0.001 and p = 0.003, respectively). A significant association was found between the severity of LLE and advanced age (p = 0.04), and the severity of LLE and higher body mass index (BMI; p = 0.04) in patients with vulvar cancer. In the patients with vulvar cancer, there was a significant correlation between the severity of LLE and worse QoL in the following domains: physical, cognitive, emotional, social, fatigue, pain, sleep and financial questions (p < 0.05). There was no difference in urinary function between the two groups (p = 0.113). Age and number of deliveries were the only variables associated with the occurrence of urinary incontinence (p = 0.01). Urinary incontinence was present in women with a mean age of 74.9 +/- 4.6 years and a mean of 7.3 +/- 1.3 normal deliveries. There was no difference between the groups in terms of the sexual function. Multivariate analysis showed an association between sexual function and age (p = 0.01), and sexual function and being in a stable relationship (p = 0.02).Conclusion: Patients submitted to vulvectomy or inguinofemoral lymphadenectomy for vulvar cancer are at higher risk of developing LLE compared with healthy, age-matched women. This has a negative effect on QoL, but does not interfere with urinary or sexual function. (C) 2012 Elsevier B.V. All rights reserved

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved