Young women in a socioeconomic situation of vulnerability, with low schooling and multiparous represent the majority of HIV-positive pregnant women attended at the service. Evaluations performed during the prenatal period were relevant for the diagnosis of infection in most cases. An early diagnosis associated with proper clinical, obstetrical and psychological monitoring and with nursing care is important to provide appropriate treatment compliance and a reduction of the rates of vertical transmission.
-Medical Education.-Professional Training.-Learning. ABSTRACT A cross-sectional descriptive study was conducted at the Santa Maria university hospital from November 2008 to January 2009. It aimed to assess medical residents' point of view regarding the activities of a residency. The participation was voluntary and confidential and was approved by the
Resumo: A Região Sul do Brasil conta com o maior número de casos de câncer de pele no país, logo, a descrição de dados sobre a morbidade desses cânceres nesta região é de grande relevância. Realizouse estudo descritivo retrospectivo populacional, envolvendo pacientes que realizaram exame anatomopatológico no serviço de dermatologia do HUSM, no período de 1993 a 2008. Utilizaramse os testes Quiquadrado e Exato de Fisher. Incluiuse 1.246 pacientes, sendo 56,7% do sexo masculino e 43,3% do feminino, com média de idade de 61,1 (±11,8) anos, sendo a maioria com mais de 60 anos. O tipo histológico mais encontrado foi o carcinoma basocelular (60,5%), seguido do epidermóide (27,4%) e melanoma (8,4%). Constatouse predomínio do câncer não melanoma, tipo basocelular, na faixa etária acima de 60 anos e em áreas fotoexpostas. Os cuidados com a exposição solar permanecem como uma das principais medidas preventivas contra o câncer de pele.
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Pretendeu-se estimar a prevalência e o comportamento quanto ao uso de condom entre estudantes universitários através de inquérito epidemiológico. Utilizaram-se a estatística descritiva das variáveis e análise bivariada, com a realização dos testes qui-quadrado de Pearson, exato de Fisher e t de Student. De 330 estudantes, 84,5% foram incluídos na análise. O percentual de alunos que já haviam usado condom foi de 96,9% e o uso consistente deste foi maior entre os homens (p=0,013). Os indivíduos que não usaram preservativo na última relação sexual (57,3%) justificaram o fato por possuírem relacionamento estável. Os homens afirmaram redução do prazer ao uso de condom. Dos entrevistados, 67,2% acreditavam na importância do uso do método como prevenção contra doenças sexualmente transmissíveis. A relação estável demonstrou ser fator para o não uso do condom, e várias pessoas referiram desconforto e menor prazer com o método. As mulheres foram mais suscetíveis ao sexo desprotegido.
Introduction: Pelvic organ prolapse (POP) is a herniation of the pelvic organs to or beyond the vaginal walls. Treatment is indicated for women with symptoms or associated conditions (urinary, bowel or sexual dysfunction). Surgery is an option when a conservative treatment failed or is declined. A variety of surgical approaches are available. The use of transvaginal mesh (TVM) procedures has revolutionized this operative field, related with high success. At 2008 FDA alert about potential complications that conduct of withdrawn from the market of several mesh systems. The aim of this study was to report outcomes after the TVM procedure. Methods: We performed a retrospective analysis of 54 women surgically treated with Prolift TM TVM at Urogynecology division of Leiria Hospital Center, between January 2009 and January 2016. Outcome was assessed using the POP Quantification system and complications were reported with the Prosthesis Complication Classification Code designed by the International Continence Society/International Urogynecological Association. Failure was defined as recurrent prolapse (stage ≥2). Statistical analysis was performed with STATA13 (p < 0.05). Results: Over a 6-year period, 54 menopausal women were included with a mean follow-up of 51.9 months (9-82). Mean age was 63.8 years (51-85), median vaginal labor was 2 (0-5), 39% was grade 1 obese, 51.8% had stress urinary incontinence (SUI) and 5.6% urge incontinence (UI), 40.7% had a previous hysterectomy and 9.3% previous POP surgery. Thirty-seven patients had a stage 3 (68.5%), 12 a stage 4 (22.2%) and 5 stage 2 (9.3%). Total mesh was used in 10 patients (18.5%), an isolated anterior mesh in 40 (74%) and an isolated posterior mesh in 4 patients (7.5%). Eleven patients had concomitant posterior colpoperineoplasty (PCP) (20.4%) and 31 vaginal sling procedure (57.4%). At intraoperative context, none bladder injury, transfusion or bleeding ≥250 mL were reported. According to CTS Classification, we report 16.8% complications, 4 patients at T1 (7.4%: 2 C1Aa and 2 C1Bc), 3 at T2 (5.6%: 2 C2Bc and C2Bc), 1 at T3 (1.9%: C3Bc) and 1 T4 (1.9%: C2Aa), all S1. One mesh exposure was successfully managed with resection under anesthesia, 4 months after surgery and one partial exposure occurred at 60 months, the thread exposed was resected. We reported a failure rate of 5.6% (3), after a mean of 14 months (1-35), and one PCP failure (9%). Six patients presented de novo prolapse (11%) and six de novo urinary incontinence (3SUI and 3UI). Twenty-three patients had pre-operative sexual activity (42.6%). De novo dyspareunia rate was 11%. We don't find statistical association between POP surgery and de novo POP in the non-operate compartment. Conclusions: The Prolift TM system seems to be associated with few severe complications, we report an overall success of 94.4% with 89% asymptomatic women; 78% of complications had a medical management. A long-term follow-up is necessary to confirm the effectiveness of the procedure.
Turin. We considered 8 criteria of good practice from the review of national and international guidelines and we elaborated one or more indicators for each criterion, to evaluate caesarean delivery rate in the light of these criteria. Criteria and indicators are: Twin pregnancy with both cephalic presentation (dichorionic diamniotic, monochorionic diamniotic); preterm deliveries (≤32, ≤34 and ≤36 weeks of gestational age); maternal request; maternal age ≥45 years; previous caesarean delivery; BMI ≥50; HCV and HIV maternal infection. The rate of caesarean sections found in each criterion was compared with the respective standard in literature. The value obtained for each indicator has been tested for statistical significance (CI 95%). We considered performing indicators whose final rate was found to be better or equal to the reference standard.Results: Performing indicators: dichorionic diamniotic (≤59% vs. 44%); monochorionic diamniotic (≤77% vs. 71%); preterm deliveries ≤36 weeks (≤18.9 vs. 13%); maternal request for CS (≤40% vs. 12%). Non performing indicators: previous caesarean delivery (≤30% vs. 84%); preterm deliveries ≤34 weeks (≤27% vs. 29%); preterm deliveries ≤32 weeks (≤45.5% vs. 77%).Conclusions: The majority of the analysed indicators resulted to be performant and we suggest to consolidate the clinical practice that relates to such indicators. The rate of repeated caesarean sections was significantly higher than the standard value (84% vs. ≤30%). To reduce inappropriate repeated surgical intervention, our clinical audit provides a plan of improvement based on internal protocols, written informations and dedicated counselling for women with previous caesarean sections. Currently, we are re-auditing the impact of the implemented measures on repeated caesarean sections. Even if there analysis is still not completed, the general trend appears to be decreasing. In conclusion we support the use of Audit as a mean to improve health practice and we encourage comparison of the results and diffusion of the model in other clinical settings.http://dx.(S. Pedrosa).Protein S (PS) deficiency is associated with venous thromboembolism (VTE) and adverse pregnancy outcome and its prevalence is 0.03-0.13% in the European population. Many studies have focused on establishing the references curves for the gestational age for free PS (FPS) and total PS (TPS), in order to differentiate normal and abnormal PS deficiency in pregnancy. In 2006, Maternidade Bissaya Barreto laboratory construct reference ranges derived from normal gestations in caucasian women. The aim of this retrospective study is to evaluate the PS deficiency in women with adverse obstetric outcome or family/personal history of VTE and assess the impact of treatment in subsequent pregnancy.Methods: This study (since 2012-2015) included 297 women who have previously experienced adverse pregnancy outcomes or personal/family history of thrombosis. These women were submitted to FPS and TPS tests in preconceptional period after cessation of estrogen or vitamin K-a...
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