The female genital tract represents the first line of defence against HIV. Biological factors such as female sex hormones, and the vaginal microbiota are known to affect HIV susceptibility at this site. The female sex hormone estradiol is known to play a protective role, whereas the progestin based contraceptive medroxyprogesterone acetate increases HIV susceptibility HIV. In addition, a Lactobacilli dominant vaginal microbiota is generally protective against HIV. Therefore, in this study, we aimed to elucidate the effects of female sex hormones, and Lactobacilli on the innate immune response of vaginal epithelial cells. / Thesis / Master of Science (MSc)

Made available in DSpace on 2014-08-26T17:31:46Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 69587.pdf: 2997505 bytes, checksum: dc74916c69c19057bfb89c77256c2717 (MD5) / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil / Introdução: O câncer do colo do útero é a 3ª neoplasia mais frequente no Brasil e tem alto potencial de prevenção e de cura. Não conhecemos a frequência de doença invasiva em mulheres com diagnóstico citopatológico de lesão de alto grau não podendo excluir microinvasão (HSIL-micro). Objetivo: Estimar o risco, por meio da razão de prevalências (RP), de lesão pré-invasiva e de lesão invasiva em mulheres com exame citopatológico de HSIL-micro em comparação àquelas com lesão de alto grau (HSIL), bem como sua relação com os achados colposcópicos. Metodologia: Estudo de corte transversal em que mulheres com HSIL-micro encaminhadas para duas unidades de referência foram identificadas na base de dados do laboratório que centralizava esses exames no município do Rio de Janeiro, no período de junho de 2006 a junho de 2012. Para cada mulher com HSIL-micro foram identificadas quatro mulheres com diagnóstico de HSIL recebidas em datas mais próximas de cada uma com HSIL-micro e que preenchessem os critérios de inclusão. Os dados foram obtidos a partir de revisão dos prontuários. Resultados: Foram incluídas 47 pacientes com laudo de HSIL-micro e 188 pacientes com laudo de HSIL. Controlando para idade, mulheres com HSIL-micro apresentaram RP de lesões pré-invasivas e invasivas 1,25 (IC95% 1,10-1,42) vezes maior do que as com HSIL. Para lesão invasiva, a RP foi 3,67 (IC95% 2,30-5,85) vezes maior nas mulheres com HSIL-micro. Não encontramos associação significativa entre a presença de lesões e achados colposcópicos ou possibilidade de visão da Junção escamo-colunar. / Introduction: Cervical cancer is the 3rd most common cancer in Brazil and has a high potential for prevention and cure. We do not know the prevalence of invasive and pre–invasive disease in women with cytological diagnosis of high-grade lesion-can not exclude microinvasion (HSIL-micro). Objective: To estimate the prevalence ratio(PR)of pre-invasive and invasive lesions in women with HSIL-micro Pap smearcompared to those with high-grade lesion (HSIL), as well as their relationship with colposcopic findings. Methods: Cross-sectional study in which women with HSIL-micro and HSIL routed to two reference units were identified in the cytology lab database, from June 2006 to June 2012. For each woman with HSIL-micro, four women with a diagnosis of HSIL who fulfilled the inclusion criteria were identified. Data were obtained from review of medical records. Results: We included 47 patients with report of HSIL -micro and 188 patients with report of HSIL. Controlling for age, women with HSIL-micro presented a PR of pre-invasive and invasive lesions of 1.25 (95% CI 1.10 to 1.42) times greater than those with HSIL. For invasive lesion only, the PR was 3.67 (95%CI 2.30 to 5.85) times greater in women with HSIL micro. We did not find a significant association between the presence of lesions and colposcopic findings or possibility of vision of the squamocolumnar junction .

This project aims towards offering people with vulva an insight in their vaginal bacterial flora through vaginal discharge. Together with users, experts and collaboration partners, a problem space is defined. There are tabooin the society concerning how we relateto female genitalia which creates issues regarding shame and obstacles in seeking medical care when its needed. This is what the project hopes to contribute a small change to. Throughout this project process there is a sense of working together and creating together. The result is a vaginal discharge tracking device that offers peoplea visualization of their discharge in theform of colored light. The aim is to bring the conversation of vulvae, vaginal discharge and vaginal problems to a tangible space in order to normalize and actively work against shame connected to female genitalia. The concept also aims to enncourage people to be more open to talking to other people about the subject and seek medical care when needed. / Det här projektet är riktat mot att erbjuda personer med vulva insyn i sin vaginala bakterieflora genom flytningar. Tillsammans med användare, experter inom området och samarbetspartner, har en problemfromulering definierats. I samhället vi lever i råder mycket tabu kring hur vi relaterar till feminin intimbiologi vilket skapar problem i form av skam och hindrar personer med vulva frånatt söka vård då de behöver det. Detta är vad projektet hoppas kunna bidra med förändring till. Genom hela projektprocessen har fokus varit på gemenskap, att arbeta och skapa tillsammans. Resultatet är en produkt för att dokumentera och följa sina vaginala flytningar, som erbjuder personer med vulva en visualisering av flytningar i form av ljus. Syftet är att ta konversationen rörande underlivet, flytningar och vaginala problem till ett fysiskt utrymme för att normalisera och aktivt arbeta emot skam kopplat till kvinnliga könsorganet. Konceptet är också riktat åt att uppmuntra personer med vulva att vara mer öppna om att prata med andra om sitt underliv och att söka vård då de behöver det.

Objetivo: Comparar la morbimortalidad materno perinatal entre parto vaginal y cesárea electiva en gestantes a término con antecedente de cesárea anterior una vez. Materiales y Métodos: Estudio descriptivo retrospectivo comparativo en gestantes con cesárea previa, que tuvieron parto vaginal o cesárea del 2000 al 2002 (36 meses). La población de estudio lo conforman gestantes con antecedente de cesárea previa única sin contraindicación actual para parto vaginal. Se revisaron 1128 casos, excluyéndose 260(23.05%) por no cumplir con los criterios de inclusión, obteniéndose 868 casos (94.86%); los casos se analizaron en tres grupos de acuerdo a la culminación de parto: 460 parto vaginal, 231 cesárea intra parto (durante trabajo de parto) y 177 cesárea electiva. Resultados En la población de estudio el grupo etáreo predominante fue de 20 a 34 años con 79.0%; el 100% fueron gestantes a término, sólo 61.1% tenían control prenatal adecuado (mayor o igual a 5); 408 gestantes (47.0%) del total culminaron en cesárea; de 691 gestantes que intentaron parto vaginal 460 (66.77%) fueron exitosos; las complicaciones presentes fueron endometritis, infección de herida operatoria, ITU, fiebre puerperal, transfusión sanguínea, éstas dos últimas sin causa definida, las gestantes que se sometieron a cesárea electiva tuvieron 6.78% de complicaciones en comparación con el 5.35% de gestantes que intentaron parto vaginal, pero en conjunto no hubo diferencia significativa (p:0.07). No hubo ningún caso de rotura uterina, muerte materna o neonatal. Oxitocina fue usada en 161 pacientes (18.54%), se uso fórceps en 03 gestantes (0.34%), vacuum extractor en 02 gestantes(0.23%). Existió mayor frecuencia de asfixia moderada a severa en el grupo de cesárea electiva con 1.13%(02 neonatos) en comparación con el grupo de chance vaginal con 0.87%(06 neonatos) estadísticamente no significativa (p:0.6). Conclusión: El chance vaginal en cesareadas anteriores una vez fue exitoso en 66.77%, no encontrándose diferencia significativa en la morbilidad materno-perinatal en comparación con el parto por cesárea.

La Endometriosis es una situación muy frecuente en nuestro medio. Para resolverla disponemos actualmente de diferentes alternativas diagnosticas y terapéuticas. Y evaluamos si el diagnostico ecográfico precede al diagnostico laparoscopico en mujeres con diagnostico de infertilidad y posteriormente luego de su tratamiento laparoscopico el porcentaje de éxito de su fertilidad Objetivo: Definir la utilidad de la ecografía transvaginal y su correlación con el diagnostico laparoscópico en pacientes con infertilidad y que fueron llevados a cirugía en el Hospital Nacional Arzobispo Loayza / -- he Endometriosis is a very frequent situation in our means. In order to solve we have it different alternatives at the moment you diagnose and therapeutic. And we evaluated if I diagnose ecográfico precedes to I diagnose laparoscopic in women with I later diagnose of infertility and after its laparoscopic treatment the percentage of success of its. Objective fertility: To define the utility of the transvaginal ecografía and its correlation with I diagnose laparoscopic in patients with infertility and who were taken to surgery in the National Hospital Loayza.

Two vaginal phylotypes of the genus Megasphaera (phylotype 1 and phylotype 2) were recently associated with bacterial vaginosis (BV), an infection characterized by vaginal dysbiosis. Through an analysis of 16S rRNA profiles of 3,986 women enrolled in the Vaginal Human Microbiome Project, we confirmed that while both phylotypes were associated with BV, Megaspheara phylotype 1 had higher specificity for the condition. Megasphaera phylotype 2 was strongly associated with trichomoniasis. Previous studies have reported that BV-associated organisms are excluded in pregnancy. We observed that Megasphaera phylotype 1, which has been associated with adverse pregnancy outcomes, exhibited a trend of increased prevalence in the pregnant cohort. We sequenced the genomes of isolates of the two phylotypes and performed comparative analyses. We demonstrate that these two phylotypes have distinct genomic features and unique potential for metabolic processes that reveal niche specialization. These findings may provide insight into their differential associations with vaginal infections.

OBJETIVO: Comparar las complicaciones materno neonatales de la cesárea electiva versus parto vaginal en pacientes con cesárea previa atendidas en el Instituto Nacional Materno Perinatal, 2015. METODOLOGÍA: Estudio de tipo descriptivo comparativo, retrospectivo de corte transversal. Para este trabajo se trabajó con dos muestras: 102 gestantes con cesárea previa que culminaron en cesárea y 48 gestantes con cesárea previa cuyo parto culminaró en parto vaginal, atendidas en el Instituto Nacional Materno Perinatal en el año 2015. Para el análisis descriptivo de las variables cuantitativas y cuantitativas se estimó medidas frecuencias absolutas y porcentajes Se utilizaron las herramientas graficas de Microsoft Excel 2013 como diagramas barras. RESULTADOS: Los datos obtenidos acerca de las complicaciones maternas, en el grupo de cesárea se presentaron como principales complicaciones maternas hemorragia post parto 2.9%, anemia leve 34.3% y anemia moderada con 11.8%; otras complicaciones tuvieron un porcentaje de 21.6% tales como síndrome adherencial pélvico e inminencia de rotura uterina, se reportó un caso de rotura uterina y ningún caso de muerte materna. Para el grupo de parto vaginal se observó que el desagarro vulvoperineal grado I tuvo un porcentaje de 35.4% y el de grado II con 2.1%, al 50% de las pacientes se le realizó episiotomía; el 45,8% tuvo anemia leve y el 6.3% tuvo anemia moderada y solo el 4.2% tuvo otras complicaciones tales como alumbramiento incompleto y hematoma perineal. Con respecto a las complicaciones neonatales se observó que en el grupo de cesárea se presentaron como principales complicaciones neonatales Síndrome de Dificultad Respiratoria con 7.8%, Taquipnea Transitoria del Recién Nacido con 5.9% y Líquido aminiótico meconial fluido con un porcentaje de 14.7% y el meconial espeso con 9.8%; se reportaron 2 casos de APGAR 3 y APGAR 7 a los 5 minutos respectivamente y 1 caso de muerte neonatal. Para el grupo de parto vaginal se observó que el 39.6% sufrió de trauma obstétrico como caput succedaneum y cefalohematoma y el 25% presentó Liquido meconial fluido. Para ambos grupos, solo el 2% presentó otras complicaciones tal como recién nacido hospitalizado. CONCLUSIÓN: Ambas vías de parto fueron seguras y la decisión final depende de la evaluación individual de cada gestante, así como de la adecuada comunicación de los riesgos y beneficios para la toma de decisión conjunta del médico con la paciente. PALABRAS CLAVES: Complicaciones maternas, complicaciones neonatales. / --- OBJECTIVE: To compare maternal and neonatal complications of elective caesarean section versus vaginal delivery in patients with previous cesarean section served by the Instituto Nacional Materno Perinatal, 2015. METHODOLOGY: Study of comparative, retrospective descriptive cross-sectional. For this work, we worked with two samples: 102 pregnant women with previous cesarean culminating in caesarean and 48 pregnant women with previous cesarean whose birth culminaró in vaginal delivery, served by the National Materno Perinatal Institute in 2015. For the descriptive analysis of the variables quantitative and quantitative measures was estimated absolute frequencies and percentages graphical tools such as Microsoft Excel 2013 bar diagrams were used. RESULTS: The data on maternal complications in cesarean group were presented as major maternal complications postpartum hemorrhage 2.9%, 34.3% mild and moderate anemia anemia with 11.8%; other complications had a percentage of 21.6% syndrome such as pelvic adhesions and imminence of uterine rupture, a case of uterine rupture and no cases of maternal death was reported. For the group of vaginal delivery it was observed that the Vulvo desagarro grade I had a percentage of 35.4% and 2.1% Grade II, 50% of patients underwent episiotomy; 45.8% had mild anemia and 6.3% had moderate anemia and only 4.2% had other complications such as incomplete delivery and perineal hematoma. Regarding neonatal complications was observed in the group of caesarean section were presented as major neonatal complications Respiratory Distress Syndrome with 7.8% Transient Tachypnea of Newborn with 5.9% and aminiótico meconium fluid with a percentage of 14.7% and meconium thick with 9.8%; 2 cases of APGAR 7 APGAR 3 and 5 minutes respectively and 1 case of neonatal death were reported. For the group of vaginal delivery it was observed that 39.6% of obstetrical trauma suffered as caput succedaneum and cephalohematoma and 25% had meconium fluid. For both groups, only 2% had other complications such as newborn hospitalized. CONCLUSION: Both routes were safe delivery and the final decision depends on the individual assessment of each expectant mother, as well as the proper communication of risks and benefits for joint decision making with the patient's physician. KEY WORDS: maternal complications, neonatal complications

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Family Medicine. / Introduction South Africa has more people living with HIV than any other country in the world.1 Women infected with HIV have a high risk in the development of cervical dysplasia and cancer of the cervix more so than women who are not infected.2,3 Methods A cross-sectional descriptive study was carried out by reviewing cervical smears of HIV positive women in a district hospital. Three hundred and ninety cervical Pap smears were classified according to the Bethesda system. Adherence was measured by the patient’s report and viral load. Data was collected through the use of self administered questionaire and data capture sheet. Results The prevalence of abnormal Pap smears was 57 per cent and LSIL was the commonest abnormality seen (142/390, 36%). Eighty-four per cent (328/390) had stage 1 WHO-HIV classification. WHO stage 3 participants seemed to be three times more likely to have abnormal Pap smears than those with WHO stage 1 (OD 3.3, STD. error 1.70, p=0.018, 95% CI 1.23-9.04). Abnormal pap smears were seen more in participants with CD4 cell count ≤ 350 cells/μL as compared to participants with CD4 cell count ≥ 500 cells/μL { 122/172, (71.00 %) vs 48/117, (41.03%), p-0.000, 95% CI : 0.09-0.37}. Similarly, participants who did not use HAART had more abnormal results as compared to those who used HAART {42/60(70.00%) vs 180/330 (55.00%), p-0.028, 95% CI 0.28-0.93}.Adherence to HAART did not show any link with abnormal smears. Conclusion The more immune-suppressed a woman is, the higher the risk of developing cervical cancer precursors. The high risk group in this study was found to be the participants with the CD4 cell count of ≤ 350 cells/μL and the viral load ≥1000 copies/mm3. The self-reported adherence level did not show any impact.

"Vulvovaginal candidiasis (VVC) is a mucosal infection caused by Candida species and represents one of the most common clinical problems in women of reproductive age (68,71). Annually in the United States there are approximately 13 million cases of VVC, resulting in 10 million gynecologic office visits per year (38). It is estimated that 75% of women will experience at least one episode in their lifetime, with a projected 50% of all women experiencing multiple episodes (23). Candida albicans is a dimorphic commensal organism of the urogenital and gastrointestinal tracts and has been identified as the main pathogenic agent in VVC, accounting for approximately 85-90% of patients with positive cultures (52). Despite extensive research, the invasive mechanism of vaginal yeast infections is not well understood. Traditionally it has been assumed that changes in the host vaginal environment promote the dimorphic transition from blastospore to hyphae, resulting in a shift from asymptomatic colonization to symptomatic vaginitis (28). In contrast to the normal, systemic immune response, which confers an aseptic environment for tissue and organs, immune responses at the mucosal level are designed to prevent tissue invasion and local disease while maintaining an indigenous flora that could be both beneficial and pathogenic (28). Since fungi are eukaryotic, the vital cellular mechanisms that are usually targeted by modern pharmacologic agents, such as DNA replication and protein translation, are either conserved or have a strong homology to their human orthologs. Obtaining a better understanding of natural fungal suppression mechanisms and molecules at the mucosal level may pave the way for the development of more efficacious drugs or preventative regiments. The mechanism by which the human immune system is able to resist fungal invasion at the vaginal mucosa is unknown. Our research was aimed at finding any host factors that might play a role in the suppression of or prevention of a fungal infection at the vaginal mucosa. In order to screen candidate molecules that might be important in this type of vaginal defense, we chose a pathogenic C. albicans strain, SC5314, to test fungal cell viability upon introduction of the candidate molecules. We have identified a host factor that exhibits strong fungicidal activity when organically extracted from both human and bovine serum albumins. Characterization of this factor through organic extractions and acetone separations reveal that this molecule is a non-polar lipid. Serum samples that have been thoroughly stripped of fatty acids and other lipophilic molecules show no apparent fungicidal activity in cell viability assays. Since the factor is extractable from both human and bovine serum albumins, it may be conserved among mammals. Identification and characterization of this molecule may play a pivotal role in understanding host-Candida interactions at the mucosal membrane interface. Due to its human origin, the use of this factor as an antifungal would be extremely advantageous in regards to FDA (Food and Drug Administration) guidelines and ADMET (Adsorption, Distribution, Metabolism, Excretion, Toxicology) properties. "

<p>Urininkontinens är en sjukdom erkänd av Världshälsoorganisationen(WHO)1998. The International Continence of Society(ICS) har definierat urininkontinens: "Det är ett urinläckage som är objektivt påvisbart och utgör ett socialt och hygieniskt problem för individen" urininkontinens drabbar ofta kvinnor i förbindelse med graviditet, förlossning eller kejsarsnitt. Det kan räcka med att bli gravid. Syftet med litteraturstudien var att belysa riskfaktorer som kan orsaka stressinkontinens under graviditet och efter vaginal förlossning. Resultatet visar att vaginal förlossning som avslutas med forceps utgör störst risk att drabbas av stressinkontinens. Det behövs fler studier för att upplysa barnmorskor om hur de kan ge evidensbaserad vård till kvinnor som föder vaginalt för att undvika urodynamiska skador.</p>