Orientador: Simões, José Antonio, Luis Guillermo Bahamondes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-09T14:34:37Z (GMT). No. of bitstreams: 1 Lessard_TriciaAlbuquerqueRocha_M.pdf: 479763 bytes, checksum: 603ad88ed5dd9e2fd143cdb633df0f9c (MD5) Previous issue date: 2007 / Resumo: Objetivo: Estudar as alterações citológicas e a flora vaginal nos esfregaços cérvico-vaginais de usuárias de sistema intra-uterino liberador de levonorgestrel (SIU-LNG), por um período de até sete anos. Métodos: O estudo foi realizado no Ambulatório de Planejamento Familiar da Universidade Estadual de Campinas, onde 187 mulheres tiveram o SIU-LNG inserido entre abril e setembro de 1998, ininterruptamente por sete anos consecutivos. Todas as mulheres incluídas faziam parte de um outro estudo para avaliar a eficácia do DIU por esse período de tempo e assinaram um termo de consentimento pós-informado. A cada consulta ginecológica, foram colhidos esfregaços endocervicais e ectocervicais, que foram enviados ao Laboratório de Citopatologia e classificados segundo Bethesda 2001. Todas as mulheres incluídas na análise tinham citologia oncológica prévia negativa denominada citologia oncológica (CO) zero e pelo menos uma citologia pós-inserção. Foram designadas CO1 as citologias colhidas entre seis meses e um ano pós-inserção, CO2 aquelas colhidas entre um ano a dois anos pós-inserção e assim, sucessivamente, até CO7 para as citologias com mais de seis anos pós-inserção. Para a avaliação microbiológica deste estudo, todas as lâminas foram revisadas utilizando como critério diagnóstico a classificação de Bethesda 2001, exceto para a avaliação de vaginose bacteriana que foi considerada a presença de 20% ou mais de clue cells no Papanicolaou. Nos casos inconclusivos, os esfregaços foram enviados para uma médica citopatologista designar o diagnóstico final. A incidência das alterações citológicas e a flora vaginal ao longo dos sete anos de uso do SIU-LNG, foram analisadas através do teste de tendência Cochran-Armitage. Resultados: Durante os sete anos de seguimento do SIU-LNG, houve maior freqüência de infecção por cândida sp nestas usuárias. Não foram encontradas diferenças significativas em relação a qualquer outra alteração microbiológica ao longo dos sete anos de uso. Em relação à presença de alterações citológicas, não foram encontrados resultados estatisticamente significativos, apesar de ter sido observado um aumento na frequência de alterações citológicas no sexto ano de uso do SIU-LNG. Conclusão: O uso prolongado do SIU-LNG esteve associado a uma maior frequência de cândida sp. Entretanto, há a necessidade de se considerar que as queixas clínicas de cândida sp vaginal não foram referidas pelas usuárias, mas sim observadas em seus esfregaços cérvico-vaginais. Em relação a patologia cervical o SIU-LNG mostrou-se seguro, pois não se observou, no Papanicolaou, desenvolvimento de lesões intra-epiteliais de alto grau ou neoplasia cervical ao longo dos sete anos de uso / Abstract: Objective: To evaluate the cytophatological abnormalities and vaginal flora in cervical smears samples women using the Levonorgestrel-releasing intrauterine system (LNG-SIU) for a period of up to seven years. Methods: The study was carried out at the Family Planning Out-patient of the Universidade Estadual de Campinas where 187 women who had an LNG-IUS inserted between April and September of 1998, without exchange. At each gynecological consultation the endocervical and ectocervical samples was collected for smears and sent to the Cytophatology Laboratory where they were stained according to the Papanicolaou technique. Cytopathological evaluation was carried out using 2001 Bethesda System classification. All 187 subjects had normal Pap-smears preinsertion that was nominated Pap-smear (C.O.) zero and, at least, one postinsertion Pap-smear. The postinsertion Pap-smear collected between six months to one year was defined CO1; another one collected between one to two years was defined CO2 and thus, successively, until CO7 for postinsertion Pap-smears collected with more than six years. For this study, all the slides were submitted to a second analysis by a cytologist who considered the presence of 20% or more clue cells as the diagnostic criteria for bacterial vaginosis (BV). In the cases in witch this evaluation did not agree with the initial diagnosis, either with respect to microbiological flora or to cytopathological abnormalities, the smears were then examined by another cytopathologist, who gave the final diagnosis of the smear. The frequency of the cytophatological abnormalities and vaginal flora versus long term use of LNG-SIU was analyzed using Cochrane-Armitage trend test. Results: The cytopathological abnormalities found over the 7 years of follow-up showed no variation in the incidence of any cytopathological lesion or of low-grade or high-grade squamous intraepithelial lesions. With respect a cervicovaginal infections the frequency over the 7 year follow-up period remained constant with respect to any kind of microbiological alteration for every year post-insertion. However, a significant increase incurred in the percentage of cases positive for cândida sp after 4 years of use, which reverted in the 7th year Conclusion: The results of this study have shown that the LNG-SIU may be associated, in some users and after long periods of use with a greater predisposition for cândida sp. Nevertheless, it should be taken into consideration that the clinical complaints of cândida sp were not reported by the users, but were observed in their cervicovaginal smears. These findings also confirm the safety of the LNG-IUS as a contraceptive method throughout 7 years of use, since, according to cervical smear test results, the device was not associated with any increase in intraepithelial lesions that could evolve to cervical cancer, no significant cytopathological alterations being detected over this long period of use / Mestrado / Tocoginecologia / Mestre em Tocoginecologia

Made available in DSpace on 2014-06-12T18:28:04Z (GMT). No. of bitstreams: 2 arquivo1143_1.pdf: 1341192 bytes, checksum: 28c1a0abdeb803275cd83cc199fae089 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009 / INSTITUTO DE MEDICINA INTEGRAL PROF FERNANDO FIGUEIRA / Esta tese, apresentada em dois artigos, teve por objetivo comparar dois tratamentos para Vaginose Bacteriana, utilizando metronidazol e aroeira, em aplicação tópica vaginal e estudar o perfil clínico, epidemiológico e bacteriológico das mulheres participantes, antes de serem submetidas ao tratamento. O primeiro artigo consistiu de um ensaio clínico randomizado, duplamente mascarado, que comparou a eficácia entre os dois tratamentos em mulheres com vaginose bacteriana diagnosticada, concomitantemente, pelos critérios de Amsel e Nugent. Foi utilizada a Análise por Intenção de Tratar. Do total de 277 participantes do ensaio clínico, 137 mulheres foram tratadas com gel de Aroeira e 140 tratadas com Metronidazol. Na avaliação de cura pelos critérios de Amsel, 21,2% das pacientes que utilizaram aroeira e 62,1% que usaram metronidazol obtiveram cura. Quando o Escore de Nugent foi utilizado foram curadas 13,9% das mulheres do grupo da aroeira e 56,4% do grupo metronidazol. A cura total (com a utilização dos dois critérios) foi observada em 12,4% do total de pacientes no grupo da aroeira e 56,4% das mulheres que usaram metronidazol. O segundo artigo constou de uma série de casos onde foram estudados os achados clínicos, epidemiológicos e microbiológicos das participantes do ensaio clínico antes do tratamento, além da presença de lactobacilos nas citologias oncóticas e a população bacteriana componente das microbiotas vaginais identificadas por culturas de secreção vaginal. Entre as queixas clínicas, as mais frequentes foram o corrimento genital, observado em 74,4% das participantes e o odor de peixe da secreção vaginal, que ocorreu em 68,6% dos casos. As culturas de conteúdo vaginal permitiram a identificação de Gardnerella vaginalis em 96,8% e de Mobiluncus em 53,1% dos casos. Apenas em uma terça parte dos exames (32,1%) havia a presença de Lactobacillus. Como conclusões dos estudos, foram observados índices de cura menores com a utilização de Aroeira do que com Metronidazol; os efeitos colaterais foram pouco frequentes e sem maior gravidade em ambos os grupos e continuam necessários novos estudos que melhor elucidem as inter-relações entre os achados microbiológicos e a expressão clínica da doença

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Athymic nude mouse models have been extensively used to study biological behaviour of normal and diseased human tissues. In such models, immune-deficient mice act as hosts for cysts constructed from human material. A unique biocyst model that entails transplantation of human vaginal cysts into athymic nude mice has been implemented to study diseases of oral mucosa. To date, only one immunohistochemical study of this biocyst model has been reported. Nevertheless, conclusions made in that study were only based on the observed expression patterns of human and murine markers. Statistical assessment of immunohistochemical data had been omitted by the investigator. Therefore, the objective of this study was to further delineate the immunohistochemical profile of normal human vaginal tissue and human vaginal tissue that had been xenografted into nude mice.Experimental cysts constructed from human vaginal mucosa were xenografted into athymic nude mice and harvested 9-weeks post transplantation. Immunohistochemical analysis of normal human vaginal tissue and human vaginal tissue that had been xenografted into nude mice was performed using a panel of human and murine markers. Expression patterns of human and murine markers were assessed. Human markers included cytokeratin 1,cytokeratin 5, cytokeratin 13, cytokeratin 14, collagen type IV, laminin, elastin, fibronectin,Langerhans cells and VEGFR-3. Murine markers included collagen type IV, laminin,fibronectin, Langerhans cells and VEGFR-2. Staining intensities were quantified and statistically analysed using one-way ANOVA with subsequent Friedman’s test for multiple comparisons. Since the sample size was small, the power of the test statistic was enhanced by including Dunn’s post-test for further multiple comparisons. A strong positive expression of all cytokeratins was detected in both normal and xenografted vaginal tissues. Human markers that exhibited weak to moderate positive expression were collagen IV, laminin, fibronectin and VEGFR-3. Human elastin and human Langerhans cells exhibited strong and varying expression patterns respectively. Weak expression patterns for all murine markers were reported, with an exception of VEGFR-2 which was negatively expressed in all xenografted vaginal tissues. Significant differences (P<0.05) in the mean staining intensities between normal and xenografted vaginal tissues were reported for cytokeratin 1, fibronectin and Langerhans cells. There were no statistical differences (P>0.05) in the mean staining intensities for other markers.In conclusion, immunohistochemical studies proved that human vaginal tissue could not only survive in nude mice, but could also become active and develop structures necessary for survival, in this case, a newly formed stromal layer. The epithelium and stromal layer exhibited a human ecosystem.

Lactobacilli are dominant bacteria of the vaginal flora. Lactobacillus-containing probiotics products are used for the treatement and profylaxis of bacterial urogenital infections. This work is focused on DNA identification and species identification of probiotic bacteria in 5 different vaginal tablets using molecular-genetic methods. Total DNA isolated from complex matrix of vaginal tablets was used for amplification in polymerase chain reaction. DNA was isolated from crude cell lysates by magnetic particles P(HEMA-co-GMA) and by method of phenol extraction. Identification of species of probiotic bacteria was verified using genus-specific and species-specific PCRs. Results of bacterial identification obtained by PCR were compared with declared specification given by producers. Bacteria of genus Lactobacillus were proved in all tablets whereus species identification was in accordance with the stated composition in 1 tablet only.

Objectives: To compare postoperative urinary retention and pain control when bupivacaine versus saline for hydrodissection is used while placing tension-free vaginal tape midurethral slings. Methods: A prospective, randomized, double-blind trial was performed after institutional review board approval. Sixty women were randomized to receive bupivacaine or saline for hydrodissection. Subjects and research team were blinded to subject assignments. Group characteristics were compared using the Student t test, the χ2 test, and the Mann-Whitney U test. Proportions of subjects with a successful postoperative voiding trial along with measurements of postoperative pain and analgesic use were compared using similar appropriate tests. The study was powered to detect differences in voiding trial success from an estimated 58% to greater than 90% with P < 0.05 and 0.8 power using 25 subjects per group. Results: Thirty patients were allocated to each group. One subject in the saline-only group was excluded. Group characteristics were not different. After surgery, pain medication use (20/30 vs 25/29 for bupivacaine vs saline only; P = 0.08), pain scores (36 ± 22 vs 31 ± 24; P = 0.49), and successful voiding trials did not differ (14/30 vs 19/29; P = 0.14), whereas postvoid residuals did differ (225 ± 180 mL vs 140 ± 147 mL; P = 0.043). Conclusions: Bupivacaine was not seen to improve immediate postoperative pain after placement of a tension-free vaginal tape. It did not increase the risk of failing a postoperative voiding trial. Without an obvious benefit, the use of an additional medicine is not supported. We suggest saline alone be used for hydrodissection.

Determina las barreras que limitan la participación de las mujeres en la toma de Papanicolaou en el C.S San Martín de Porres durante Julio 2013, mediante un estudio descriptivo, cuantitativo, transversal como resultado de una encuesta de opción múltiple dirigida a 100 usuarias que acuden al servicio de Obstetricia del Centro de Salud San Martin de Porres. La mayoría de mujeres encuestadas son jóvenes entre 20 y 29 años, con grado de instrucción secundaria y proveniente de la costa de nuestro país. Un 73 por ciento señaló que prefiere que su atención sea realizada por personal femenino. El 43 por ciento calificó su último Papanicolaou como “rápido” y solo un 21 por ciento como “doloroso”. Todas las encuestadas señalan que es importante realizarse esta prueba. La mayoría (65%) refiere que sí recibe información sobre esta prueba por parte de su centro de salud. Casi todas (81%) viven a menos de 10 cuadras de su establecimiento de salud y el 56 por ciento refiere que demoran en la atención. Para el 95% de las mujeres este test no es costoso a pesar de ser amas de casa la mayoría de ellas (67%) y contar con un ingreso familiar como sueldo mínimo (49%). / Tesis

Urininkontinens (UI) innebär att individen får ett ofrivilligt och besvärligt urinläckage.  Problemet är ett av våra största folkhälsoproblem och kan uppkomma hos alla i olika åldrar men det är främst kvinnor som drabbas. Resultatet är byggt på tio intervjuer som fokuserat på kvinnors upplevelser av att leva med UI efter vaginal förlossning. Att läcka urin efter en vaginal förlossning anses av många kvinnor som ett normalt tillstånd därför dröjer de med att söka hjälp. De försöker istället att hantera situationen på bästa sätt genom olika strategier för att klara det dagliga livet. Det innebär exempelvis att kvinnor minskar intag av dryck samt att de kissar innan de lämnar hemmet. Kvinnor blir begränsad i deras dagliga liv eftersom de inte kan utföra och delta i vissa fysiska aktiviteter och att umgås med andra på grund av rädsla att läcka och lukta urin. Kvinnor upplever att UI har negativ inverkan på deras sexualliv samt kan leda till en försämring i deras sexuella relationer. Kvinnor upplever även att de blir nonchalant bemötta av vårdpersonalen samt att det saknas kunskaper kring UI. Det framkommer känslor hos kvinnorna att vårdpersonalen struntar och ignorerar deras UI problem samt att ingen inom vården följer upp dem. Vårdpersonalen måste få ökad förståelse och kunskap för kvinnor med UI, för att bättre stödja och hjälpa dessa kvinnor så att de kan få en bättre livskvalitet. / Background: Urinary incontinence (UI) is an involuntary urinary leakage that affects the individual’s social life and quality of life. Urinary incontinence may occur in both sexes, but it is more common in women than men. Women may suffer from UI after vaginal delivery. Although UI causes a lot of suffering for women, there are few who seek help. In order for health professionals to be able to help and support these women, it is important to have knowledge and understanding of how UI affects women’s world of living. Aim: The aim of the study was to describe women’s experience of living with urinary incontinence after vaginal delivery. Method: Semi-structured qualitative interviews were performed with ten women with urinary incontinence after vaginal delivery. Qualitative content analysis was used for the analysis which resulted in seven categories. Results: The results show how UI affects women in daily life and how they handle the situation in the best way. The women experienced mixed feelings about the meeting with healthcare professionals. Seven categories emerged: How to handle urinary incontinence that is seen as a normal state, Experiencing limitations in life, To hide or share experiences with others, Urinary incontinence affects relationships, Urinary incontinence affects sex life, Meeting healthcare professionals and Experiencing urinary incontinence treatments. Conclusion: Women may suffer from urinary incontinence after vaginal delivery. They find it difficult to talk to others about this sensitive subject, which indicates that they are suffering in silence. Healthcare professionals and district nurses have an important role to catch, help and take these women's UI trouble seriously.

Problem: Vulvodynia, an unexplained vulvar pain, is a medical condition affecting women of all ages, races, and ethnicities and causes pain levels ranging from very mild discomfort to extreme suffering. Purpose: The purpose of this study was to explore women’s knowledge toward seeking care for vulvodynia and to explore the different types of treatments prescribed after diagnosis. The secondary purpose of this review was to describe the treatments most effective in reducing pain caused by vulvodynia. Methods: A review of the literature was conducted using articles from 2001 to 2021 that focused on diagnosis of vulvodynia and the relief of pain with various types of treatment options for women diagnosed with vulvodynia. Multiple databases were used, and world-wide research was compiled for context on diagnosis of vulvodynia and treatment options that worked best to reduce pain. From the literature review, 14 articles met the inclusion criteria and were used to compare diagnosis of vulvodynia and the different treatment methods to relieve pain. Results: All studies suggest women did not seek immediate care or have a timely diagnosis for vulvodynia because of speculation by health care providers that vulvodynia is a pseudoscience. Women avoided seeking early diagnosis due to embarrassment discussing the condition and fear of skepticism about the level of pain associated with vulvodynia. The studies showed topical ointments and complementary treatments were the most prescribed agents. Effectiveness ranged from no pain relief to complete relief, but the conclusions were relatively similar in all the results. A multidisciplinary approach to vulvodynia, with mental health professionals and gynecologic providers had the best outcomes in relieving pain and optimizing treatment. Conclusion: Knowledge about vulvodynia is very limited due to under diagnosis and embarrassment of admitting that something is wrong. Most of the research conducted was a general overview of cases and is focused on diagnosis of the condition. Benefits of therapy differ from woman to woman and complete pain relief, or remission is elusive in many instances. CAM therapies in combination with medications for individuals with vulvodynia to alleviate pain can be useful and finding multiple methods that can be used together for pain relief is of value for further research.

Background: The composition of the vaginal microbiota (VMB) in the female genital tract (FGT) can impact the vaginal epithelium and protect against or increase risk of sexually transmitted viral infections. The VMB grows as a biofilm, a complex structure formed by bacteria for increased survival. When the VMB consists of a diverse bacterial community it correlates with pathogenic effects that lead to adverse health conditions and an increased risk of HIV infection. When the VMB contains Lactobacillus species, beneficial health effects and decreased susceptibility to infection are observed. The aim of this project is to optimize an in vitro model of biofilm formation for different bacteria associated with the VMB, identify the effects that biofilm has on vaginal epithelial cells and test biofilm treatment strategies. We hypothesize that a Lactobacillus biofilm will enhance barrier function and decrease cytotoxicity of vaginal epithelial cells whereas dysbiotic biofilm will decrease barrier function and induce cytotoxicity. We also hypothesize that various conditions, such as presence of estradiol and eubiotic short-chain fatty acids, will stimulate Lactobacillus biofilm growth and suppress dysbiotic biofilm growth in a vaginal epithelial cell model. Methods: For optimization of the biofilm model, VK2/E6E7 cells were grown in air-liquid interface (ALI) or liquid-liquid interface (LLI) cultures in presence or absence of L. crispatus, L. iners, G. vaginalis or P. bivia bacteria. Biofilm formation was assessed using FilmTracerTM SYPRO® Ruby biofilm matrix protein stain. Hormone effects were tested by adding estradiol (10-9 M) and progesterone (10-7 M) to culture media. Short-chain fatty acid (SCFA) effects were tested by adding lactic acid, acetic acid, succinic acid and butyric acid in varying concentrations to culture media. Enzyme effects were tested by adding sialidase to Vk2 cells before bacteria inoculation. Results: A novel in vitro model of biofilm formation on vaginal epithelial cells was created. Vk2 cells in ALI and LLI cultures remained viable in anaerobic conditions and showed mucin-1 production in aerobic and anaerobic conditions. Matrix protein staining provided a means to accurately visualize and quantify biofilm formation in this model. L. crispatus and L. iners biofilm growth maintained vaginal epithelial barrier integrity without cytotoxicity. G. vaginalis and P. bivia biofilm growth significantly reduced barrier integrity (p=0.0166, p=0.0115) and increased cytotoxicity (p=0.0024, p<0.0001). Estradiol significantly increased the growth of L. crispatus biofilm in the co-culture system (p<0.0001). Progesterone significantly increased G. vaginalis biofilm growth in the Vk2 cell co-culture (p=0.006). L. crispatus biofilm formation in the estradiol condition, G. vaginalis biofilm formation in the progesterone condition and P. bivia biofilm growth in the normal media condition were significantly decreased in the presence of sialidase (p<0.0001, p=0.0001, p=0.0380). Conclusion: A novel in vitro model of biofilm formation on a vaginal epithelial cell line that can be used to visualize and quantify biofilm growth was generated. This model was used to test various strategies for biofilm enhancement or dissociation. Estradiol enhanced beneficial Lactobacillus biofilm growth, while progesterone enhanced dysbiotic biofilm growth. Mucin- digesting enzyme sialidase was effective at dissociating all biofilms. This model can be used in the future to test different strategies of dysbiotic biofilm dissociation and enhancement of Lactobacillus biofilm in order to investigate treatments for Bacterial Vaginosis (BV) and reduce susceptibility to HIV transmission in women. / Thesis / Master of Science (MSc)

No / Objectives: High prevalence of bacterial vaginosis (BV) has been reported in lesbians but most studies were based in sexually transmitted infection clinic settings; therefore, we wished to determine the prevalence and risk factors of BV in lesbians and heterosexual women in a community setting in the UK. Methods: A cross-sectional study recruiting lesbian women volunteers from community groups, events, clubs and bars. Heterosexual women were recruited from a community family planning clinic. They self-swabbed to create a vaginal smear, which was Gram-stained and categorised as BV, intermediate or normal flora. They completed a questionnaire about age, ethnic group, smoking, genital hygiene practices and sexual history. Results: Of 189 heterosexuals and 171 lesbians recruited, 354 had gradeable flora. BV was identified in 43 (25.7%) lesbians and 27 (14.4%) heterosexuals (adjusted OR 2.45, 95% CI 1.25 to 4.82; p¿=¿0.009). Concordance of vaginal flora within lesbian partnerships was significantly greater than expected (27/31 (87%) couples, ¿¿=¿0.63; p<0.001). Smoking significantly increased the risk of BV regardless of sexuality (adjusted OR 2.65; p¿=¿0.001) and showed substantial concordance in lesbian partnerships but less than for concordance of flora. Conclusions: Women who identified as lesbians have a 2.5-fold increased likelihood of BV compared with heterosexual women. The prevalence is slightly lower than clinic-based studies and as volunteers were recruited in community settings, this figure may be more representative of lesbians who attend gay venues. Higher concordance of vaginal flora within lesbian partnerships may support the hypothesis of a sexually transmissible factor or reflect common risk factors such as smoking.