Introduction: Several factors have been observed to influence the value of newborn screening analytes (NBS) and should be adjusted for in the interpretation of blood spot samples. The thesis aimed to examine the association of NBS with 1) mode of delivery among term infants and 2) clinical subtypes (i.e., spontaneous onset of labour) of birth among preterm infants. Methods: A retrospective population-based cross-sectional study design was employed. A multivariable logistic regression model was used to examine associations between NBS and mode of delivery among term infants and subtypes among preterm infants. Results: 1) Metabolic profiles of infants born by planned cesarean delivery differ from those born by vaginal delivery following spontaneous onset of labour and 2) Metabolic profiles of preterm infants did not differ by clinical subtype. Conclusions: Our findings conclude that mode of delivery is an important covariate to consider in future modelling studies, but the inclusion of preterm birth subtypes is less compelling.

Resumo: Analisar o efeito do raloxifeno sobre o epitélio vaginal de mulheres pós-menopausa. Métodos: Estudaram-se prospectivamente entre novembro de 2004 a fevereiro de 2006, 80 mulheres na pós-menopausa. Quarenta pacientes receberam 6Omg/dia de raloxifeno (GR) e 40 mulheres compuseram o grupo não tratado (grupo controle, GC), pareado por idade e tempo de menopausa. O grupo tratado foi composto por pacientes com osteoporose de coluna lombar e/ou colo do fêmur. Foram excluídos aquelas com sinais e/ou sintomas de infecção do trato genital inferior e usuárias de terapia hormonal (TH) até seis meses prévios ao estudo. Os esfregaços vaginais foram coletados em dois momentos: inicial (MO) e após seis meses de seguimento (Ml). Para avaliação do epitélio vaginal foi utilizado o valor de maturação, com a contagem de células superficias, intermediárias e parabasais. Os esfregaços foram analisados por único citopatologista, sem conhecimento dos dados das pacientes. Para análise estatística empregou- se o teste t de Student, teste Wilcoxon Mann-Witney e o teste Qui-Quadrado. Resultados: Na comparação estatística inicial os grupos foram homogêneos. Comparando os momentos inicial e final, não foram observadas diferenças estatisticamente sígnífícativas nos valores medianos de maturação do epitélio vaginal e na porcentagem de células superficiais, intermediárias e parabasais entre os grupos. Não foi constatada correlação linear significativa entre o valor de maturação e a idade, o tempo de menopausa, o uso ou não de TH prévia, tabagismo e o índice de massa corpórea, em ambos os grupos. Conclusão: O tratamento com raloxifeno por seis meses não alterou o valor de maturação do epitélio vaginal em mulheres na pós-menopausa. / Abstract: To analyze the effect of raloxifene on the vaginal epithelium of postmenopausal women. Methods: Eighty postmenopausal women were studied prospectively between November of 2004 and February of 2006. Forty patients received 6omglday of raloxifene (GR), and 40 women comprised the non-treated group (control group, CG), paired by age and time of menopause. The treated group was composed of patients with osteoporosis of the lumbar column and / or femur. Those with signs and / or symptoms of infection of the inferior genital tract and users of hormonal therapies (HT) up to six months prior to the study were excluded. Vaginal smears were collected at two moments: initial (MO) and after six months of follow-up (Ml). To evaluate the vaginal epithelium, the maturation value was determined, along with counts of superficial, intermediate and parabasal cells. Smears were analyzed by only one cytopathologist, without knowledge of patient data. For statistical analysis Student's t test, Wilcoxon Mann Witney test and Chi-Squared test were employed. Results: In the initial statistical comparison the groups were homogeneous. Comparing the initial and final moments, no statistically significant differences were observed in median values of vaginal epithelial maturation or in percentage of superficial, intermediate and parabasal cells between the groups. There was no significant linear correlation between value of vaginal epithelial maturation and age, time of menopause, use or not of previous HT, smoking or body mass index, in both groups. Conclusion: Treatment with raloxifene for six months did not alter the maturation value of vaginal epithelium in postmenopausal women. / Orientador: Jorge Nahás Neto / Coorientador: Eliana Aguiar Petri Nahás / Banca: Paulo Traiman / Banca: Lúcia Simões Costa-Paiva / Mestre

Made available in DSpace on 2014-06-12T15:05:09Z (GMT). No. of bitstreams: 2 arquivo4535_1.pdf: 868209 bytes, checksum: ac62da0f4de644010d96febb054dd9df (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2005 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / No período compreendido entre outubro de 2003 e agosto de 2004, foram realizadas coletas de secreção vaginal para exame micológico em 146 mulheres: 12 grávidas, 11 com sintomas e 1 sem sintomas; 134 não grávidas, 117 com sintomas e 17 sem sintomas de levedurose vaginal, atendidas no ambulatório de ginecologia do Centro de Saúde Manuel Caldas de Araújo, Cidade do Paulista-PE. Antes da coleta foi aplicado um questionário social e clínico para análise estatística dos dados epidemiológicos como idade, gravidez, presença ou ausência de sintomas, número de filhos, fidelidade ao parceiro, ciclo menstrual, primeira menstruação, primeira relação sexual, estado civil, endereço, profissão, escolaridade, presença de diabetes, anemia, hipertensão e os fatores predisponentes, uso de antibióticos, alérgenos, uso de DIU, contraceptivos, bebida alcoólica e tabagismo. Em 60% das amostras de secreção vaginal, foram detectadas leveduras ao exame direto e foi obtida cultura. Em 27 % não foram observadas estruturas fúngicas ao exame direto e cultura não foi obtida. Em 13 % foram observadas estruturas fúngicas ao exame direto e cultura não foi obtida. Da secreção vaginal de mulheres grávidas com sintomas foram obtidas 592 unidades formadoras de colônia (UFC) e das mulheres sem sintomas 84 UFC; da secreção vaginal das não grávidas com sintomas foram obtidas 3.366 UFC e daquelas sem sintomas 432 UFC. Da secreção vaginal de 75% das mulheres grávidas foram isoladas 9 amostras de leveduras sendo 8 de mulheres com sintomas e uma de mulher sem sintomas; da secreção vaginal de 59% das mulheres não grávidas foram obtidas 84 amostras de leveduras sendo 73 amostras de mulheres com sintomas e 11 de mulheres sem sintomas. Foram isoladas leveduras pertencentes aos gêneros Candida (82%), Trichosporon (9%), Rhodotorula (8%) e Kloeckera (1%). Os recursos metodológicos estatísticos adotados permitiram conhecer como fatores predisponentes as leveduroses vaginais entre diferentes condições socioeconômicas, idade, nível de escolaridade, estado civil, anemia, alérgenos, comportamento sexual e outros aspectos epidemiológicos das mulheres que participaram deste estudo

Submitted by Gisely Teixeira (gisely.teixeira@uniceub.br) on 2018-06-12T17:47:00Z No. of bitstreams: 1 51500731.pdf: 367519 bytes, checksum: cd6d5a6168e65a56f7b7641ff16e5ff8 (MD5) / Made available in DSpace on 2018-06-12T17:47:00Z (GMT). No. of bitstreams: 1 51500731.pdf: 367519 bytes, checksum: cd6d5a6168e65a56f7b7641ff16e5ff8 (MD5) Previous issue date: 2018 / Introdução: O parto é o evento final da gestação, um momento importante para a mulher, porém informações recebidas por ela acerca do parto pode influenciar na hora da escolha da via de parto, principalmente em mulheres nuliparas. Objetivo: Analisar a intenção da via de parto em nulíparas, relacionando-a com os fatores associados a essa escolha. Métodos: Foi feito um estudo analítico transversal onde participaram do estudo 150 mulheres nulíparas, estudantes do UniCEUB. As participantes responderam um questionário sobre intenção de via de parto e os fatores que as influenciaram nessa escolha. Resultados: A intenção de via de parto escolhida pela maioria foi o parto vaginal (66,67%). Os fatores determinantes para essa escolha, segundo elas, estão associados à rápida recuperação pós-parto (93%) e o menor período de internação (49%). Quanto ao que mais as influenciavam, as participantes responderam que foi a família (46%) e o médico (11%). Conclusão: Mulheres nulíparas são facilmente influenciadas por diversos fatores durante a vida, o que pode ser determinante na hora da escolha do parto, apesar dos resultados do estudo ainda há um grande número de cesáreas sendo realizadas sem indicação.

Submitted by Gisely Teixeira (gisely.teixeira@uniceub.br) on 2018-06-12T18:07:20Z No. of bitstreams: 1 51500775.pdf: 218657 bytes, checksum: 2a53a6e2ea21cb0d600a571ae81eaaaa (MD5) / Made available in DSpace on 2018-06-12T18:07:20Z (GMT). No. of bitstreams: 1 51500775.pdf: 218657 bytes, checksum: 2a53a6e2ea21cb0d600a571ae81eaaaa (MD5) Previous issue date: 2018 / A incontinência fecal é uma queixa muito comum em mulheres, acredita-se que uma das causas está relacionadas a via de parto, principalmente o parto vaginal. O objetivo desta pesquisa foi verificar a associação de incontinência fecal e a via de parto. O método de pesquisa constituiu em aplicação de entrevista e o questionário de Wexner validado e traduzido para português, com n= 75 mulheres, na Rodoviária de Brasília. Nos resultados percebeu maior número (52%) de incontinentes em mulheres que realizaram parto vaginal do que aquelas de parto cesário. Conclui-se que, nas mulheres estudadas, houve maior frequência de sintomas de incontinência fecal nas que tiveram filhos por via de parto vaginal quando comparadas as que realizaram parto cesário.

Orientadores: Paulo Cesar Giraldo, Ana Katherine S. Gonçalves / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-08T15:31:40Z (GMT). No. of bitstreams: 1 Amaral_RoseLuceGomesdo_M.pdf: 734908 bytes, checksum: 93d7f5663377e139f755920fc4edece2 (MD5) Previous issue date: 2007 / Resumo: Objetivo: Verificar se o uso de duchas higiênicas íntimas (DHI) pode interferir na microbiota vaginal de mulheres profissionais do sexo. Sujeitos e Métodos: Estudo de corte transversal realizado durante seis meses verificou o risco de 155 mulheres profissionais do sexo (PS), usuárias e não usuárias de DHI, apresentarem flora vaginal alterada e/ou vaginose bacteriana. As PS foram atendidas em centro de saúde (CS) localizado em zona de prostituição no município de Campinas, São Paulo, e agrupadas em usuárias e não usuárias de duchas higiênicas íntimas para análise da microbiota vaginal. A anamnese determinou os perfis sociodemográfico e sexual destas mulheres que procuraram o CS por diferentes motivos. O conteúdo vaginal foi coletado com swab estéril de Dacron e disposto em duas lâminas de vidro que foram coradas por técnica de Gram. A caracterização da microbiota vaginal pelos critérios de AMSEL adaptado foi realizada por microscopia óptica com lente de imersão. Análises univariável, bivariável com testes de qui-quadrado e exato de Fisher, além de regressão múltipla variável (stepwise) demonstraram o poder de associação entre as variáveis. Resultados: A média de idade, a etnia branca, a escolaridade básica e hábito de fumar encontrados respectivamente nas 94 usuárias e nas 61 não usuárias de DHI foram de 25,5 (± 6,2) vs. 26,0 (± 6,8)anos (p=ns), 48,9% vs. 47,5% (p=ns), 60,6% vs. 45% (p=ns) e 41,5% vs. 49,2% (p=ns) dos casos. Não houve diferença no uso regular de condom com seus parceiros sexuais fixos. Apenas o uso de lubrificantes vaginais foi significativamente maior nas usuárias de DHI (63,8%) que nas não usuárias (36,1%), p=0,0007. As prevalências de flora vaginal alterada, vaginose bacteriana, candidíase, tricomoníase e vaginose citolítica foram de 75,48%; 50,96%; 5,1%; 0,64% e 1,9%, respectivamente. Não houve diferenças significativas destas prevalências quando foram analisados estes achados entre as usuárias e não usuárias de DHI (78,7% vs. 70,5%, ns), (47,9% vs. 55,7%, ns), (5,3% vs. 4,9%, ns), (0 vs. 1,6%, ns) e (1,1% vs. 3,3%, ns). A análise de regressão múltipla tipo stepwise não identificou qualquer risco aumentado de ter flora vaginal alterada ou de vaginose bacteriana em mulheres usuárias de DHI. Conclusão: O uso de DHI não aumentou o risco de flora vaginal alterada e/ou de vaginose bacteriana em mulheres PS. Palavras-chave: profissionais do sexo, duchas higiênicas íntimas, microbiota vaginal, vaginose bacteriana, candidíase vaginal / Abstract: Aims: Verify if vaginal douching (VD) can cause vaginal flora imbalance in Female Sex Workers (FSW). Patients and Methods: A cross sectional study, carried out for six months, analysed the risk of vaginal flora imbalance and/or vaginal bacteriosis due to vaginal douching in 155 FSW. The FSW were seen at a public outpatient in a prostitution area in the city of Campinas, the state of São Paulo, Brazil. The vaginal douching (VD) users and non-users made up the two groups for vaginal microbiological analysis. The social-demographic and sexual profile of these women, who were seen for different reasons, was checked by anamnesis. Vaginal content was collected using a sterile Dacron Swab and placed on two glass slides that were stained using Gram technique. Adapted AMSEL criteria characterized the vaginal flora using optic microscope with immersion lens. Univariate, bivariate statistical analyses with X2 and exact Fisher tests apart from multiple variate regression (Stepwise) analysis determined the association between variables. Results: Mean age, white ethnicity, level of schooling and the habit of smoking analysed in the 94 users and 61 non-users of VD respectively were 25.5 (± 6.2) vs. 26.0 (± 6.8) years (p=ns), 48.9% vs. 47.5% (p=ns), 60.6% vs. 45% (p=ns) and 41.5% vs. 49.2% (p=ns) of the cases. There was no difference in the regular use of condoms with their steady sexual partners. Only the use of vaginal lubricant was significantly higher in the VD users (63.8%) than in the non-users (36.1%); p=0.0007. General prevalence of abnormal flora, bacterial vaginosis, candidiasis, trichomoniasis and cytolitic vaginosis was 75.48%, 50.96%, 5.1%, 0.64% and 1.9% respectively. There were no significant differences when analysing the findings between users and non-users of VD (78.7% vs. 70.5%; ns); (47.9% vs. 55.7%; ns); (5.3% vs. 4.9%; ns); (0 vs. 1.6% ns) and (1.1% vs. 3.3%; ns). Stepwise multiple regression analysis did not identify any increased risk of altered vaginal flora or bacterial vaginosis in VD users. Conclusion: The use of VD did not increase the risk of vaginal flora imbalance and/or bacterial vaginosis in FSW / Mestrado / Ciencias Biomedicas / Mestre em Tocoginecologia

Burkitt lymphoma is a highly aggressive B cell non-Hodgkin lymphoma characterized by the translocation t(8,14) and deregulation of the MYC gene on chromosome 8. The endemic (African) form presents classically as an expanding mass in the jaw. The nonendemic (European/North American) form often presents with an abdominal mass. We present an interesting case of Burkitt’s Lymphoma with atypical features. A thirty-five-year-old lady with no significant medical history presented to the hospital with a three week complaint of vaginal bleeding and lower abdominal pain/cramps associated with night sweats and chills. She underwent gynecologic workup with an ultrasound revealing endometrial thickening followed by a hysteroscopic Dilatation and Curettage procedure. Laboratory workup revealed direct hyperbilirubinemia and elevated liver enzymes. MRCP showed gallbladder wall thickening but no biliary obstruction. A diagnosis of acalculous cholecystitis was considered and she underwent a laproscopic cholecystectomy and liver biopsy. Her initial complete blood count revealed mild leukocytosis. Follow up lab work revealed worsening leukocytosis and a hematology consultation was sought. A peak WBC of 81,000 with peripheral blood blasts as high as 31% was noted. Peripheral smear exam revealed moderate sized immature wbc precursors/blasts with high nuclear-cytoplasmic ratio. Further hematological work up including bone marrow aspirate and biopsy was expedited. Pathology resulted positive for Burkitt's lymphoma/leukemia, positive molecular studies, t(8,14), involving bone marrow, gallbladder, liver and endometrium. Patient was emergently treated with dexamethasone and nitrogen mustard as elevated bilirubin levels precluded standard treatment. She was started on Rituxan as this neoplasm is a CD 20+ B cell malignancy but could not tolerate it. HyperCVAD multi-agent chemotherapy was subsequently initiated along with intrathecal chemotherapy (cytarabine and methotrexate). CSF cytology remained negative for lymphoma. Patient’s clinical condition has improved after 2 cycles of chemotherapy and she is currently receiving on going therapy. Burkitt’s lymphoma is one of the most aggressive neoplasms with a tumor doubling time of a few days. The usual presentation is with constitutional symptoms and adenopathy or a mass lesion, and sometimes may manifest solely in the peripheral circulation as an L3 variant of acute lymphoblastic leukemia. Hepatic parenchymal involvement is rare, but reported. Gallbladder involvement with endoluminal deposits is even rarer. Simultaneous hepatic, gallbladder, uterine, nodal and leukemic involvement at presentation is unique. Treatment is primarily with systemic chemotherapy and multi agent regimens effective in acute lymphoblastic leukemia and/or aggressive lymphomas have been used successfully in this condition with a complete response rate of 80%-90% with a long-term survival rate of approximately 60%. Therapy is fraught with risks of fatal tumor lysis syndrome, pancytopenia, infection/sepsis, and bleeding. Potential progression/relapse in the CNS with the CSF serving as a sanctuary site has been well documented necessitating prophylactic intra thecal chemotherapy administration as in our patient. Aggressive biology of this disease required urgent treatment, as delay in institution of combination chemotherapy could result in poor outcome. This case highlights the need to maintain an open mind while evaluating apparently routine symptoms and the importance of rapid diagnosis and treatment of a hematologic-oncologic emergency.

Antropóloga Social / En Chile el modelo de atención de los procesos reproductivos posee un carácter predominantemente tecnocrático, privilegiando una mirada patológica sobre la gestación y el parto. Lo anterior produce un actuar obstétrico basado en la repetición de intervenciones rutinarias no justificadas medicamente con poca o nula evidencia científica que las respalde. La mayoría de las veces, estas intervenciones constituyen un daño para la salud de la madre y el/la recién nacido/a tanto a corto como a largo plazo. Un ejemplo paradigmático de estas intervenciones es la cesárea, que en salud privada asciende a un 71,8% excediendo ampliamente el límite de 15% recomendado por la Organización Mundial de la Salud (OMS). Las explicaciones médicas justifican en parte este porcentaje en el deseo de las mujeres, sin embargo, la mayoría tiene una preferencia explícita por el parto por vía vaginal y en el caso de la salud privada esto se vuelve relevante, ya que las mismas poseen la facultad de elegir ciertos elementos y condiciones de su atención. Este alto nivel de intervención y el actuar en contra de las preferencias de las usuarias por parte del personal de salud, responde a condiciones culturales del actual modelo de atención. En orden de aportar a describir estas condiciones exploramos las representaciones en torno al cuerpo gestante y las vías de parto en mujeres gestantes y puérperas del sistema de salud privado de la Región Metropolitana y cómo estas influyen en el proceso de toma de decisiones respecto al parto. Las principales representaciones sobre el cuerpo gestante y las vías de parto que se producen en las interacciones entre usuarias, personal de salud y entorno social a lo largo de la gestación objetifican al cuerpo gestante como un medio y destacan su carácter potencialmente patológico. Además el carácter paternalista de las relaciones que se producen con los/as obstetras sitúan a las mujeres en una posición secundaria y despojada de poder. Si bien el parto por vía vaginal es preferido por las usuarias a nivel explícito, las representaciones existentes en torno a él, como más doloroso, sufriente y más riesgoso generan inseguridades, temores e incertidumbres a su alrededor. De esta forma las intervenciones obstétricas se instalan como herramientas apropiadas para controlar y reparar potenciales patologías. Lo anterior a través de la entrega de información no basada en evidencia por parte del personal de salud y de la culpabilización constante hacia los cuerpos de las mujeres. Esta forma de atención termina por convencer o directamente obligar a las mujeres a tomar decisiones en contra de sus preferencias iniciales, instalando la idea de que fueron ellas quienes eligieron la forma de atención que recibieron (lógica de la elección)

With this thesis, I have been looking at opportunities for improvement of childbirth in Scandinavia with a focus on prevention of perineal tears and levator injuries during labor. I have aimed to help couples during their pregnancy by giving them a more active role to avoid tears during childbirth. I have strived to help pregnant mothers to improve their well-being as well as improve cooperation between pregnant couples for them to have a better birthing experience. My goal has been to develop a concept that could improve today’s situation and that in theory could be implemented today in Scandinavia. Another goal was to create a discursive design topic, to question childbirth as it is today and show a new vision for how it could look like in the future. I wanted to show the importance of quality of life and that childbirth both could and should be questioned and looked into more to improve it.

BACKGROUND: Sensory over-responsivity (SOR) is a type of Sensory Modulation Disorder (SMD), where the individual has an over-responsive behavioural reaction to non-harmful or non-threatening sensory stimulation, which is out of proportion to the stimulus. SOR can negatively impact a child’s engagement and performance in their daily life. SOR is frequently diagnosed by occupational therapists, and deep pressure is an important facet of the treatment of SOR by occupational therapists. Prior research (Alberts &amp; Ronca, 2012) indicates that the component of pressure in the vaginal birth process aids the infant’s neurophysiological adaption to extra-uterine life. This component is absent in elective caesarean section births. This study therefore set out to determine whether method of birth could be associated with SOR, as well as investigating demographic and other variables linked to SOR. It was hypothesised that there would be a higher prevalence of SOR in children aged 3-5 years born by elective caesarean section compared to those born by vaginal birth. The study objectives were: • To establish a profile (demographic and variables linked to SOR) of participants (mother-child dyads) by birth method group (CS or vaginal delivery) • To determine the prevalence of SOR by birth method • To establish if there is a statistically significant difference in SOR and birth method • To establish which variables (for example birth weight, jaundice, birth complications) are associated with SOR METHOD: A quantitative, descriptive, analytical study was conducted with a sample of 91 children between the ages of 3 years 0 months and 4 years 11 months. Children across various language, cultural and socio-economic groups were recruited and allocated to two groups based on their method of birth - vaginal delivery and elective caesarean section. Caregivers of each child completed the Short Sensory Profile 2 (SSP2) questionnaire as well as a demographic information questionnaire. The scores for SOR were calculated for each participant, and prevalence of SOR between the two birth method groups was compared. Demographic variables were tested for significance between the two groups. The variables showing a significant difference were further analysed to determine any association with SOR. RESULTS: There were 91 participants, 58 in the VB group and 33 in the CS group. Mothers in the VB group gave birth at a younger age (U = 499.0, p < .001), were of a lower income level (chi-square = 11.49, df = 2, p = .003) and more likely to be single (Fishers exact p (2-tailed) = .037). The children in the VB group were of a greater gestational age (U = 472.5, p = .001), had a shorter time period before the first breastfeed (U = 478.0, p = .006), and had fewer sleeping difficulties (Fishers exact p (2-tailed) = .003). The prevalence of SOR for the total sample was 22%. There was a significant association in SOR prevalence and birth method (Fishers exact p (2-tailed) = .034), with greater prevalence in the VB group (29%) as opposed to the elective CS group (9%). There were statistically significant associations between SOR and maternal age (U = 380.5, p = .004), marital status (Fishers exact p (2-tailed) = .003) and time after birth to the first breastfeed (U = 394.5, p = .049). CONCLUSION: There was a statistically significant difference in SOR between the two birth method groups, with higher prevalence in the VB group. This was thought to be linked to cultural and language challenges associated with the use of the SSP2, and the impact of low socio-economic circumstances on child development and the ability to regulate sensory input. Recommendations include developing and validating a culturally appropriate sensory profile questionnaire, available in the most common official languages to facilitate the accurate assessment of sensory modulation of all children living in South Africa. In addition, there is a need to test the birth method hypothesis in demographically balanced groups.