6 research outputs found
Ultrasonographic, hysterossonographic, hysterocopic and anatomopatologic study of uterine cavity of women postmenopausal
No full textNo Setor de Climaterio da Disciplina de Ginecologia da Faculdade de Medicina de Catanduva e no Setor de Oncocirurgla da Disciplina de Ginecologia da Universidade Federal de São Paulo- Escola Paulista de Medicina, realizou-se o estudo em 58 mulheres na pos-menopausa com vistas a avaliacao do endometrio e da cavidade uterina. Efetuaram-se ananmese, exame fisico e ginecologico, e a seguir, a ultrasonografia transvaginal com medida da espessura do eco endometrial. Em toda paciente, com esta espessura maior ou igual a quatro milimetros, procederam-se aos exames de histerossonografia, histeroscopia e biopsia endometrial dirigida. Observaram-se 40 casos (68,9 por cento)de alteracoes endometriais e 18 (31,1 por cento) de endometrio atrofico. Encontram-se polipo em 30 casos (51,7 por cento), hiperplasia sem atipia em 5 (8,6 por cento), adenocarcinoma em 2 (3,4 por cento), mioma submucoso em 2 (3,4 por cento) e endometrio proliferativo em 1 (1,8 por cento) caso. Confrontaram-se o resultado dos exames de histerossonografia com o da biopsia do endometrio. A histerossonografia detectou 51 (87,9 por cento) cavidades com alteracoes e 7 (l2,1 por cento) sem alteracao com sensibilidade de 97,5 por cento e especificidade de 33,3 por cento. A porcentagem de pacientes com alteracao endometrial, quando da histerossonografia anormal, foi de 76,4 por cento e o endometrio atrofico, quando da histerossonografia normal , foi de 85,78 por cento. Ao confrontarem-se os resultados dos exames de histerossonografia e de histeroscopia, verificou-se boa concordancia entre os metodos. Conclui-se que, na avaliacao da cavidade uterina de pacientes com eco endometrial maior ou igual a quatro milimetros pela ultra-sonografia transvaginal, a histerossonografia e metodo capaz de ampliar a visibilizacao da cavidade uterina e melhorar o diagnostico. Pode, ainda, melhorar o processo de triagem pre-operatoria para aquelas que precisam ser operadasBV UNIFESP: Teses e dissertaçõe
Histomorphological effects of isoflavone on skin of the postmenopausal women
No full textA pele é considerada o maior órgão, do corpo humano, funcionando como barreira biológica metabolicamente ativa; secreta hormônios e vitaminas e está relacionada à defesa, homeostasia interna, além de fazer a contenção do corpo. Após a menopausa, existe declínio progressivo na concentração do colágeno dérmico, ressecamento cutâneo e até atrofia da pele. O objetivo deste estudo foi avaliar os efeitos da isoflavona na pele de mulheres na pós-menopausa, analisando a espessura da epiderme, o índice papilar (pregueamento), a quantidade de fibras elásticas e colágenas e o número de vasos na derme. Realizou-se estudo prospectivo em 30 mulheres na pós-menopausa atendidas no setor de Climatério da Disciplina de Ginecologia da Faculdade de Medicina de Catanduva. Efetuou-se, em todas, anamnese, exames físico e ginecológico, e biópsia da pele, antes e após o uso de 100mg/dia de extrato concentrado de soja durante seis meses. Após a rotina histológica, as lâminas foram coradas pelos métodos de Hematoxilina-Eosina (espessura da epiderme), Verhoeff (fibras elásticas), picrosirius-red (colágeno) e marcadas com o antígeno CD 34 (vasos sangüíneos). Para a análise estatística, empregou-se o teste paramétrico pareado "t Student" para comparar os resultados antes e depois do tratamento. Na epiderme, constatou-se aumento da espessura em 23 pacientes (79,3 por cento) com média de 560,8 ± 4,4 Jlm e 613 ±4,6 Jlm, respectivamente, antes e após o tratamento (p .::; 0,01). Já o índice papilar teve redução em 21 mulheres (72,4 por cento), com média de 0,84 ±0,17 e 0,71 ± 0,15, respectivamente, antes e após o tratamento (p .::; 0,01). O índice papilar é inversamente proporcional ao pregueamento da pele, ou seja, há maior número de papilas após o tratamento. A quantidade de colágeno na derme aumentou em 25 (86,2 por cento) mulheres; passou de 152 :!: 2,2 para 163 :!: 2,3 após a terapia (p :::; 0,01). Em vinte e duas mulheres (75,8 por cento) detectou-se aumento das fibras elásticas, de 525,4 :!: 4,2 :t para 611,2 :t 4,6 (p:::; 0,01). Notou-se incremento do número de vasos em 21 (72,4 por cento) mulheres, com médias de 64,2 :t 1,4 antes e 74,1 :t 1,6 após o tratamento (p :::; 0,01). Nossos dados mostraram que o uso do extrato concentrado de soja por seis meses consecutivos proporcionou aumento de espessura do epitélio e da concentração de fibras colágenas e elásticas da derme, bem como do número de vasos.BV UNIFESP: Teses e dissertaçõe
Effects of isoflavones on the skin of postmenopausal women: a pilot study
No full textOBJECTIVE: The aim of this study was to evaluate the effects of isoflavones on the skin of postmenopausal women. DESIGN: A prospective study was performed with 30 postmenopausal women before and immediately after the end of treatment with 100 mg/day of an isoflavones-rich, concentrated soy extract for six months. A skin punch was performed in the gluteal region for sample collection before and immediately after the treatment program. Morphometric determination of epidermal thickness, the papillary index (wrinkling), and the amount of dermal elastic and collagen fibers was assessed. In addition, the number of blood vessels in the sample was also evaluated. The paired Student's t-test was used for statistical analysis (P < 0.05). RESULTS: Isoflavone treatment resulted in a 9.46% increase in the thickness of the epidermis in 23 patients. In addition, the papillary index was reduced in 21 women. The papillary index was inversely proportional to skin wrinkling, i.e., there were a large number of papillae after treatment. The amount of collagen in the dermis was increased in 25 women (86.2%). In 22 women (75.8%) we observed that the number of elastic fibers increased. The number of dermal blood vessels was significantly increased in 21 women. CONCLUSION: Our data show that the use of a concentrated, isoflavone-rich soy extract during six consecutive months caused significant increases in epithelial thickness, the number of elastic and collagen fibers, as well as the blood vessels
Efeitos das isoflavonas sobre o assoalho pélvico e a vascularização peri-uretral de mulheres na pós-menopausa Effects of isoflavones on the pelvic floor and the periurethral vascularization of postmenopausal women
No full textOBJETIVO: avaliar a força muscular do assoalho pélvico e os vasos periuretrais de mulheres na pós-menopausa, antes e após seis meses de uso contínuo de extrato de soja. MÉTODOS: estudo prospectivo com 30 mulheres na pós-menopausa antes e após o uso de extrato de soja (100 mg/dia) durante seis meses consecutivos. Foram investigadas a perda urinária e a força muscular do assoalho pélvico por perineômetro digital e avaliação funcional. Avaliou-se ainda o número de vasos da região peri-uretral pela dopplervelocimetria. Para comparar os resultados antes e após tratamento, utilizou-se o teste pareado t de Student. RESULTADOS: das 30 mulheres analisadas, 20 referiram alguma forma de perda urinária no inicio do experimento. A melhora deste sintoma ocorreu em 15 (75%) mulheres após o tratamento. A medida da pressão vaginal (força muscular do assoalho pélvico) foi 12,9±1,7 e 15,8±1,8 Sauers, respectivamente, antes e após o tratamento (pPURPOSE: to evaluate muscular strength of the pelvic floor and the periurethral vessels of postmenopausal women before and after six months of soybean extract treatment. METHODS: the study was conducted on 30 postmenopausal women before and after six consecutive months of soyabean extract (100 mg/day) administration. Urinary loss and muscular strength of the pelvic floor were investigated through digital perineometer and functional evaluation. Digital color Doppler in the periurethral region was used to count the number of vessels. For statistical analysis, the paired Student t test was applied to compare the results before and after the treatment. RESULTS: twenty women reported urinary incontinence before the treatment period. The amelioration of this symptom was observed in 15 (75%) women after the treatment. Vaginal pressure (muscular strength of the pelvic floor) was 12.95±1.73 and 15.86±1.86 Sauers, before and after the treatment, respectively (p<0.001). Twenty-two women (73.3%) presented an increase in the pressure at the end of this study. In relation to the function evaluation, 18 (60%) had improvement in muscular strength and 12 women did not present any change. On ultrasonography (Doppler), the number of vessels was 2.20±0.15 blood vessels/field in the beginning of this study and 3.46±0.25 blood vessels/field at the end of the treatment (p<0.001). An increase in the number of periurethral vessels was detected in 21 women (70%). CONCLUSION: it is important to emphasize that these are preliminary results. A double blind randomized and placebo-controlled clinical trial with a high number of participants is necessary. However, the treatment with concentrated soybean extract (100 mg per day) for six consecutive months may determine an improvement in pelvic floor muscular strength and an increase in the number of periurethral vessels in postmenopausal women
SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
No full textBackground: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.
Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.
Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.
Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population
30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studiesResearch in context
No full textSummary: Background: Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems. Methods: This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January–May 2020), Period 2 (June–July 2020), Period 3 (October 2020), and Period 4 (December–March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score. Findings: A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3–5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53–0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50–0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30–0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42–0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75–0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62–0.80) had lower mortality. Interpretation: Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics. Funding: National Institute for Health and Care Research, United Kingdom
