Maristela Carbol Patta

Improved treatment of vulvovaginal candidiasis with fluconazole plus probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14

Aims:u2002 To determine the ability of probiotic lactobacilli to improve the treatment of vulvovaginal candidiasis (VVC) using a randomized, double‐blind and placebo‐controlled trial.

Incidência de cesáreas segundo fonte de financiamento da assistência ao parto

OBJECTIVE: To study the types of delivery according to the category of patient admission and the most frequently reported indications for cesarean sections. METHODS: In a retrospective survey of deliveries performed in the municipality of Ribeirao Preto, Sao Paulo, Brazil, from 1986 to 1995, the type of delivery, category of admission and recorded diagnoses were assessed. Data were obtained from the Center of Hospital Data Processing of the Department of Social Medicine in the University of Sao Paulo, Ribeirao Preto. RESULTS: A total of 86,120 deliveries were registered during the study period; 5.4% were allocated in the private category, 28.7% in the prepayment category, and 65.9% in the public health system (SUS). It was observed a decrease in the private and SUS categories and an increase in the prepayment category. During the study period, the percentage of cesarean deliveries increased from 68.3% to 81.8% in the private category and from 69.1% to 77.9% in the prepayment category, and decreased from 38.7% to 32.1% in the SUS category. The major indications for cesarean section were fetal distress, with the incidence of 9.5%, 10.9% and 9.0% in the private, prepayment and SUS categories, respectively; and cephalopelvic dystocia, at the rates of 5.8%, 6.5% and 3.9%, respectively. CONCLUSION: The incidence of cesarean section varied according to admission category, with a rising trend as the pregnant womans social status increased, but without a correlation with the obstetrical risk.

A Adolescente Grávida: Alguns Indicadores Sociais

Purpose: the objective of the present study was to determine the number and type of deliveries, category of admission to the hospital, occupation and obstetrical diagnosis for adolescents from the municipality of Ribeirao Preto, from January 1992 to December 1996. Methods: the information obtained from hospital discharge forms was analyzed at the Hospital Data Processing Center. The 6.04a-text processor Epi-Info System, a data bank and statistics for epidemiology produced by the Centers of Disease Control and Prevention (Atlanta, GA, USA), and Dbase IV were used to process the information. The association between variables was tested by the c2 test, with the level of significance set at 5%. The analyzed parameters were: number and type of delivery, category of hospital admission, occupation and obstetric diagnosis. Results: a total of 42,969 deliveries occurred during the study period, among which 7,134 (16.6%) corresponded to adolescent deliveries. An increase in the number of deliveries by girls in this age range occurred over the years, from 1,225 in 1992 to 1,538 in 1996. Deliveries were reported starting from 12 years of age, with a gradual increase in this number, especially after 14 years of age, when a 104.2% increase occurred for deliveries at this age, followed by 48.8% at 15 years, 36.1% at 16 years, 14.0% at 17 years, 52.8% at 18 years, and with practically no increase among 19-year-old girls. The highest number of deliveries (5,709) was recorded for the unified health system category of admission, followed by 1,277 deliveries for the prepaid category and 148 deliveries for the private category. With respect to occupation, 14.1% of the patients belonged to the economically active population, while 85.8% did not. Of the total deliveries, 59.2% were normal, 5.6% were forceps deliveries, and 35.2% were cesarean sections. The most frequent obstetrical diagnoses were: problems of fetus or placenta affecting maternal management (7.9%), fetus-pelvis disproportion (6.0%), problems with the amniotic cavity and membranes (5.0%), hypertension complicating delivery and puerperium (3.5%), and premature or false labor (3.4%). Conclusions: most deliveries were normal and occurred more frequently at the end of adolescence, especially among girls belonging to the unified health system. There was a predominance of adolescents not belonging to the economically active population. Some obstetrical complications were diagnosed at the time of resolution of pregnancy.

Both a combined oral contraceptive and depot medroxyprogesterone acetate impair endothelial function in young women.

BACKGROUNDnThe study was conducted to determine whether the use of a combined oral contraceptive (COC) or depot medroxyprogesterone acetate (DMPA) interferes with endothelial function.nnnSTUDY DESIGNnThe study was conducted on 100 women between the ages of 18 and 30 years. Fifty women had not used hormonal contraception (control group) for at least 12 months, 25 were current users of a COC (ethinylestradiol 30 mcg+levonorgestrel 150 mcg) and 25 were current users of DMPA (150 mg) for at least a 6-month period. All women were evaluated for brachial flow-mediated dilation (FMD), intima-media thickness, carotid distensibility and stiffness index, arterial pressure, body mass index, waist circumference, heart rate and lipid profile.nnnRESULTSnA significant difference in FMD was observed between the COC and control groups (6.4+/-2.2% vs. 8.7+/-3.4%, p<.01) and between the DMPA and control groups (6.2+/-2.1% vs. 8.7+/-3.4%, p<.01). The DMPA group had lower values of total cholesterol (TC) and low-density lipoprotein (LDL-C) than COC users and the control group (TC: DMPA=139.9+/-21.5 mg/dL vs. controls=167.1+/-29.2 mg/dL vs. COC=168.2+/-37.5, p=.001; LDL-C: DMPA=85.3+/-20.1 mg/dL vs. controls=102+/-24.5 mg/dL vs. COC=106.7+/-33.3 mg/dL, p=.01). The control group had higher levels of high-density lipoprotein (HDL-C) than the DMPA and COC groups (controls=52.4+/-14.1 mg/dL vs. DMPA=42.2+/-7.2 mg/dL vs. COC=45.4+/-9.1 mg/dL, p=.001). No significant differences were observed regarding the other variables.nnnCONCLUSIONSnFMD was lower among COC and DMPA users, suggesting that these hormonal contraceptives may promote endothelial dysfunction.

Analysis of Vaginal Lactobacilli from Healthy and Infected Brazilian Women

ABSTRACT Culture-dependent PCR-amplified rRNA gene restriction analysis and culture-independent (PCR-denaturing gradient gel electrophoresis) methodologies were used to examine vaginal lactobacilli from Brazilian women who were healthy or had been diagnosed with vulvovaginal candidiasis (VVC) or bacterial vaginosis. Only Lactobacillus crispatus was detected accordingly by both methods, and H2O2-producing lactobacilli were not associated with protection against VVC.

Indicadores sociais de grávidas adolescentes: estudo caso-controle

OBJETIVO: verificar diferencas entre alguns indicadores sociais de uma populacao de gestantes adolescentes (12 a 19 anos) e de adultas, procedentes de e que tiveram parto em Ribeirao Preto-SP, entre janeiro de 1992 e dezembro de 1996. METODOS: foram analisadas informacoes relacionadas a internacao, obtidas das folhas de alta hospitalar no Centro de Processamento de Dados Hospitalares do Departamento de Medicina Social, FMRP-USP. Os parâmetros analisados foram: tipo e numero de partos, categoria de internacao, ocupacao e diagnosticos obstetricos. Para processar as informacoes, foram utilizados o Sistema Epi-Info processador de texto 6.04a, banco de dados e estatistica para epidemiologia, produzido pelos Centers of Disease Control and Prevention (Atlanta, GA, USA), e o Dbase IV. A associacao entre variaveis foi testada pelo c² com nivel de significância de 5%, usando o software GraphPad Prism versao 2.0, 1995. RESULTADOS: ocorreram 43.253 partos no periodo, sendo 7.134 (16,5%) de adolescentes e 36.119 (83,5%) de adultas. Observou-se aumento de 25,5% no numero de partos nas adolescentes no decorrer dos anos. A proporcao de partos de adolescentes aumentou significativamente na categoria SUS no periodo. A proporcao de internacoes de adolescentes pelo SUS foi significativamente superior a de adultas. Apenas 14,1% das adolescentes tinham insercao na populacao economicamente ativa, comparado com 34,8% das adultas. Apenas 6,8% das adolescentes eram estudantes, ao passo que 79,0% eram do lar ou sem ocupacao remunerada. Houve aumento da proporcao de parto vaginal entre adolescentes quando comparadas as mulheres adultas, enquanto a proporcao de cesareas permaneceu estavel e maior entre as adultas. O trabalho de parto prematuro ou falso foi significativamente mais frequente entre as adolescentes. CONCLUSOES: observamos aumento do numero de partos entre adolescentes, sendo a maioria normal. Tanto a proporcao de partos pelo SUS quanto a proporcao de partos vaginais foi maior entre a populacao de adolescentes. Houve predominio de adolescentes com atividades no lar e sem remuneracao. Assim, recomendamos medidas para prevencao de gestacao na adolescencia, com enfase a populacao mais carente.

Padrão endometrial em mulheres submetidas à laqueadura tubária

PURPOSE: to study the histological modifications that occur in the endometrium of women before and six months after tubal ligation (TL) and to correlate these findings with progesterone (P4) levels. METHODS: the study was conducted on 16 women with normal menstrual cycles who were evaluated before and in the sixth cycle after TL. P4 levels were determined from the 8th day at 2-day intervals until ovulation and on the 8th, 10th and 12th day after ovulation or on the 24th day of the cycle. An endometrial biopsy was obtained between the 10th and 12th day after ovulation or on the 24th day of the cycle and a correlation with P4 was determined. Data were analyzed statistically by the nonparametric McNemar test for the evaluation of hormonal determination and by the exact Fisher test for the histological evaluation of the endometrium, with the level of significance set at p 10 ng/ml and 3/8 (37.5%) had P4 10 ng/ml in 4/7 (57.1%) and 0.05). CONCLUSION: six months after TL, the intermenstrual interval and the duration of bleeding were unchanged. P4 levels decreased during the luteal phase although this did not interfere in the endometrial response.

An innovative approach to the assessment of laypersons' knowledge of contraceptive methods, followed by an educational intervention

Objectives To assess the knowledge of laypersons about contraceptive methods and to pilot an educational strategy. Design Cross-sectional survey using an anonymous questionnaire followed by an educational intervention. Participants A total of 167 respondents to 400 invitations. Method A questionnaire with 10 questions about contraceptive methods was answered before a meeting between laypersons and health professionals. Small groups facilitated by a health professional discussed the answers. One representative from each group presented the conclusions. At the end of the discussion session, gynaecologists gave lectures about contraceptive methods. Results Of the 167 people who attended, only 65 (39%) individuals handed over their anonymous answers for analysis. Those who did knew about the existence of contraceptive methods, but most of them showed incorrect or little knowledge about mechanism of action or risks. Conclusion Embarrassment led many participants not to hand in their questionnaires but the results were evidence of the need for educational interventions. Lessons learnt from this experience are discussed.