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[PMID]: 29424508 [Au] Autor: Beltrán-Montoya J; Escudero-Gontes S; Martínez-Huerta NE; Ávila-Vergara MA; Morales-Hernández V; Canchola-Sotelo C; Palacios-González B; Vadillo-Ortega F [Ti] Título: [Pilot tests using molecular diagnostic assay cervicovaginal infection during pregnancy]. [Ti] Título: Ensayo piloto del uso de pruebas moleculares para el diagnóstico de infecciones cervicovaginales en pacientes embarazadas.. [So] Source: Ginecol Obstet Mex;84(8):475-83, 2016 08. [Is] ISSN: 0300-9041 [Cp] País de publicação: Mexico [La] Idioma: spa [Ab] Resumo: Background: The prevalence of cervicovaginal infections during pregnancy has been associated with adverse perinatal outcomes however, the actual approach used for diagnosis is not effective. The aim of this study was to compare the diagnosis of vaginal infections in pregnant women using clinical, molecular diagnostic and traditional microbiological culture in a pilot study, to determine the prevalence and association with the development of preterm labor. Materials and methods: We performed a nested cross-sectional study composed by 54 women in a cohort of pregnant women in Mexico City. Cervicovaginal infections were evaluated by clinical methods, microbiology culture and a commercially available molecular biology test. Results: Prevalence of cervicovaginal infections during pregnancy was estimated between 28% and 50% according to methodologies. Considering the clinical diagnosis of preterm labor as the gold standard, all diagnostic tests were poor as predictors of preterm labor. Conclusion: Traditional approaches to establish the significance of cervicovaginal infection in pregnancy are exhausted, so be sought new ways to understand this complex relationship. Meanwhile it is recommended to continue to use traditional methods to identify infections during pregnancy in both knowledge of new methods aimed at understanding these relationships are sophisticated. [Mh] Termos MeSH primário: Técnicas de Diagnóstico Molecular/métodos Complicações Infecciosas na Gravidez/diagnóstico Doenças do Colo do Útero/diagnóstico Doenças Vaginais/diagnóstico [Mh] Termos MeSH secundário: Adolescente Adulto Estudos de Coortes Estudos Transversais Feminino Seres Humanos México Trabalho de Parto Prematuro/epidemiologia Projetos Piloto Gravidez Complicações Infecciosas na Gravidez/microbiologia Resultado da Gravidez Doenças do Colo do Útero/microbiologia Doenças Vaginais/microbiologia Adulto Jovem [Pt] Tipo de publicação: COMPARATIVE STUDY; JOURNAL ARTICLE [Em] Mês de entrada: 1803 [Cu] Atualização por classe: 180301 [Lr] Data última revisão: 180301 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 180210 [St] Status: MEDLINE

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[PMID]: 28459057 [Au] Autor: Koroleva EA; Kobets NV; Shcherbinin DN; Zigangirova NA; Shmarov MM; Tukhvatulin AI; Logunov DY; Naroditsky BS; Gintsburg AL [Ad] Endereço: Gamaleya Institute of Epidemiology and Microbiology, Ministry of Health of Russian Federation, Gamaleya Street 18, Moscow 123098, Russia. [Ti] Título: Chlamydial Type III Secretion System Needle Protein Induces Protective Immunity against Intravaginal Infection. [So] Source: Biomed Res Int;2017:3865802, 2017. [Is] ISSN: 2314-6141 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: imposes serious health problems and causes infertility. Because of asymptomatic onset, it often escapes antibiotic treatment. Therefore, vaccines offer a better option for the prevention of unwanted inflammatory sequelae. The existence of serologically distinct serovars of suggests that a vaccine will need to provide protection against multiple serovars. spp. use a highly conserved type III secretion system (T3SS) composed of structural and effector proteins which is an essential virulence factor. In this study, we expressed the T3SS needle protein of TC_0037, an ortholog of CdsF, in a replication-defective adenoviral vector (AdTC_0037) and evaluated its protective efficacy in an intravaginal model. For better immune responses, we employed a heterologous prime-boost immunization protocol in which mice were intranasally primed with AdTC_0037 and subcutaneously boosted with recombinant TC_0037 and Toll-like receptor 4 agonist monophosphoryl lipid A mixed in a squalene nanoscale emulsion. We found that immunization with TC_0037 antigen induced specific humoral and T cell responses, decreased loads in the genital tract, and abrogated pathology of upper genital organs. Together, our results suggest that TC_0037, a highly conserved chlamydial T3SS protein, is a good candidate for inclusion in a vaccine. [Mh] Termos MeSH primário: Proteínas de Bactérias Vacinas Bacterianas Infecções por Chlamydia Chlamydia muridarum Sistemas de Secreção Tipo III [Mh] Termos MeSH secundário: Administração Intranasal Animais Proteínas de Bactérias/genética Proteínas de Bactérias/imunologia Vacinas Bacterianas/genética Vacinas Bacterianas/imunologia Infecções por Chlamydia/imunologia Infecções por Chlamydia/microbiologia Infecções por Chlamydia/prevenção & controle Chlamydia muridarum/genética Chlamydia muridarum/imunologia Modelos Animais de Doenças Feminino Imunização Camundongos Camundongos Endogâmicos BALB C Sistemas de Secreção Tipo III/genética Sistemas de Secreção Tipo III/imunologia Vacinas de DNA/genética Vacinas de DNA/imunologia Doenças Vaginais/imunologia Doenças Vaginais/microbiologia Doenças Vaginais/prevenção & controle [Pt] Tipo de publicação: JOURNAL ARTICLE [Nm] Nome de substância: 0 (Bacterial Proteins); 0 (Bacterial Vaccines); 0 (Type III Secretion Systems); 0 (Vaccines, DNA) [Em] Mês de entrada: 1802 [Cu] Atualização por classe: 180227 [Lr] Data última revisão: 180227 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170502 [St] Status: MEDLINE [do] DOI: 10.1155/2017/3865802

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[PMID]: 29202966 [Au] Autor: Donnez O; Roman H [Ad] Endereço: Institut du sein et de Chirurgie gynécologique d'Avignon, Polyclinique Urbain V (Elsan Group), Avignon, France, and Pôle de recherche en gynécologie, IREC institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Electronic address: pr.olivier.donnez@gmail.com. [Ti] Título: Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? [So] Source: Fertil Steril;108(6):931-942, 2017 Dec. [Is] ISSN: 1556-5653 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Deep endometriosis (DE) remains the most difficult endometriotic entity to treat. Medical treatment for DE can reduce symptoms but does not cure the disease, and surgical removal of the lesion is required when lesions are symptomatic, impairing bowel, urinary, sexual, and reproductive functions. Although several surgical techniques such as laparoscopic bowel resection, disc excision, and rectal shaving have been described, there is no consensus regarding the choice of technique or the timing of surgery. Our review of publications reporting results and complications of surgery for rectovaginal DE reveals a relatively higher complication rate after bowel resection compared with shaving and disc excision, especially for rectovaginal fistulas, anastomotic leakage, delayed hemorrhage, and long-term bladder catheterization. Data show that shaving is feasible even in advanced disease. The risk of immediate complications after shaving and disc excision is probably lower than after colorectal resection, allowing for better functional outcomes. The presumed higher risk of recurrence related to shaving has not been demonstrated. For these reasons, surgeons should consider rectal shaving as a first-line surgical treatment of rectovaginal DE, regardless of nodule size or association with other digestive localizations. When the result of rectal shaving is unsatisfactory (rare cases), disc excision may be performed either exclusively by laparoscopy or by using transanal staplers. Segmental resection may ultimately be reserved for advanced lesions responsible for major stenosis or for several cases of multiple nodules infiltrating the rectosigmoid junction or sigmoid colon. [Mh] Termos MeSH primário: Tomada de Decisão Clínica Procedimentos Cirúrgicos do Sistema Digestório/métodos Endometriose/cirurgia Procedimentos Cirúrgicos em Ginecologia/métodos Laparoscopia Seleção de Pacientes Doenças Retais/cirurgia Doenças Vaginais/cirurgia [Mh] Termos MeSH secundário: Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos Endometriose/complicações Endometriose/diagnóstico Feminino Procedimentos Cirúrgicos em Ginecologia/efeitos adversos Seres Humanos Laparoscopia/efeitos adversos Masculino Complicações Pós-Operatórias/etiologia Doenças Retais/diagnóstico Fatores de Risco Resultado do Tratamento Doenças Vaginais/diagnóstico [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171215 [Lr] Data última revisão: 171215 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171206 [St] Status: MEDLINE

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[PMID]: 29202965 [Au] Autor: Vercellini P; Buggio L; Somigliana E [Ad] Endereço: Department of Clinical Sciences and Community Health, Università degli Studi; and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: paolo.vercellini@unimi.it. [Ti] Título: Role of medical therapy in the management of deep rectovaginal endometriosis. [So] Source: Fertil Steril;108(6):913-930, 2017 Dec. [Is] ISSN: 1556-5653 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: Defining whether medical therapy is effective in women with deep rectovaginal endometriosis and in which circumstances it can be considered an alternative to surgery is important for patients and physicians. Numerous observational and some randomized controlled studies demonstrated that different hormonal drugs improved pain and other symptoms in approximately two-thirds of women with deep rectovaginal endometriosis. Because major differences in the effect size of various compounds were not observed, much importance should be given to safety, tolerability, and cost of medications when counseling patients. Progestins seem to offer the best therapeutic balance when long-term treatments are planned. Women should be informed that hormonal drugs control but do not cure endometriosis and that, to avoid surgery, they should be used for years. Medical therapy is not an alternative to surgery in women with hydronephrosis, severe subocclusive bowel symptoms, and in those wishing a natural conception. A progestin should systematically be chosen as a comparator in future randomized trials on novel medications for deep endometriosis. In the meantime, the use of existing drugs should be optimized, and medical and surgical treatments could be viewed as subsequent stages of a stepwise approach. In general, there is no absolute "best" choice, and women must be thoroughly informed of potential benefits, potential harms, and costs of different therapeutic options and allowed to choose what they deem is better for them. [Mh] Termos MeSH primário: Endometriose/tratamento farmacológico Endométrio/efeitos dos fármacos Hormônios/uso terapêutico Doenças Retais/tratamento farmacológico Doenças Vaginais/tratamento farmacológico [Mh] Termos MeSH secundário: Animais Biópsia Colposcopia Endometriose/complicações Endometriose/diagnóstico Endometriose/fisiopatologia Endométrio/patologia Endométrio/fisiopatologia Estrogênios/uso terapêutico Feminino Hormônios/efeitos adversos Seres Humanos Progestinas/uso terapêutico Doenças Retais/complicações Doenças Retais/diagnóstico Doenças Retais/fisiopatologia Resultado do Tratamento Doenças Vaginais/complicações Doenças Vaginais/diagnóstico Doenças Vaginais/fisiopatologia [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Nm] Nome de substância: 0 (Estrogens); 0 (Hormones); 0 (Progestins) [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171215 [Lr] Data última revisão: 171215 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171206 [St] Status: MEDLINE

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[PMID]: 29202940 [Au] Autor: Faubion SS; Sood R; Kapoor E [Ad] Endereço: Women's Health Clinic, Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: faubion.stephanie@mayo.edu. [Ti] Título: Genitourinary Syndrome of Menopause: Management Strategies for the Clinician. [So] Source: Mayo Clin Proc;92(12):1842-1849, 2017 Dec. [Is] ISSN: 1942-5546 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: Genitourinary syndrome of menopause (GSM), previously known as atrophic vaginitis or vulvovaginal atrophy, affects more than half of postmenopausal women. Caused by low estrogen levels after menopause, it results in bothersome symptoms, including vaginal dryness, itching, dyspareunia, urinary urgency and increased frequency, and urinary tract infections. Even though women with GSM can have sexual dysfunction that interferes with partner relationships, women are often embarrassed to seek treatment, and health care professionals do not always actively screen for GSM. As a result, GSM remains underdiagnosed and undertreated. Several effective treatments exist, but low-dose vaginal estrogen therapy is the criterion standard. It is effective and safe for most patients, but caution is suggested for survivors of hormone-sensitive cancers. Newer treatment options include selective estrogen receptor modulators, vaginal dehydroepiandrosterone, and laser therapy. Nonprescription treatments include vaginal lubricants, moisturizers, and dilators. Pelvic floor physical therapy may be indicated for some women with concomitant pelvic floor muscle dysfunction. Sex therapy may be helpful for women with sexual dysfunction. This concise review presents a practical approach to the evaluation and management of GSM for the primary care physician. [Mh] Termos MeSH primário: Vaginite Atrófica/terapia Menopausa Incontinência Urinária/terapia Doenças Vaginais/terapia Doenças da Vulva/terapia Saúde da Mulher [Mh] Termos MeSH secundário: Terapia de Reposição de Estrogênios Feminino Seres Humanos Meia-Idade Qualidade de Vida Síndrome [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1712 [Cu] Atualização por classe: 171212 [Lr] Data última revisão: 171212 [Sb] Subgrupo de revista: AIM; IM [Da] Data de entrada para processamento: 171206 [St] Status: MEDLINE

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[PMID]: 28972465 [Au] Autor: Carrillo-Ávila JA; Serrano-García ML; Fernández-Parra J; Sorlózano-Puerto A; Navarro-Marí JM; Stensvold CR; Gutiérrez-Fernández J [Ad] Endereço: 1​Biobank of the Andalusian Public Health System (BBSSPA), Granada, Spain. [Ti] Título: Prevalence and genetic diversity of Trichomonas vaginalis in the general population of Granada and co-infections with Gardnerella vaginalis and Candida species. [So] Source: J Med Microbiol;66(10):1436-1442, 2017 Oct. [Is] ISSN: 1473-5644 [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: PURPOSE: Purulent or exudative genitourinary infections are a frequent cause of consultation in primary and specialized healthcare. The objectives of this study were: to determine the prevalence of Trichomonas vaginalis and co-infections with Candida spp. and Gardnerella vaginalis in vaginal secretion; and to use multilocus sequence typing (MLST) to analyse the genetic diversity of T. vaginalis strains. METHODOLOGY: The samples were submitted for analysis (n=5230) to a third-level hospital in Granada (Southern Spain) between 2011 and 2014; eight T. vaginalis strains isolated during 2015 were randomly selected for MLST analysis. Culture and nucleic acid hybridization techniques were used to detect microorganisms in the samples. RESULTS: The prevalence of T. vaginalis was 2.4 % between 2011 and 2014, being higher during the first few months of both 2011 and 2012. Among samples positive for T. vaginalis, co-infection with G. vaginalis was detected in 29 samples and co-infection with Candida spp. in 6, while co-infection with all three pathogens was observed in 3 samples. The only statistically significant between-year difference in co-infection rates was observed for T. vaginalis with G. vaginalis due to an elevated rate in 2011. MLST analysis results demonstrated a high genetic variability among strains circulating in our setting. CONCLUSION: These findings emphasize the need for the routine application of diagnostic procedures to avoid the spread of this sexually transmitted infection. [Mh] Termos MeSH primário: Candida/classificação Candidíase/complicações Gardnerella vaginalis/isolamento & purificação Variação Genética Tricomoníase/microbiologia Trichomonas vaginalis/genética [Mh] Termos MeSH secundário: Adolescente Adulto Idoso Idoso de 80 Anos ou mais Candidíase/epidemiologia Coinfecção/epidemiologia Coinfecção/microbiologia Coinfecção/parasitologia Feminino Infecções por Bactérias Gram-Positivas/complicações Infecções por Bactérias Gram-Positivas/epidemiologia Infecções por Bactérias Gram-Positivas/microbiologia Seres Humanos Meia-Idade Espanha/epidemiologia Tricomoníase/complicações Tricomoníase/epidemiologia Doenças Vaginais/epidemiologia Doenças Vaginais/microbiologia Doenças Vaginais/parasitologia Adulto Jovem [Pt] Tipo de publicação: JOURNAL ARTICLE [Em] Mês de entrada: 1710 [Cu] Atualização por classe: 171018 [Lr] Data última revisão: 171018 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 171004 [St] Status: MEDLINE [do] DOI: 10.1099/jmm.0.000603

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[PMID]: 28779515 [Au] Autor: Liabsuetrakul T; Choobun T; Peeyananjarassri K; Islam QM [Ad] Endereço: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand, 90110. [Ti] Título: Antibiotic prophylaxis for operative vaginal delivery. [So] Source: Cochrane Database Syst Rev;8:CD004455, 2017 08 05. [Is] ISSN: 1469-493X [Cp] País de publicação: England [La] Idioma: eng [Ab] Resumo: BACKGROUND: Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. OBJECTIVES: To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (12 July 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (12 July 2017) and reference lists of retrieved studies. SELECTION CRITERIA: All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. DATA COLLECTION AND ANALYSIS: Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the one included trial using the GRADE approach. MAIN RESULTS: One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. The trial compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. This trial reported only two out of the nine outcomes specified in this review. Seven women in the group given no antibiotics had endomyometritis and none in prophylactic antibiotic group, the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21; low-quality evidence). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41; low-quality evidence). Overall, the risk of bias was judged to be unclear. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay. AUTHORS' CONCLUSIONS: One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity. [Mh] Termos MeSH primário: Antibioticoprofilaxia Extração Obstétrica/efeitos adversos Infecção Puerperal/prevenção & controle Doenças Vaginais/prevenção & controle [Mh] Termos MeSH secundário: Endometrite/prevenção & controle Feminino Seres Humanos Forceps Obstétrico Gravidez Ensaios Clínicos Controlados Aleatórios como Assunto Vácuo-Extração/efeitos adversos [Pt] Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170920 [Lr] Data última revisão: 170920 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170806 [St] Status: MEDLINE [do] DOI: 10.1002/14651858.CD004455.pub4

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[PMID]: 28711083 [Au] Autor: Micheletti RG; Dominguez AR; Wanat KA [Ad] Endereço: Departments of Dermatology and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: robert.micheletti@uphs.upenn.edu. [Ti] Título: Bedside diagnostics in dermatology: Parasitic and noninfectious diseases. [So] Source: J Am Acad Dermatol;77(2):221-230, 2017 Aug. [Is] ISSN: 1097-6787 [Cp] País de publicação: United States [La] Idioma: eng [Ab] Resumo: In addition to aiding the diagnosis of viral, bacterial, and fungal diseases, mineral oil preparation, Tzanck smear, and other techniques can be used to diagnose parasitic infections, neonatal pustular dermatoses, blistering diseases, Stevens-Johnson syndrome, and a plethora of other benign and malignant conditions, including granulomatous diseases and tumors. In many cases, these techniques are specific, reliable, and easy to perform and interpret. In others, a certain amount of training and expertise are required. In the proper clinical scenario, these tests are rapid, economical, and compare favorably with other diagnostic methods. [Mh] Termos MeSH primário: Dermatologia/métodos Testes Imediatos Dermatopatias Parasitárias/diagnóstico Dermatopatias Vesiculobolhosas/diagnóstico Neoplasias Cutâneas/diagnóstico [Mh] Termos MeSH secundário: Feminino Seres Humanos Leishmaniose Cutânea/diagnóstico Infestações por Ácaros/diagnóstico Oncocercose/diagnóstico Neoplasias Cutâneas/patologia Coloração e Rotulagem Doenças Vaginais/diagnóstico Doenças da Vulva/diagnóstico [Pt] Tipo de publicação: JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1708 [Cu] Atualização por classe: 170825 [Lr] Data última revisão: 170825 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170717 [St] Status: MEDLINE

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[PMID]: 28539177 [Au] Autor: Pinkerton JV; Bushmakin AG; Komm BS; Abraham L [Ad] Endereço: University of Virginia Health System, Charlottesville, VA, United States. [Ti] Título: Relationship between changes in vulvar-vaginal atrophy and changes in sexual functioning. [So] Source: Maturitas;100:57-63, 2017 Jun. [Is] ISSN: 1873-4111 [Cp] País de publicação: Ireland [La] Idioma: eng [Ab] Resumo: OBJECTIVE: Conjugated estrogens/bazedoxifene (CE/BZA) has demonstrated benefit in vulvar-vaginal atrophy (VVA, part of genitourinary syndrome of menopause) and the sexual function domain of the Menopause-specific Quality of Life (MENQOL) questionnaire. The study's objective was to determine the relationship of VVA symptoms and clinical parameters with MENQOL sexual functioning in postmenopausal women receiving VVA treatment. STUDY DESIGN: Post hoc analysis data were derived from the 12-week SMART-3 trial, which evaluated CE/BZA's effect on VVA in nonhysterectomized postmenopausal women (aged 40-65 years) experiencing one or more moderate to severe VVA symptoms (dryness, itching/irritation, pain with intercourse) and vaginal pH>5.0 (N=664). MAIN OUTCOME MEASURES: Repeated measures models were used to determine relationships of VVA symptoms and clinical parameters (vaginal pH, parabasal/superficial cells) with sexual functioning; sensitivity analyses were performed to check assumptions of linearity. RESULTS: VVA symptoms showed an approximately linear relationship with sexual functioning. A 1-point improvement in pain on intercourse (which has a large effect size [ES]=0.85) corresponded to medium improvement (ES=0.57) in MENQOL sexual functioning. Equivalent improvements (in terms of ES) in dryness and itching/irritation corresponded to small to medium (ES=0.35) and small (ES=0.27) improvements in sexual functioning, respectively. The same ES improvement in clinical parameters corresponded to small-trivial improvements in sexual functioning. CONCLUSIONS: VVA symptoms have an approximately linear relationship with sexual functioning. Sexual functioning was most improved when pain on intercourse was reduced. Similar magnitudes of improvements in other VVA symptoms were linked with smaller, though potentially beneficial, improvements in sexual functioning. Changes in clinical parameters had only small or trivial associations with sexual functioning. Trial registration number NCT00238732. [Mh] Termos MeSH primário: Atrofia/patologia Disfunções Sexuais Fisiológicas/patologia Vagina/patologia Doenças Vaginais/patologia Vulva/patologia [Mh] Termos MeSH secundário: Adulto Idoso Atrofia/tratamento farmacológico Coito Método Duplo-Cego Feminino Seres Humanos Indóis/uso terapêutico Meia-Idade Dor Pós-Menopausa Prurido Qualidade de Vida Moduladores Seletivos de Receptor Estrogênico/uso terapêutico Disfunções Sexuais Fisiológicas/tratamento farmacológico Doenças Vaginais/tratamento farmacológico [Pt] Tipo de publicação: JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL [Nm] Nome de substância: 0 (Indoles); 0 (Selective Estrogen Receptor Modulators); Q16TT9C5BK (bazedoxifene) [Em] Mês de entrada: 1711 [Cu] Atualização por classe: 171108 [Lr] Data última revisão: 171108 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170526 [St] Status: MEDLINE

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[PMID]: 28502966 [Au] Autor: Matsuhashi T; Nakanishi K; Hamano E; Kamoi S; Takeshita T [Ad] Endereço: Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital. [Ti] Título: Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review. [So] Source: J Nippon Med Sch;84(2):90-95, 2017. [Is] ISSN: 1347-3409 [Cp] País de publicação: Japan [La] Idioma: eng [Ab] Resumo: Vaginal cuff dehiscence is a rare but serious complication that can develop after hysterectomy. Emergent surgical intervention is required for vaginal cuff dehiscence due to the potential subsequent vaginal evisceration, which may lead to necrosis of the small bowel. A 62-year-old nulliparous woman with a 30-year history of smoking, diabetes mellitus, and rheumatoid arthritis (treated with oral steroids) presented with a vaginal cuff dehiscence. Thirty-eight days before the admission, she had undergone a radical operation including total abdominal hysterectomy for uterine corpus cancer at another hospital. We performed emergent laparoscopic surgery to reduce the prolapsed small bowel into the abdominal cavity and repaired the vaginal cuff with a two-layer continuous closure using absorbable barbed sutures. The patient experienced no postoperative complications, and no recurrence of the vaginal cuff dehiscence occurred. Vaginal cuff dehiscence and evisceration can be surgically managed using an abdominal, vaginal, or laparoscopic approach, and the choice of method should be based on patient characteristics and the surgeon's skills. Laparoscopic vaginal cuff repair with a two-layer continuous closure using absorbable barbed sutures is a minimally invasive technique that is safe and effective for medically stable patients with no small bowel injury or vascular compromise and no pelvic abscess. [Mh] Termos MeSH primário: Histerectomia/efeitos adversos Histerectomia/métodos Laparoscopia/métodos Complicações Pós-Operatórias/etiologia Complicações Pós-Operatórias/cirurgia Deiscência da Ferida Operatória/etiologia Deiscência da Ferida Operatória/cirurgia Neoplasias Uterinas/cirurgia Vagina/cirurgia Doenças Vaginais/etiologia Doenças Vaginais/cirurgia [Mh] Termos MeSH secundário: Feminino Seres Humanos Meia-Idade Técnicas de Sutura Resultado do Tratamento [Pt] Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE; REVIEW [Em] Mês de entrada: 1709 [Cu] Atualização por classe: 170928 [Lr] Data última revisão: 170928 [Sb] Subgrupo de revista: IM [Da] Data de entrada para processamento: 170516 [St] Status: MEDLINE [do] DOI: 10.1272/jnms.84.90

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