Cervical cancer is one of the most preventable and treatable malignancies, however, it still has high incidence and mortality rates, especially in less developed countries. For Brazil, the estimate is more than 16,000...Cervical cancer is one of the most preventable and treatable malignancies, however, it still has high incidence and mortality rates, especially in less developed countries. For Brazil, the estimate is more than 16,000 new cases and more than 6000 deaths annually. Despite this, vaccines against HPV (responsible for cervical cancer) are effective and promote a significant decrease in infections and neoplastic lesions of the cervix. As recommended by the World Health Organization, girls aged 9 to 14 should be vaccinated before becoming sexually active. Although the vaccine was developed in 2006, in Brazil immunization only started to be carried out in 2014, initially only for girls between 9 and 11 years old. The present work is an integrative review, with the objective of explaining the current situation of vaccination against HPV throughout the country. Using the PubMed, MED-LINE and Google Scholar databases, a search for scientific articles was carried out during the year 2022, using the descriptors “Vaccine”, “HPV” and “Brazil”, simultaneously selecting 17 articles. The Brazilian recommendations for vaccination against HPV have undergone several strategic changes over time, in the following points: age group and gender of the target population, major site of application of vaccines and number of doses to be applied. Currently, in Brazil, the recommendation for vaccination against HPV is neutral in gender, between 9 and 14 years old and in immunosuppressed people up to 45 years old, with a vaccination schedule of 2 doses with an interval of 6 months between them, and 3 doses for those from 15 years and immunocompromised individual (0 - 2 - 6 months). The tetravalent vaccine offered by public funding continues to be applied at health centers, despite several favorable criticisms of the return of application in schools. Even though the vaccine is available free of charge, studies point to the difficulty in achieving and maintaining vaccination coverage, especially for the second dose. Among the factors that impede success, they cite illiteracy in health generated mainly by social inequality and the lack of educational actions by the government, demonstrating the need to plan effective strategies in this regard.展开更多
GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdevel...GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis of the pathology results in inadequate classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to point out updated national and international practice protocols of diagnosis of GTD, through an integrative review. Seven articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized (usually one month for Partial Hydatidiform Mole six months for Complete Hydatidiform Mole and one year for Gestational Trophoblastic Neoplasia). Unfortunately, regarding the diagnosis of MH, the guidelines of some countries show the absence or difficulty of access to the karyotype test and ploid p57 or pelvic ultrasound accompanying the uterine curettage, contrary to what is proposed by the IFGO guideline. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.展开更多
The Human Papillomavirus (HPV) is responsible for almost 99% of cervical cancers. Cervical cancer is a public health problem, being the fourth most common type of tumor among women worldwide and the third most common ...The Human Papillomavirus (HPV) is responsible for almost 99% of cervical cancers. Cervical cancer is a public health problem, being the fourth most common type of tumor among women worldwide and the third most common cancer among women in Brazil. It is known that cervical cancer is one of the most easily preventable forms of cancer, as there is a highly effective vaccine against HPV, however, morbidity and mortality rates related to human papillomavirus are still frightening, especially in less developed countries. Low vaccination adherence rates, especially the second dose, are probably a reflection of the lack of knowledge about this virus, its clinical repercussions, and the vaccine. A clinical trial was carried out in a higher education institution in Alagoas (Brazil), with students of the medical course to whom a validated questionnaire was applied on HPV in the virtual environment (google forms). Data collection was carried out throughout the month of May of the year 2023. It was shown that the knowledge of medical students about the human papillomavirus was less than what would be desired for future doctors. The alert for the acute need to assess health illiteracy is clear, especially regarding cancer that can be prevented by a highly effective vaccine.展开更多
Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age...Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.展开更多
HPV (Human Papillomavirus) is an adenovirus of the Papillomaviridae family with approximately 200 subtypes (subdivided into low and high oncogenic risk groups), responsible for almost 99% of cervical cancers. Worldwid...HPV (Human Papillomavirus) is an adenovirus of the Papillomaviridae family with approximately 200 subtypes (subdivided into low and high oncogenic risk groups), responsible for almost 99% of cervical cancers. Worldwide, there are more than 570,000 new cases and more than 311,000 women die each year from cervical cancer;for Brazil, the estimate is of more than 16,000 new cases per year. It is known that cervical cancer is one of the most easily preventable forms of cancer, as there is a highly effective vaccine against HPV. However, the morbidity and mortality rates correlated with human papillomavirus are still concerning, especially in less developed countries. In 2020, the WHO (World Health Organization) presented three goals to achieve by 2030 the worldwide extermination of cervical cancer;among these goals is vaccination. Is the world preparing for this battle? The present work is an integrative review, comparing national and international guidelines for HPV vaccination published in the last five years in the consulted databases, using the descriptors “cervical cancer”, “prevention” and “guideline” and the boolean operator “and”, from which nine articles were selected. The study made it possible to compare international and national guidelines for vaccination against HPV, showing that developed countries implemented the HPV vaccine longer ago and follow the WHO recommendations more rigorously and effectively than underdeveloped or developing countries. Adopting a single dose as a strategy, as suggested by the WHO in April 2022, could be an important step towards increasing coverage and providing protection for a greater number of girls who do not have access to HPV immunization.展开更多
GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdevel...GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (Gestational Trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.展开更多
文摘Cervical cancer is one of the most preventable and treatable malignancies, however, it still has high incidence and mortality rates, especially in less developed countries. For Brazil, the estimate is more than 16,000 new cases and more than 6000 deaths annually. Despite this, vaccines against HPV (responsible for cervical cancer) are effective and promote a significant decrease in infections and neoplastic lesions of the cervix. As recommended by the World Health Organization, girls aged 9 to 14 should be vaccinated before becoming sexually active. Although the vaccine was developed in 2006, in Brazil immunization only started to be carried out in 2014, initially only for girls between 9 and 11 years old. The present work is an integrative review, with the objective of explaining the current situation of vaccination against HPV throughout the country. Using the PubMed, MED-LINE and Google Scholar databases, a search for scientific articles was carried out during the year 2022, using the descriptors “Vaccine”, “HPV” and “Brazil”, simultaneously selecting 17 articles. The Brazilian recommendations for vaccination against HPV have undergone several strategic changes over time, in the following points: age group and gender of the target population, major site of application of vaccines and number of doses to be applied. Currently, in Brazil, the recommendation for vaccination against HPV is neutral in gender, between 9 and 14 years old and in immunosuppressed people up to 45 years old, with a vaccination schedule of 2 doses with an interval of 6 months between them, and 3 doses for those from 15 years and immunocompromised individual (0 - 2 - 6 months). The tetravalent vaccine offered by public funding continues to be applied at health centers, despite several favorable criticisms of the return of application in schools. Even though the vaccine is available free of charge, studies point to the difficulty in achieving and maintaining vaccination coverage, especially for the second dose. Among the factors that impede success, they cite illiteracy in health generated mainly by social inequality and the lack of educational actions by the government, demonstrating the need to plan effective strategies in this regard.
文摘GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis of the pathology results in inadequate classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to point out updated national and international practice protocols of diagnosis of GTD, through an integrative review. Seven articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized (usually one month for Partial Hydatidiform Mole six months for Complete Hydatidiform Mole and one year for Gestational Trophoblastic Neoplasia). Unfortunately, regarding the diagnosis of MH, the guidelines of some countries show the absence or difficulty of access to the karyotype test and ploid p57 or pelvic ultrasound accompanying the uterine curettage, contrary to what is proposed by the IFGO guideline. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.
文摘The Human Papillomavirus (HPV) is responsible for almost 99% of cervical cancers. Cervical cancer is a public health problem, being the fourth most common type of tumor among women worldwide and the third most common cancer among women in Brazil. It is known that cervical cancer is one of the most easily preventable forms of cancer, as there is a highly effective vaccine against HPV, however, morbidity and mortality rates related to human papillomavirus are still frightening, especially in less developed countries. Low vaccination adherence rates, especially the second dose, are probably a reflection of the lack of knowledge about this virus, its clinical repercussions, and the vaccine. A clinical trial was carried out in a higher education institution in Alagoas (Brazil), with students of the medical course to whom a validated questionnaire was applied on HPV in the virtual environment (google forms). Data collection was carried out throughout the month of May of the year 2023. It was shown that the knowledge of medical students about the human papillomavirus was less than what would be desired for future doctors. The alert for the acute need to assess health illiteracy is clear, especially regarding cancer that can be prevented by a highly effective vaccine.
文摘Endometriosis is a clinical and recurrent condition characterized by the presence of functional endometrial tissue outside the uterine cavity and myometrium. It is estimated that 6% to 10% of women of reproductive age, 50% to 60% of adolescents and adults with pelvic pain, and up to 50% of women with infertility are pregnant from the condition. However, this proportion tends to be even greater due to the difficulty in diagnosing it: because it presents different symptoms, lack of information from health professionals, and a high-cost diagnostic test. Another aggravating factor is the average time from the onset of symptoms to the medical diagnosis, which even today ranges from five to ten years;this delay has consequences for disease progression, as it prevents early treatment, which is important for improving pain levels and physical and psychological well-being. Aware of these mishaps, it is therefore important to assess the difficulties faced by doctors in the diagnosis of endometriosis in the public health system, in Brazil, the Unified Health System (SUS). With this purpose, a cross sectional was carried out, developed in the virtual environment using traffic in Google forms, with the difficulties quantified in the Likert scale. Participating physicians pointed out a medium difficulty for patients with endometriosis to access the consultation (58%) and moderate difficulty (52%) to perform an ultrasound examination;also signaled great difficulty in performing magnetic resonance imaging (77%) and laparotomy (61%) in these patients. It is hoped that knowledge about the difficulties faced by physicians in the diagnosis of endometriosis in the SUS will give these physicians a voice and corroborate, even if minimally, so that there is more research that provokes the search for these difficulties, in order to improving the quality of life of these women.
文摘HPV (Human Papillomavirus) is an adenovirus of the Papillomaviridae family with approximately 200 subtypes (subdivided into low and high oncogenic risk groups), responsible for almost 99% of cervical cancers. Worldwide, there are more than 570,000 new cases and more than 311,000 women die each year from cervical cancer;for Brazil, the estimate is of more than 16,000 new cases per year. It is known that cervical cancer is one of the most easily preventable forms of cancer, as there is a highly effective vaccine against HPV. However, the morbidity and mortality rates correlated with human papillomavirus are still concerning, especially in less developed countries. In 2020, the WHO (World Health Organization) presented three goals to achieve by 2030 the worldwide extermination of cervical cancer;among these goals is vaccination. Is the world preparing for this battle? The present work is an integrative review, comparing national and international guidelines for HPV vaccination published in the last five years in the consulted databases, using the descriptors “cervical cancer”, “prevention” and “guideline” and the boolean operator “and”, from which nine articles were selected. The study made it possible to compare international and national guidelines for vaccination against HPV, showing that developed countries implemented the HPV vaccine longer ago and follow the WHO recommendations more rigorously and effectively than underdeveloped or developing countries. Adopting a single dose as a strategy, as suggested by the WHO in April 2022, could be an important step towards increasing coverage and providing protection for a greater number of girls who do not have access to HPV immunization.
文摘GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (Gestational Trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.
