Impact of Selective vs Routine Midline Episiotomy and Lacerations of the Anal Sphincter

Introduction: Obstetric anal sphincter tear (OAST) is associated with anal incontinence. Episiotomy was proposed as a form of protection of the anal sphincter at delivery;however, several studies have shown that routine use of episiotomy does not reduce the risk of OAST. Objective: This study aims to analyse whether the reduction in the rate of episiotomy in a school hospital in Brazil was associated with an increase in the incidence of obstetric lacerations of the anal sphincter, in addition to associated factors. Methods: Observational, cross-sectional and retrospective study. We included all vaginal deliveries of single pregnancies, cephalic presentation, from 34 weeks of gestational age, performed in 2011-2012 (liberal episiotomy) and 2015-2016 (restricted episiotomy), and compared in relation to the rate of mediolateral episiotomy and OAST. Results: 4268 births were analysed (2043 in 2011-2012 and 2225 in 2015-2016). The episiotomy rate decreased from 59.4% to 44.2% (p ≤ 0.0001). In 2011-2012, there were 10 obstetric anal sphincter lacerations in 2043 births (0.48%), while in the period 2015-2016 there were 31 lacerations in 2225 births (1.39%). There was interaction when comparing the two periods in relation to the episiotomy and the occurrence of OAST (p ≤ 0.0001). Factors associated with OAST were labor induction and shoulder dystocia. Conclusion: There was an increase in the rate of lacerations of the anal sphincter with use of restrictive episiotomy. However, this increase occurred both in deliveries with and in deliveries without episiotomy.

Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature

Complement deficiencies are uncommon types of primary immunodeficiency. Necrotizing fasciitis is a rare complication in pregnancy characterized by soft tissue invasion and necrosis of the subcutaneous and other adjacent tissues, leading to high mortality rates. We report a case of a 29-year-old pregnant woman with functional deficiency of the C4 complement component and short uterine cervix. Admitted at the hospital with preterm labor, she received multiple doses of immunoglobulin. After 8 weeks, she had a premature membrane rupture, and due to pelvic presentation she had a cesarean. The patient presented multiple obstetric complications, such as operative wound infection, endometritis, sepsis, necrotizing fasciitis and pelvic septic thrombophlebitis. She underwent multiple antimicrobial schemes, a hysterectomy and 4 extensive debridements of the abdominal wall because of significant necrosis. She stayed at the hospital for 101 days (32 of those in ICU in immediate postpartum). 41 days after cesarean, patient was discharged in good conditions. Our case emphasizes individual handling and high multiple doses of immunoglobulin for favorable outcome of the case.

Female Sexual Function after Surgical Treatment of Urinary Incontinence

Introduction: Urinary incontinence is a common problem that can affect the quality of life of women of all ages and can negatively influence the exercise of sexuality. Aim: The aim of this study was to compare sexual function of women before and after surgical treatment for urinary incontinence. Method: The sample consisted of 38 women with urinary incontinence and surgical treatment (Burch or Sling procedure). The Female Sexual Function Index (FSFI) was used to evaluate sexual dysfunction before and after surgical treatment. Results: The mean age of the women in the study was 48 ± 8.8 years, and 58% were 50 years old or younger. By analyzing FSFI, it was observed that the majority of subjects had an overall index of sexual dysfunction (score < 26 points) before surgery. The desire and arousal domains improved significantly after surgery for all women included in the study. It was also observed that women with higher levels of education had more positive results related to desire. Conclusions: In our sample, in general, sexual function improved after surgical treatment of urinary incontinence, regardless of technique used, particularly in the discounter and pain domain. There was a substantial improvement of the sexual function among women who had presented with cystocele. Desire and arousal improved significantly after surgery, very likely due to the improvement of self-esteem after surgery.

Sexual Function in Pregnant Women in the Public Health System

Introduction: Pregnancy is a unique situation and involves changes in sexuality. The aim is to evaluate sexual function and satisfaction in pregnant women under prenatal care provided by the public health system. Method: Cross-sectional study with pregnant women receiving ambulatory care in the public health system in the Southern region of Brazil conducted between November 2014 and September 2015. Results: 283 pregnant women were studied. The mean age was 27.7 ± 6.3 years;64% were white and 31.1% were nulliparous. In the total sample, 8.50% were in the first trimester of pregnancy, 37.4% were in the second trimester, and 54.1% were in the third trimester. The rate of global sexual dysfunction (score 26 points) was 55.5%, following the application of The Female Sexual Function Index (FSFI). Sexual dysfunction was significantly more prevalent in the third trimester (62%) compared to the first (33.3%) and second (50.9%) trimesters (p = 0.015). There was a significant difference in all domains, except in the desired domain, according to the trimester. Pregnant women in the third trimester showed significantly lower scores compared to those in the first trimester in the domains with significance. Conclusion: The prevalence of sexual dysfunction among pregnant women in the public system was high. Knowing that more than 50% of the pregnant women presented sexual dysfunction, it is essential to approach sexuality during prenatal care involving the couple.

Profile of Female Patients at a Sexology Ambulatory in the Brazilian Public Health System

Introduction: Sexual problems are fairly common, and sexuality is an important parameter of health and quality of life. However, only a few centers in Brazil have ambulatories specialized in sexual dysfunction. This study was conducted in a service that is a state reference for these pathologies. Methods: This study was conducted at the human sexuality ambulatory of a large public hospital in southern Brazil. It was a cross-sectional descriptive study with women attending at the first medical visit to the ambulatory of human sexuality in a period of four years. Female Sexual Function Index (FSFI) questionnaires with both qualitative and quantitative questions were applied in all first medical visits to the ambulatory. Results: The 153 women attending had a mean age of 40.9 (±12.9) years. The most frequent complaint was “lack of desire” (56.8%), followed by pain in intercourse (25.4%) and lack of pleasure or inability to achieve orgasm (12.4%). The prevalence of sexual dysfunction (FSFI cut-off score < 26.5) was 74.5%. The patient’s age, the age of the partner, and the length of the relationship with the partner had a significant correlation with a lower FSFI score. There was an inverse correlation between the length of the relationship and the FSFI score. The self-attributed score for satisfaction with sexual life had a significant correlation with the FSFI total score (r = 0.708, p 0.01). Conclusion: We conclude that women who seek care in sexuality are in the perimenopausal period and that factors such as the number of children, age of menopause and length of the relationship have a negative influence on sexuality. The score for the self-assessment of sexuality could serve as an initial screening for sexual dysfunction, since it is quick and easy to apply in routine medical visits. However, more studies are required to compare the FSFI and this score.

The Effects of Lichen Sclerosus and Its Treatments on Sexuality: Case Report

Lichen sclerosus is a chronic and autoimmune dermatitis that develops in the anogenital region. It is related to genital alterations with repercussions in sexuality. We present a case of a 60-year-old woman who had several chronic diseases and had been diagnosed with vulvar lichen sclerosus for 20 years, with no response to multiple treatments (topical corticosteroids, immunomodulators). She was submitted to vulvectomy;however, it leads to worsening of her condition, presenting obliterated and fibrosed clitoris, atrophic vaginal lips, and anal and vulvar fissures. She remained with dyspareunia, decreased sexual desire and difficulty in orgasm. She underwent sexual therapy, adjustment of antidepressant medication and made intercalated use of topical corticosteroids, topical testosterone and vaginal moisturizers, with partial improvement. From this case we can conclude that, although vulvectomy can be related to some degree of improvement in patients with lichen sclerosus, serious complications can occur.

Acute Generalized Exanthematous Pustulosis during Puerperal Period Induced by Azithromycin: Case Report

Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reaction. Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor. Due to cephalopelvic disproportion, the cesarean section was indicated. In the postoperative period, the patient evolved with cutaneous rash, accompanied by productive cough and dyspnea. Because it was a fever of obscure origin, the treatment with antibiotics, including azithromycin, was initiated. On subsequent days, she presented pustules on the back, abdomen and extremities. Such reaction was attributed to the use of azithromycin. When the drug was discontinued, the lesions regressed significantly. Conclusion: The clinical picture of AGEP may occur with persistent high fever and therefore could be confused with systemic infections, consequently, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be easily treated by stopping the use of the causative drug. This case shows the importance of including AGEP as a differential diagnosis of dermatopathies in the pregnancy-puerperal cycle, especially in women who are using various medications, including antibiotics.

Massive Splenomegaly in Pregnancy: Case Report

A 33-year-old primigravida presented to an appointment at a high-risk prenatal outpatient service due to a history of splenomegaly. Her spleen occupied of the abdominal cavity and shifted the uterus to the right side of the abdomen. During investigation, an intrauterine growth restriction (IURG) and a series of other clinical complications were discovered. We admitted her to inpatient care at 28 + 1 weeks’ gestation for a better investigation of her extensive splenomegaly and for pregnancy monitoring, with a further successful delivery.

Maternal Effects of Immediate versus Delayed Umbilical Cord Clamping: A Randomized Clinical Trial

OBJECTIVE: To compare maternal preoperative and postoperative hemoglobin variation after cord clamping. METHODS: Randomized clinical trial performed in Porto Alegre, RS from January to December 2012. It was included 356 women with habitual risk gestations. In the immediate cord clamping group, the umbilical cord section was realized between 0 and 60 s (group 1) while in the delayed cord clamping group it was realized >60 s (group 2). RESULTS: The mean (±standard deviation [SD]) preoperative hemoglobin was 12.13 ± 1.06 in the group 1 and 12.13 ± 1.11 in the group 2. The mean (±SD) postoperative day 2 hemoglobin level was 10.19 ± 1.46 in the group 1 and 10.24 ± 1.42 in the group 2. CONCLUSIONS: Delayed umbilical cord clamping resulted in a similar maternal hemoglobin level reduction at postoperative day 2.

Correlation between Late Cord Clamping and Phototherapy and Other Neonatal Unfavorable Outcomes: A Randomized Clinical Trial

Background: Recently, late umbilical cord clamping is generally recommended, which decreases neonatal anemia;however, it may also increase neonatal jaundice and some other poor outcomes. Objectives: We here attempted to determine whether late clamping actually increases the incidence of phototherapy for jaundice and other poor outcomes of the term “low-risk newborns”. Methods: With the approval of the Brazilian Registry of Clinical Trials (REBEC), a total of 357 low-risk newborns (singleton, uncomplicated pregnancy/delivery, in a Brazilian public institution) were randomized into two groups: group I (n = 114): cord clamping 1 minute (early clamping) or group II (n = 243): cord clamping between 1 - 3 minutes (late clamping). Statistics were used appropriately (i.e., measures of central tendency, dispersion for continuous variables, Shapiro-Wilk, Mann-Whitney test, or Chi-square test). Results: Phototherapy was performed in 5.3% in both groups. Also, there were no statistical differences in the occurrence of secondary outcomes, such as sepsis, neonatal ICU admission, and transient tachypnea of the newborns: i.e., 0.9%, 15.8%, and 3.5%, respectively for group I versus 1.2%, 15.6%, and 5.8%, respectively for group II. Conclusion: Late umbilical cord clamping does not increase the need for phototherapy in low-risk neonates. This result corroborates the current recommendation of late cord clamping, whenever appropriate.

Hereditary Angioedema in Pregnancy and Management without Recombinant Human C1-INH

A pregnant woman diagnosed with type 1 angioedema seeks care at a public hospital for planning the delivery. This report presents ways to prevent and manage an acute HAE crisis during childbirth and early postpartum without the availability of first-line medications, such as plasma-derived human C1-INH concentrate.

Therapeutic Approach in Female Sexual Dysfunctions in an Outpatient Clinic of Sexology in the Public Health System: A Longitudinal and Prospective Study

INTRODUCTION: Sexuality is one of the parameters of quality of life, and it is essential to include care for sexual dysfunctions in primary health care. OBJECTIVE: To evaluate the therapeutic approach in female sexual dysfunction in a public health outpatient clinic. DESIGN: A prospective cohort of women with sexual dysfunctions in an outpatient clinic of sexology in the Public Health System. The Female Sexual Function Index (FSFI) and scored 0 - 10 their sexual satisfaction were applied at the beginning and end of the follow-up. RESULTS: Eighty-nine women were included with a median age of 45 years, 69 (77.5%) had less than 11 years of schooling and 95.5% lived with a partner. The main reasons for referral for follow-up at the outpatient clinic of sexuality were dysfunction of hypoactive sexual desire disorder in 67.4% and pain related to sexual function in 46%. The average number of consultations was five and the main therapeutic interventions were guidance and clarification on sexuality (86.5%), use of topical estrogen (56.2%), and relaxation techniques (37.1%). All FSFI-19 domains had better post-intervention rates (p ≤ 0.005). Considering the domains of the FSFI-19, the medians of desire, arousal, lubrication, orgasm, pleasure and pain were higher in the post-intervention period in relation to the pre-intervention period (p ≤ 0.0001 for all analysis). In addition, the score given by the participant on their sexual satisfaction was higher at the post-intervention time compared to the pre-intervention period (p ≤ 0.0001). CONCLUSION: In public health, even with the care being performed by different professionals in each consultation, we conclude that through simple interventions, it is possible to improve the sexualities of the women attended. Still, offering care in sexuality is fundamental as part of primary health care and the training of medical professionals.

Impaired of Sexuality in Premenopausal Breast Cancer Patients

Introduction: The treatment modalities for Breast cancer may impair the sexual function of women, especially in the pre-menopausal period. Treatment in this group of women has a huge impact in quality of life. The main objective of this study was to evaluate the prevalence of sexual dysfunction (SD) after treatment for breast cancer among women who were premenopausal at the diagnosis of neoplasia. Material and Methods: All women diagnosed with premenopausal breast cancer at one outpatient clinic from March 2019 to September 2020 were selected. Participants answered two sexual function questionnaires (the Female Sexual Function Index [FSFI-19] and Female Sexual Quotient [QS-F]) and a quality of life [QOL] questionnaire [EORTC QLQ-C30]). Sociodemographic and tumor characteristics were also studied. Results: Fifty-eight pre-menopausal women were included. Sexual dysfunction (SD) was observed in 43 participants (74.1%) according to the FSFI-19, while 31 (53.4%) had SD according to the QS-F. The functional and general health scales of the EORTC QLQ-C30 were positively related to the FSFI-19 and QS-F scores, while the symptom scale was negatively related to the FSFI-19 and QS-F scores. There was no relationship between chemotherapy, hormone therapy, or surgery with the FSFI-19 and QSF scores. A diagnosis of depression was negatively related to the total FSFI-19 scores. Conclusion: Pre-menopausal breast cancer women showed high rates of female SD. None breast cancer treatment modality was related to SD. The only studied variable associated with SD was depression.

游走于现代与古典的美

这所房子好像一座艺术馆。

Midline Supraumbilical Incision as an Option for Morbidly Obese Patients? Case Report

Background: Nowadays we observe growing rates of obesity, mainly among women. It has a great impact on maternal and fetal morbimortality and requires a specific obstetric approach. Aim: To discuss different approaches to abdominal incision in cesarean section in obese patients. Case presentation: Patient with morbid obesity submitted to an elective cesarean section due to fetal macrosomia and who underwent a cesarean section with a supraumbilical median incision evolving without any postpartum complications. Conclusion: It’s important to evaluate and chose the best incision in morbidly obese pregnant women aiming to reduce difficulties in fetal extraction and postoperative complications. Midline supraumbilical incision is a good choice in these cases, reducing surgical time and postpartum hemorrhage.

Nutraceutical Supplementation Based on Colostrum as Osteoporosis Treatment: A Pilot Study

Introduction: Naturally based treatments for osteoporosis are currently limited. The purpose of this investigation was to ascertain whether bovine colostrum supplementation can improve bone health in humans. Methods: In total 63 individuals volunteered in a 4-month supplementation project. They were stratified into three groups: 1) healthy post-menopausal women (n = 24); 2) individuals with osteopenia (n = 25); 3) people with osteoporosis (n = 14). Participants of each group were randomly assigned into two experimental sub-groups: a) the bovine colostrum (BC) supplementation (200 mL/day;5 days/week); b) the placebo sub-group. Before and after the 4-month supplementation, blood samples were obtained and bone mineral density (BMD) was measured. Dual-Energy X-ray Absorptiometry (DXA) was performed on three different anatomical sites: lumbar spine (LS), left femur neck (FN), and left forearm (Arm). Bone health markers (bone alkaline phosphatase (BAP), osteocalcin, C-terminal telopeptide (CTX-I), deoxypyridinoline (DPD)) as well as immunological markers (interleukin 6 (IL6) and immunoglobulin E (IgE)), were assessed in blood serum with enzyme immunoassays, at baseline and 4-months after BC supplementation. Results: No significant changes were found in bone densitometry factors (p > 0.05), for all studied blood parameters and their calculated effect sizes. Conclusions: It is concluded that, as studied herein, BC does not seem to affect human bone health. This pilot study though warrant the need for further research into the efficacy of BC in patients with osteoporosis.

雅致生活

屋主在空间的设计上，并没有什么特别的要求，经过设计师细心分析屋主的需要后，便度身设计了一间以实用为原则，并采用深色作主调的设计方案，以将这间房子打造成拥有大量储物空间，并不失时代感的家居。

Large,low-field and reversible magnetostrictive effect in MnCoSi-based metamagnet at room temperature

TiNiSi-type MnCoSi-based alloys show large magnetostriction during the magnetic-field-induced metamagnetic transition.However,the high critical field required to drive the transition directly hinders their potential applications.In this work,we systematically investigate the tricritical behavior and magnetostrictive effect in substituted MnCoSi alloys.Replacing Si with Sb or In,Co with Fe or Cu,and Mn with Co,which can simultaneously reduce the critical field and the temperature of tricritical point,are explored.Among the substituted MnCoSi alloys,Mn_(0.983)Co_(1.017)Si displays a temperature of a tricritical point of 250 K and a room-temperature critical field of 0.60 T,which is the lowest up to now.Profited from these optimizations,a large reversible magnetostrictive effect under low field is successfully realized at room temperature.In a field of 1 T,the magnetostriction of Mn_(0.983)Co_(1.017)Si alloy is close to 1000 ppm.Besides,a strong relation between critical field and valence electron concentration is revealed in the transition-metal-substituted MnCoSi alloys.Our work greatly enhances the low-field magnetostrictive performance of MnCoSi-based alloys and make them be of interest in potential applications.

A Life in Song

Famed Chinese opera singer Hao Jiang Tian completes a special 30th anniversary recital From the opening notes of Hao Jiang Tian’s recital commemorating his 30-year career as one of the world’s most celebrated operatic bass voices,including 19 years at the New York Metropolitan Opera,the audience could sense it was one of the singer’s most personal performances.The teenage Chinese factory worker with a"big voice"was transformed into a king of Verdi and Mozart,taking listeners through a repertoire of classic Chinese