Overview and aims: Hysterectomy is one of the most common gynecological surgical procedures and several studies have demonstrated the multiple advantages of laparoscopic approach in general. Obesity was initially considered to be a con traindication for laparoscopy. However, this historical perspective has been disputed. The aim of this study was to assess the effect of the body mass index (BMI) on intra-operative parameters and intra and post-operative complication rates of total laparoscopic hysterectomy (TLH). Study design: A retrospective, observational, descriptive and analytic study. Population : All TLH performed in our department, by the same surgical team, between April 2009 and March 2014, were evaluated. Methods : Medical records were reviewed for patient characteristics (BMI, age, medical and surgical history), surgical charac te ristics (surgical indication and concomitant procedure, uterine weight, operating time, post-operative hemoglobin varia tion, length of hospital stay), and intra and post-operative complications. The data were analyzed according to patients’ BMI. Results: The study population was divided in normal BMI (n=145), overweight (n=119) and obese (n=54). Obese patients were older, more frequently postmenopausal and with more medical pathology than normal BMI patients. More than 50% of the patients had history of at least one previous abdominopelvic surgery with no differences among the groups. No sig nificant differences were found in terms of uterine weight (217.7 ± 154.8 vs. 257.5 ± 176.1 vs. 225.4 ± 151.0 g; p> 0.05), post-operative hospital stay (1.6 ± 0.9 vs. 1.5 ± 1.0 vs. 1.5 ± 0.9 days; p> 0.05), operating time (72.2 ± 25.3 vs.77.5 ± 25.8 vs. 83.6 ± 35.3 minutes; p> 0.05) or complication rates (12.4% vs. 14.3% vs. 13.0%). Conclusions: This study demonstrates that, in qualified hands, obesity did not increase the operating time and the intra or post-operative complication rates associated with TLH. Thus, high BMI should not be considered a contraindication for this procedure.
The goal of human papillomavirus (HPV) vaccination is the decline of HPV related premalignant lesions, leading to prevention of cervical cancer. Vaccination against HPV is recommended until the age of 45 to prevent viral reinfections and reactivations. The aim of this study was to evaluate adhesion to HPV vaccination and their associated factors in adult women.Cross-sectional study in two tertiary hospitals, with a questionnaire distributed to women born between 1974 and 1992, from September till November 2019. Data collected included sociodemographic information, clinical information, knowledge about HPV, and the HPV vaccine and data regarding vaccine recommendation. Factors associated with vaccination were searched by bivariate and multivariate statistical analysis.In 469 questionnaires, 25.4% (n = 119) women were vaccinated. The main reason for not vaccinating was the non-recommendation (n = 276; 70.2%). In bivariate analyses, vaccinated women were younger, predominantly not married, had higher educational level, and higher careers (P ≤ .001); an abnormal cytology, HPV infection or previous excision of the transformation zone were associated with a 3 to 4-fold increase in the odds of vaccination. Age, high-risk HPV infection, and knowing someone vaccinated remained factors independently associated with HPV vaccination in the multivariate analyses (P< .05). The recommendation of "vaccinate immediately" was independently associated with effectively doing it (P< .001).HPV vaccination is associated with vaccine recommendation, especially if it is recommended to do immediately. These results reinforce the need of health professionals to be aware of the impact that their recommendation has on adhesion to HPV vaccination.
Background. The sentinel lymph node (SLN) concept might minimize surgical aggressiveness in cervical and endometrial malignancies. The aim of the study was to test the feasibility and reliability of minilaparoscopic extraperitoneal SLN excision after indocyanine green (ICG) cervical injection using a high-definition near infrared (NIR) imaging system in an in vivo porcine model. The same procedure was performed using conventional laparoscopic instruments and both outcomes were compared. Methods. Twenty-four animals were equally and randomly divided into a minilaparoscopic group (group A) and a 5-mm conventional laparoscopic group (group B). A high-definition NIR imaging system and a 30° ICG endoscope were used. First, ICG (0.5 mL) was injected in the paracervical region. The SLN coloring time was recorded. An extraperitoneal approach to the SLN was executed with the same CO 2 retropneumoperitoneum pressures (10 mm Hg). In both groups, the times for SLN localization and excision, as well as complications, were registered. Finally, a laparotomy was then done to evaluate whether any stained SLN still remained. The same surgical team performed all experiments. Results. SLNs were identified and extraperitoneally excised in all animals without major complications. The SLN localization varied between animals from external iliac to preaortic regions. The surgical times were shorter with minilaparoscopy (39.3 ± 13 minutes) than with conventional 5-mm instruments (51.3 ± 14.17 minutes; P = .042). In group B, one stained SLN remained and was only detected by laparotomy. Conclusions. We confirmed the feasibility and reliability of extraperitoneal minilaparoscopic approach for identification, dissection, and excision of SLN using an NIR imaging system and ICG.
Foetal heart rate (FHR) variability is considered a marker of foetal neurobehavioral development associated with infant self-regulation and thus may be an early precursor of the adverse impact of mother's prenatal depressive symptoms on infant self-regulation.This study analysed the mediator role of FHR variability in the association between mother's prenatal depressive symptoms and infant self-regulation at three months.The sample comprised 86 first-born infants and their mothers. Mothers reported on depressive symptoms at the first trimester of pregnancy and on depressive symptoms and infant self-regulation at three months postpartum. FHR variability was recorded during routine cardiotocography at the third trimester of pregnancy. A mediation model was tested, adjusting for mother's postnatal depressive symptoms.Higher levels of mother's prenatal depressive symptoms were associated with both lower FHR variability and lower infant self-regulation at three months. FHR variability was associated with infant self-regulation and mediated the association between mother's prenatal depressive symptoms and infant self-regulation at three months.Findings suggested FHR variability as an early precursor of infant self-regulation that underlies the association between mother's prenatal depressive symptoms and infant self-regulation. Infants of mothers with higher levels of prenatal depressive symptoms could be at risk of self-regulation problems, partially due to their lower FHR variability.
Aim: To determinate vaccine coverage of all vaccine included in Portuguese National Vaccination Program (PNVP), in 1990 to 2005 birth cohorts, in Braga Health Centre (BHC) and in their Health Extensions (HE). Type of Study: Observational cross-sectional study. Local: Braga Health Centre. Population: Individuals registered in each HE and HU of BHC, which belong to 1990 - 2005 birth cohorts. Methods: Sinus informatic program was used as information data source. Results: The attenuated polio vaccine and hepatitis B vaccine reached coverage levels higher to 95% in 2002, the Bacille Calmette-Guérin and measles, mumps and rubella vaccine in 2004 and the diphtheria-tetanus-pertussis vaccine (DTP) and Haemophilus influenzae b vaccine (Hib) in 2005. Vaccine coverage of combined vaccine against tetanus and diphtheria, of individual immunity, was always lower to 100% (values between 84 to 94%). Some HE maintains coverage levels very lower to internationally recommend. It was also verified that vaccines to which PNVP recommends more doses, such as DTP and Hib, have inferior coverage levels. Conclusions: It was demonstrated a progressive tendency to the improved coverage levels over time in BHC. However, values higher to 95% were only recently reached. Thus, the PNVP aims start to be acceptable achieve in younger birth cohorts. In this study were also described significant asymmetries in vaccine coverage levels that can delay the achievement of group immunity, being an important problem of public health..
Vulvovaginal candidiasis (VVC) has been identified as a global issue of concern due to its clinical, social and economic implications. The emerging relevance of VVC makes it crucial to increase the knowledge on its epidemiological and etiological features in order to improve its prevention and treatment. Thus, this study aimed to reveal the incidence, microbiology, antifungal pattern and risk factors of VVC in Portugal. For that, high vaginal samples were collected from 470 symptomatic and asymptomatic participants; Candida spp. were identified with molecular techniques and their antifungal susceptibility was analyzed with E-tests. The results revealed an incidence of VVC among women with vulvovaginitis of 74.4%. Furthermore, 63.7% of asymptomatic women were colonized with Candida spp. Importantly, women with history of recurrent vaginal infections, those who use over-the-counter antifungals, oral contraceptive pills and non-cotton underwear were found to be at significantly higher risk of developing VVC. Candida albicans was the most common species (59%), followed by Candida glabrata (27%), in a total of eight distinct species, with similar distribution among colonized and infected participants. Of note, various isolates, especially of the most common species, showed low susceptibility towards fluconazole. In contrast, only few isolates showed low susceptibility towards caspofungin. Overall, this study suggests that the identification of species causing VVC and their antifungal susceptibility are urgently needed in clinical practice in order to improve the decision for the most adequate treatment. It also suggests that avoiding certain risk behaviors may prevent the development of VVC.Vaginal candidiasis (VVC) is a relevant infection worldwide. In this study, we identified several risk behaviors that may promote VVC and concluded that vaginal microbiologic analyses are urgently required in clinical practice in order to improve the prevention and treatment of this disease.
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