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Background Locally advanced cervical cancer (CC) is mostly treated with concurrent chemoradiotherapy (CCRT). The amount of local extension of the disease and lymph-node invasion are the most important factors related to a worse progression-free survival (PFS) and overall survival (OS). Moreover, recently, anemia and skeletal muscle index (SMI) appears as important predictors of clinical outcomes in patients with cancer, demonstrating the association of low haemoglobin level and SMI with worse PFS and OS. However, there is no consensus about the clinical impact of pretreatment anemia and low SMI in women with CC.Objective To evaluate pretreatment level of haemoglobin and SMI as a prognostic factors in women diagnosed with CC that CCRT.Methods 151 women diagnosed with CC were included in this cohort study with retrospective data collection. Pretreatment computerized tomography (CT) images were analysed to assess SMI. Hazard ratios (HR) and multivariate Cox proportional HR with (95%CI) were used to analyse the association between low SMI, age, menstrual state, body mass index (BMI), haemoglobin levels, neutrophil and platelet count, histological type, and FIGO stage with PFS and OS. The Kaplan-Meier method was used to analyse the survival of patients with or without low SMI according to stages.Results Among the 151 patients included, 53 (35.1%) presented pretreatment low SMI. Linear regression models showed that despite showing no association with age, neutrophil or platelet counts, low SMI was associated with low pretreatment haemoglobin levels (p = 0.01). After a multivariate analysis, only haemoglobin and complete CCRT remained associated with DFS (p Conclusion Pretreatment low level of haemoglobin was significantly associated with low SMI. However, only anemia and incomplete CCRT were independently associated with poor prognosis in women with CC. Pretreatment low SMI was a predictor of poor prognostic in early stages.

SUMMARY OBJECTIVE: The aim of this study was to describe the anthropometric characteristics, eating habits, and lifestyle of non-village indigenous women living in Manaus, AM, and their association with hypertension. METHODS: This cross-sectional (descriptive-analytical) study was carried out from January 2020 to December 2021 using a questionnaire for clinical, sociodemographic, and behavioral data. Non-pregnant women who belonged to Parque das Tribos for more than a year, declared themselves indigenous, and were over 18 years of age were included in the study. RESULTS: In total, 21 ethnicities were identified, and 95 indigenous women were evaluated. The average age group was 36±12.1 years, the average height was 157 cm, and the body mass index was 28.8 kg/m2. The prevalence of systemic arterial hypertension was ±40%, and 68.5% had excess weight, with 29.1% having class I obesity. In all, 35.8% consumed a lot of salt, sugar, and industrialized foods, and 88.4% were sedentary. CONCLUSION: Much of the sample presented excess weight, and almost all were sedentary. More than one-third had unappropriated eating habits. Hypertension was present in more than one-third of these indigenous women. There was an association between higher body mass index and hypertension. Knowing the characteristics of this group of non-village indigenous women may help determine the best health approach. The data demonstrate the necessity of preventive measures.

Objective The present study aimed to develop a useful mathematical model that predicts the age at which premature ovarian insufficiency might occur after teletherapy radiation. A diagnosis of premature or early menopause has physical and psychological consequences, so women may need support and long-term medical follow-up. Methods To correlate ovarian radiation dose with ovarian function, we used the formula described by Wallace et al.: √g(z) = 10(2-0,15z), where “g(z)” and “z” represent oocyte survival rate and the radiation dose (in Gray), respectively. By simulating different ages and doses, we observed a pattern that could be used to simplify the relationship between radiation dose and remaining time of ovarian function. Results We obtained a linear function between ovarian radiation dose and loss of ovarian function (LOF) that is the percentage of decrease in the time to the ovarian failure compared with the time expected for a woman at the same age without irradiation exposition. For patients

Heavy menstrual bleeding (HMB) has an estimated prevalence of 18–32% but is known to be under-reported due to poor recognition and estimation of menstrual blood loss (MBL). HMB can negatively impact quality of life, affecting social interactions, work productivity and sexual life. Abnormal menstrual bleeding may have an underlying structural or systemic cause, such as endometrial and myometrial disorders; however, for some, there is no identified pathological cause. Several methods are available for assessing MBL, including the alkaline hematin (AH) method and the menstrual pictogram (MP). The AH method is considered to be the most accurate way to monitor MBL; however, it is associated with inconvenience and expense, therefore limiting its value outside of research. The MP requires the user to select an icon from a chart that reflects the appearance of a used sanitary product; the icon is associated with a blood volume that can be used to determine MBL. Validation studies have demonstrated that the results of the MP and AH method are well correlated, showing that the MP can measure MBL with sufficient accuracy. Additionally, the MP is more convenient for users, less expensive than the AH method, may be used in regions where the AH method is unavailable and may also be used as part of a digital application. Overall, the MP offers a convenient approach to monitor MBL both in research and clinical practice settings.

Objective: To establish a proposal for the location for ovarian transposition, considering different irradiation techniques and time to ovarian failure. Methods: Patients with cervical cancer in childbearing age submitted to adjuvant radiotherapy were selected. Delineation of simulated positions of the ovaries and pelvic radiation planning was done in CT, with three techniques: 3D conformal radiotherapy, intensity-modulated radiotherapy, and volumetric modulated arc radiotherapy. In order to correlate the ovaries maximal doses with the time to ovarian failure, the authors have used the one adaptation of Wallace model that predicts oocytes survival rates after radiation exposure. Results: Thirteen patients who were being treated between 2008 and 2017 were studied. When the ovaries were positioned 10 cm cranially from the sacral promontory, the pelvic radiation entails a decrease of 20% in the time to ovarian failure compared with that expected for a female at the same age without irradiation exposition. The placement of the ovaries 90%. There was no difference in time to ovarian failure between the radiation treatment techniques tested: 3D conformal radiotherapy, intensity-modulated radiotherapy, and volumetric modulated arc radiotherapy (p=0.197). Conclusions: The present study, based on virtual simulations, is the first to use the sacral promontory as a reference for a proposal of ovarian location with transposition. The authors have correlated the position of the ovaries and percentage of decrease in time to ovarian failure. These findings can potentially improve the management and counselling of patients with cervical cancer in childbearing age and deserve clinical validation.

Esta revisão teve como objetivo analisar os recursos e sua eficácia na reabilitação do assoalho pélvico no tratamento dos prolapsos genitais e incontinência urinária. As buscas foram realizadas nas bases de dados MEDLINE/PubMed, LILACS/SciELO e Biblioteca Cochrane. Foram encontrados 886 artigos, dos quais foram utilizados 34 estudos clínicos relevantes que respondiam às perguntas construídas pelos autores. Os estudos analisados mostraram que o treinamento do assoalho pélvico pode ser usado no tratamento dos prolapsos, porém são necessários mais estudos randomizados para sustentar essa evidência. Para a incontinência urinária a reabilitação do assoalho pélvico é eficiente e deve ser o tratamento de primeira escolha.Esta revisión tiene como objetivo analizar los recursos y su eficacia en la rehabilitación del suelo pélvico en el tratamiento de los prolapsos genitales y la incontinencia urinaria. Las búsquedas fueron realizadas en las bases de datos Medline/Pubmed, LILACS/SciELO y Cochrane. Fueron encontrados 886 artículos, de los cuales fueron utilizados 34 estudios clínicos relevantes y que respondían las preguntas construidas por los autores. Los estudios analizados mostraron que el entrenamiento del suelo pélvico puede ser usado en el tratamiento de los prolapsos, sin embargo, son necesarios más estudios randomizados para sustentar esta evidencia. Para la incontinencia urinaria la rehabilitación del suelo pélvico es eficiente y debe ser el tratamiento de primera opción.This review aimed to assess the capabilities and effectiveness of pelvic floor rehabilitation in the treatment of genital prolapse and urinary incontinence. The research was conducted in MEDLINE/PubMed, LILACS/SciELO and Cochrane Library. There were found 886 articles, of which were used 34 relevant clinical trials that answered the questions constructed by the authors. The studies analyzed showed that pelvic floor training can be used in prolapse treatment, but further randomized studies are necessary to support this evidence. For urinary incontinence pelvic floor, rehabilitation is effective and should be the treatment of first choice.

Almost 5% of women with endometrial cancer are under the age of 40, and often have well-differentiated endometrioid estrogen-dependent tumors. Frequently, these women have a strong desire to preserve fertility. Strategies to avoid or reduce the reproductive damage caused by surgery, cytotoxic agents, and radiation are needed. This review addresses options available for safe fertility preservation in endometrial cancer. Clinical treatment with progestin agents may be prescribed after careful evaluation and extensive counseling. Strict criteria should be employed to select suitable patients, using imaging methods and endometrial sampling, once it has been established that standard surgical staging will not be performed. Conservative fertility-sparing treatment should only be offered to patients with a grade 1 well-differentiated tumor, absence of lymph vascular space invasion, no evidence of myometrial invasion, metastatic disease, or suspicious adnexal masses, and strong and diffuse expression of progesterone receptors on immunohistochemistry staining of the endometrial specimen. The presence of co-existing ovarian metastatic of synchronous cancer should be investigated and excluded before the decision to preserve the ovaries. In addition to these conservative therapeutic options, the use of assisted reproductive technology (ART) has made it possible for women with endometrial cancer to give birth to a child without compromising their prognosis. Gamete, embryo, or ovarian tissue cryopreservation techniques can also be employed, although some of these are still considered experimental. Fertility preservation is infrequently applied in the cancer population, and there are scarce good quality studies in the literature, which makes careful staging, thorough counseling, and close follow-up of the patients imperative so as not to jeopardize cancer cure. (J GYNECOL SURG 28:399)

Pelvic inflammatory disease (PID) is an inflammatory process of infectious nature that can affect structures and organs of the upper genital tract. Considering this disease’s epidemiological relevance and severe complications, this article provides an update and proposes a systematic approach to PID. The main etiological agents are Neisseria gonorrhoeae, Chlamydia trachomatis and other etiological agents of urethritis, cervicitis, vulvovaginitis and vaginoses. These are generally of polymicrobial origin, which determines the treatment basis for pelvic inflammatory diseases. Women must be checked for PID when experiencing abdominal discomfort, backache, dyspareunia, or presenting with stains during gynecological examination and prior to transcervical procedures. The clinical and laparoscopic classification of PID can be divided into: a) stage I (endometritis/salpingitis without peritonitis), stage II (acute salpingitis with peritonitis), stage III (acute salpingitis with tubal occlusion or tube-ovarian abscess), and stage IV (tubeovarian abscess rupture). Defining the stage guides procedures and treatment, given that in mild forms (stage I) the treatment and follow-up can be performed in the ambulatory environment while moderate to severe cases require hospitalization so that intravenous treatment and treatment outcome monitoring can be started. Supportive treatment, removal of intrauterine device (IUD), sexual abstinence and rest are also indicated, as well as counseling on the implications of the disease and partner approach.

The uterine cervix invasive carcinoma represents a major public health problem, mainly in the developing countries. Its treatment, based on radical hysterectomy, radiotherapy and/or chemotherapy presents a considerable morbidity. Prognostic markers should be taken into consideration in the therapeutic planning, so that the results would be optimized, complications reduced, and patients' survival prolonged. Accepted prognostic markers are: stage, tumoral size, histological type, degree of differentiation, lymphovascular invasion, depth of the stromal invasion, presence of lymph nodal metastases, and surgical margins involvement. This study aims at making a literature review concerning the use of theses markers in the therapeutic planning of women with uterine cervix invasive carcinoma. The treatment based on these markers may present better results, with lower ratio of complications and an improvement in the patients' survival.

INTRODUÇÃO: Estima-se que 186 milhões de pessoas sofrem de infertilidade em todo mundo. Aproximadamente 56% dos casais inférteis irão procurar assistência médica para conceber. Os tratamentos de fertilização in vitro oferecem uma nova esperança de concepção para esses casais. Contudo, os obstáculos encontrados durante o tratamento podem induzir o estresse em várias áreas da vida. O estresse é gerado quando há um desequilíbrio na homeostase do organismo, resultado da própria resposta adaptativa do mesmo a fatores estressantes (sejam eles externos ou internos, negativos ou positivos) que tem como objetivo essencial a proteção do indivíduo. Estudos demonstram que há relação entre o insucesso da FIV e o estresse. A descontinuidade pode ser considerada um desfecho adverso do TRA, impactando no sucesso geral do programa de FIV. A decisão de um casal de descontinuar o tratamento advém de uma interação complexa de fatores. OBJETIVO: Avaliar o conhecimento existente sobre os fatores que contribuem para o desencadeamento do estresse e consequente decisão de descontinuar o TRA. METODOLOGIA: Este estudo foi realizado de acordo com Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) e registrado no Registro Prospectivo Internacional de Revisões Sistemáticas (PROSPERO). A busca eletrônica foi realizada até março de 2021 utilizando as bases de dados Pubmed e Scopus. Referências dos trabalhos encontrados e julgadas pertinentes também foram adicionadas. RESULTADOS: Os 21 estudos incluídos avaliaram 19316 pacientes em 14 países, com idade média de 34 e 38 anos (para mulheres e homens, respectivamente), tempo de infertilidade de 5,2 anos, média de 2,6 ciclos de tratamento (95% FIV/ICSI). Em 17 estudos o objetivo principal foi determinar os motivos da descontinuidade do TRA onde, em 14 as principais causas encontradas foram carga psicológica, estresse e depressão e, nos demais, fator financeiro e mau prognóstico do TRA. CONCLUSÃO: Fatores como mau prognóstico, socioeconômico, idade avançada, estresse físico, problemas relacionais, dentre outros, interagem entre si desencadeando um elevado nível de estresse ao ponto de determinar a decisão de descontinuar o tratamento.

A ativina A é um fator de crescimento produzido pelo endométrio e afolistatina é a sua proteína ligante que neutraliza a biodisponibilidade da ativina A. A produção endometrial de ativina A aumenta durante a fase secretora do ciclo menstrual. A proposta do presente estudo foi avaliar se a ativina A e a folistatina são mensuráveis no soro do sangue menstrual, e se essas duas proteínas estão alteradas em mulheres com sangramento uterino disfuncional. Avaliamos 15 mulheres (grupo 1) com ciclos menstruais regulares, que inseriram dispositivo intrauterino (DIU) para contracepção, e comparamos com 12 mulheres com sangramento uterino disfuncional (grupo 2) na unidade Floramar I de atendimento básico da Prefeitura de Belo Horizonte. Ativina A e a folistatina foram medidas no sangue menstrual e periférico usando ensaio-imunoenzimático (ELISA). As concentrações de ativina A foram quatro vezes maiores no soro menstrual que no soro perifériconas mulheres com ciclos normais (média ± desvio padrão 4,24 ± 0,19 vs 1,00 ± 0,15 ng/ml), e foram significantemente menores em mulheres com sangramento uterino disfuncional (2,70 ± 0,42 ng/ml e 0,23 ± 0,03 ng/ml no sangue menstrual e periférico, respectivamente; p