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Nina Grotenhuis,1 Miranda C Schreuder,1 Tine WL van den Bos,2 Henk van der Worp,1 Marco H Blanker1 1Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 2Foundation Bekkenbodem4All, Tiel, the NetherlandsCorrespondence: Miranda C Schreuder, Department of General Practice and Elderly Care medicine, University Medical Center Groningen, University of Groningen, FA21, PO Box 196, Groningen, 9700AD, the Netherlands, Tel +31 625647144, Email m.c.schreuder@umcg.nlPurpose: We aimed to examine how supply source affects satisfaction with continence products and care among individuals with urinary incontinence (UI). Supply source was compared among pharmacies, national suppliers, and shops. The secondary aim was to compare participant characteristics between the three groups.Patients and Methods: A survey questionnaire was distributed via social media between April and June 2020. This included the international consultation on incontinence questionnaire (ICIQ) UI short form (ICIQ-UI-SF), the ICIQ-PadPROM, and the ICIQ-LUTSqol, together with questions about respondent characteristics and satisfaction with continence products.Results: Of the 1045 respondents, 706 fully completed and 339 partially completed the survey. Among these, 322 (45.6%), 199 (28.1%), and 185 (26.2%) made purchases from shops, national suppliers, and pharmacies, respectively. The mean ICIQ-UI-SF sum scores were comparable for the pharmacy (13.3 ± 3.7) and national supplier (13.8 ± 3.5) groups, but were significantly lower for the shop group (12.0 ± 3.3). Mean sum scores for satisfaction with continence products and satisfaction with continence care were also significantly lower in the shop group (7.9 ± 2.6 and 6.4 ± 2.7, respectively) compared with the pharmacy (9.1 ± 2.7 and 7.9 ± 2.6, respectively) and national supplier (9.3 ± 2.6 and 8.1 ± 3.0, respectively) groups. There were no statistically significant differences in the ICIQ-PadPROM and ICIQ-LUTSqol scores. Respondents’ characteristics were similar, apart from the significantly lower number of males in the shop group.Conclusion: Satisfaction with continence products and continence care is lower for people with UI who purchase materials from a shop than from a pharmacy or national supplier.Keywords: incontinence care, health insurance, incontinence pads, urinary loss

Objectives To assess the correlation of urine loss rate after catheter removal with long-term continence after robot-assisted radical prostatectomy. Methods We enrolled 163 patients on whom robot-assisted radical prostatectomy was carried out and whose urine loss rate we were able to evaluate after catheter removal. Urinary incontinence was evaluated from immediately after removal of the catheter to the date of discharge, and at 1, 3, 6 and 12 months after surgery. Urine loss rate was defined as the urine loss volume divided by the total urine volume. Results The continence rates of patients with ≤1% urine loss rate on the day of catheter removal were 100% at 6 and 12 months after surgery. A multivariate analysis proved that ≤10% urine loss rate on the day of catheter removal was a significant predictor of continence at 3 months after surgery. Furthermore, the continence rate at 12 months of patients who did not achieve ≤10% urine loss rate on the day of catheter removal was 79.5%. Among them, the continence rate at 12 months of patients who achieved ≥15% urine loss rate improvement from the day of catheter removal to the next day was 95.2%; the factor differed significantly between the continence and incontinence groups at 12 months after surgery. Conclusions The urine loss rate on the day of catheter removal is significantly related to the acquisition of urinary continence. Furthermore, our findings suggest that long-term urinary continence can be expected, even in the event of poor urine loss rate on the day of catheter removal, if it improves on the next day.

Objective: To verify the prevalence of SUI symptoms in practitioners of high intensity physical activities, such as CrossFit, and to analyze the correlation of the high frequency of this activity with urinary losses, in a CrossFit gym in Greater Florianopolis - SC. Methods: This is a cross-sectional study in which the sample was composed of women who had practiced the CrossFit modality for over a month and over 18 years of age. A questionnaire was applied to assess the data regarding personal characteristics, reproductive life, training frequency and Crossfit time, perceptions about urine loss and evaluation by the Pad-test. Results: The final sample was 34 women, the average age of the participants was 30.3 ± 6.43 years. Among them, 76.4% were nulliparous, 61.7% had been practicing the sport for at least 8 months, 14% reported perceiving urine loss on a daily basis and 88.2% had stress urinary incontinence characterized as mild to moderate. A correlation of greater urinary loss was found the greater the frequency of weekly training Conclusion: Most of the women participating presented urine loss on exertion, classified as mild to moderate. Demonstrating that high intensity activities, such as Crossfit, and their weekly frequency can directly influence stress urinary incontinence. There is a need for further research with a larger sample, greater homogeneity of training and individualization in the evaluation.

Objetivo: Verificar as caracteristicas da incontinencia urinaria em mulheres atendidas na Atencao Primaria em Saude. Alem disso, compreender como a queixa de perda urinaria e abordada na pratica clinica da Atencao Primaria em Saude. Metodos: Estudo transversal com mulheres com perda urinaria atendidas na Atencao Primaria em Saude foram avaliadas por questionario estruturado e International Consultation On Incontinence Questionnaire . Resultados: Foram avaliadas 86 mulheres. As principais caracteristicas da incontinencia urinaria em mulheres atendidas na Atencao Primaria em Saude foram a perda de urina uma vez por semana, em pequena quantidade, do tipo incontinencia urinaria de esforco e que promoveu impacto moderado na qualidade de vida. A maioria das mulheres nao relatam aos profissionais de saude da Atencao Primaria em Saude seus sintomas de perda urinaria, principalmente por desconhecimento do assunto. Quando relatada a queixa de perda urinaria, as mulheres foram direcionadas para realizacao de exames. Conclusao: A incontinencia urinaria em mulheres atendidas na Atencao Primaria em Saude apresentou caracteristicas especificas. Alem disso, intervencoes que aumentem o conhecimento sobre incontinencia urinaria podem trazer melhora na comunicacao desta queixa, podendo resultar em tratamento mais eficiente.

INTRODUÇÃO: A IU atinge cerca de 10 milhões de brasileiros de todas as idades, sendo duas vezes mais comum no sexo feminino, de acordo com a Sociedade Brasileira de Urologia (SBU). Considerada qualquer perda involuntária de urina de acordo com a ICS, podendo ser classificadas em IUU, IUE e IUM. O tratamento para a IU pode ser cirúrgico, farmacológico ou fisioterapêutico. OBJETIVO: Identificar a prevalência de incontinência urinária em mulheres praticantes de exercício físico de alto impacto, em comparação com mulheres que não praticam atividade física. MATERIAIS E MÉTODOS: O estudo foi do tipo transversal, onde se realizou um estudo de caso, sobre a perda involuntária de urina por mulheres, durante o exercício físico de impacto. As participantes foram divididas dois grupos: Grupo 1, mulheres praticantes de exercícios físicos de alto impacto e Grupo 2, mulheres não praticantes de exercícios físicos. As voluntárias realizaram o Pad Test de uma hora, padronizado pela ICS. Além disso, todas responderam o questionário Internacional Consultation on Incontinence Questionnaire – Short Form (ICIQ-SF). RESULTADOS: Houve a presença de sintomas de IUE em ambos os grupos investigados. Entretanto, foi possível comprovar que no grupo onde as mulheres praticavam exercícios de alto impacto a perda de urina foi bem maior em quantidade e em qualidade, observando-se resultados superiores a 60% nas praticantes de exercícios de alto impacto. CONCLUSÃO: As mulheres praticantes de exercícios de alto impacto apresentaram maior perda urinária comprovada pelo Pad Test e uma maior interferência desses sintomas urinários na qualidade de vida comprovada pelo ICIQ-SF.

Athletic urinary incontinence is characterized by urinary loss during sports practice. This condition occurs in the case of CrossFit®, a modality based on high intensity training and functional movements, it can also be considered as having a high impact on the pelvic floor. This study aimed to compare the force and the contraction capacity of the pelvic floor musculature and urinary incontinence between female CrossFit® practitioners (AG) and non-practitioners (CG). We performed a cross-sectional observational study in the period from December 2018 and May 2019. Complaints of urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF); the functional evaluation of the pelvic floor was performed by digital palpation; resting tone, maximum voluntary contraction, fast contractions and sustained contraction of the pelvic floor muscles was tested by electromyography. The prevalence of urinary incontinence was significantly higher in AG compared with CG (

When readymade parenteral nutrition in multi-chamber bags is supplied without vitamins and minerals, these have to be added or given separately. Separate rapid infusion has logistical advantages but has been claimed to saturate tissue mechanisms, potentially increasing urine micronutrient losses. The present study compared urinary losses after fast (1 h) v. slow (10 h) trace elements infusion. The study enrolled thirty-nine consecutive patients who were starting parenteral nutrition postoperatively. One day’s dose of a complete intravenous micronutrient product was infused over 1 h and over 10 h, in random order, with a washout day after each infusion day. Urinary Zn, Mn, Se, Cr, Cu and Fe losses were measured by 24-h urine collection, recorded for each infusion day and subsequent washout day. For Zn, a dose of 100 μmol was given, and total urinary loss over the next 2 d was mean 40·6 (sd 23·8) μmol after the fast (1 h) infusion v. 33·4 (sd 25·4) μmol after the slow (10 h) infusion, that is, 7 % more of the 1-d dose was lost after fast infusion (P = 0·01). For Mn, after a dose of 1000 nmol, losses were 9·8 (sd 23·9) nmol after the fast infusion v. 22·1 (sd 47·2) nmol after the slow infusion, that is, 1 % more of the 1-d dose was lost after slow infusion (P = 0·04). There were no other significant differences: after 1 μmol Se, the losses were 1·5 (sd 0·6) μmol fast v. 1·3 (sd 0·5) μmol slow; after 200 nmol Cr, 257 (sd 92) μmol fast v. 246 (sd 107) nmol slow; after 8 μmol Cu, 1·6 (sd 1·4) μmol fast v. 1·5 (sd 1·3) μmol slow; and after 20 μmol Fe, 0·6 (sd 1·1) μmol fast v. 0·8 (sd 1·6) μmol slow (P > 0·05 for all). Overall, trace element retention appears to be minimally affected by infusion time.

OBJECTIVE: To evaluate the quality of life (QL) of women participating in the Family Health Support Center (NASF) in the city of Carmo do Paranaiba/MG. METHODS: A cross-sectional study with a sample of 50 women who, after signing the Informed Consent Form, answered to the personal evaluation sheet and the King's Health Questionnaire (KHQ) which evaluates the quality of life in individuals with urinary incontinence (UI). A descriptive analysis was carried out using measures of central tendency and variability for numerical variables and frequency distribution for categorical variables. RESULTS: As for the sociodemographic profile, it was observed that the average age of the sample was 67.6 years, most were married and completed only elementary school. As for the obstetric history, it was noted that 68% had had vaginal birth, with an average of 3.6 births. In the assessment of the prevalence of UI, it was found that 60% reported urinary loss and, for 75% of them, this condition had a negative impact on quality of life. CONCLUSIONS: UI had a negative impact on the QL of the sample studied, mainly due to physical limitations and activities of daily living.

Making dairy farming more cost-effective and reducing nitrogen environmental pollution could be reached through a reduced input of dietary protein, provided productivity is not compromised. This could be achieved through balancing dairy rations for essential amino acids (EAA) rather than their aggregate, the metabolizable protein (MP). This review revisits the estimations of the major true protein secretions in dairy cows, milk protein yield (MPY), metabolic fecal protein (MFP), endogenous urinary loss and scurf and associated AA composition. The combined efficiency with which MP (EffMP) or EAA (EffAA) is used to support protein secretions is calculated as the sum of true protein secretions (MPY + MFP + scurf) divided by the net supply (adjusted to remove the endogenous urinary excretion: MPadj and AAadj). Using the proposed protein and AA secretions, EffMP and EffAA were predicted through meta-analyses (807 treatment means) and validated using an independent database (129 treatment means). The effects of MPadj or AAadj, plus digestible energy intake (DEI), days in milk (DIM) and parity (primiparous v. multiparous), were significant in all models. Models using (MPadj, MPadj × MPadj, DEI and DEI × DEI) or (MPadj/DEI and MPadj/DEI × MPadj/DEI) had similar corrected Akaike's information criterion, but the model using MPadj/DEI performed better in the validation database. A model that also included this ratio was, therefore, used to fitting equations to predict EffAA. These equations predicted well EffAA in the validation database except for Arg which had a strong slope bias. Predictions of MPY from predicted EffMP based on MPadj/DEI, MPadj/DEI × MPadj/DEI, DIM and parity yielded a better fit than direct predictions of MPY based on MPadj, MPadj × MPadj, DEI, DIM and parity. Predictions of MPY based on each EffAA yielded fairly similar results among AA. It is proposed to ponder the mean of MPY predictions obtained from each EffAA by the lowest prediction to retain the potential limitation from AA with the shortest supply. Overall, the revisited estimations of endogenous urinary excretion and MFP, revised AA composition of protein secretions and inclusion of a variable combined EffAA (based on AAadj/DEI, AAadj/DEI × Aadj/DEI, DIM and parity) offer the potential to improve predictions of MPY, identify which AA are potentially in short supply and, therefore, improve the AA balance of dairy rations.

Introdução: A Incontinência Urinária (IU) é toda perda involuntária de urina, de acordo com a Sociedade Internacional de Continência (ICS). Objetivos: Analisar a prevalência de sinais e sintomas de Incontinência Urinária por esforço em mulheres praticantes de musculação. Metodologia: Estudo transversal do tipo quantitativo, realizado via online por 195 mulheres que praticavam musculação, sendo que dessas apenas 52 foram incluídas no presente estudo, as mesmas responderam a um questionário ao qual colhia informações da vida pessoal para análise de critérios e em seguida o ICIQ-SF para análise da IU no que se refere à frequência, quantidade, interferência na vida pessoal e em que momento perde urina. Resultados: Houve relatos de perdas urinárias em 19,24% das voluntárias. A média de idade foi de 27,11 anos (DP ± 5,61), 21,15% das que apresentaram perda urinária relatam impacto de grave a muito grave e 73,08% disseram não ter nenhum impacto. Prevaleceu 11,54% das mulheres apresentando queixas de atividades que exigem esforço. A perda urinária foi maior naquelas que realizam mais de um tipo de atividade física, ocorrendo em 6 das 10 mulheres que apresentaram incontinência. Conclusão: Pôde-se concluir que, apesar da limitação na amostra, observou-se que os sinais e sintomas de incontinência urinária estavam presentes nas mulheres praticantes de musculação e o impacto que a patologia ocasiona na qualidade de vida destas.

Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women. Materials and Methods: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects. Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation. Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.

Sodium-glucose co-transporter-2 (SGLT-2) inhibitor is the latest class of anti diabetic medication that improves glycemic control in insulin independent fashion by increasing urinary loss of filtered glucose. Since its introduction in 2013, several cases of euglycemic DKA have been reported in patients being treated with SGLT-2 inhibitors. Blood glucose levels in range lower than expected for DKA makes the diagnosis challenging if clinical suspicion for euglycemic DKA is not high. We report a case of a patient being treated with canagliflozin who presented with DKA, AKI and mild hyperglycemia that was complicated by stress-induced cardiomyopathy.

Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T18:41:50Z No. of bitstreams: 2 Patricia Zaidan de Barros_Tese.pdf: 1684876 bytes, checksum: 5a10fa5731c318982a2d4c6e0d1f4e9e (MD5) Patricia Zaidan de Barros_Tese parcial.pdf: 206587 bytes, checksum: 09cbca989d11a7cb65b68aa0c3649be4 (MD5) Made available in DSpace on 2021-01-05T18:41:50Z (GMT). No. of bitstreams: 2 Patricia Zaidan de Barros_Tese.pdf: 1684876 bytes, checksum: 5a10fa5731c318982a2d4c6e0d1f4e9e (MD5) Patricia Zaidan de Barros_Tese parcial.pdf: 206587 bytes, checksum: 09cbca989d11a7cb65b68aa0c3649be4 (MD5) Previous issue date: 2019-04-09 Conselho Nacional de Desenvolvimento Científico e Tecnológico The aim of this thesis was to identify the most frequently used frequency in electrostimulation for the recovery of urinary incontinence (UI) in women and men; to verify the effectiveness of electrostimulation in the treatment of stress urinary incontinence; to verify the reliability, stability, intra-examiner, of the measurement of the strength of the MAPs, performed with Peritron; and to verify the effect of 65 Hz electrostimulation on UI, pelvic floor muscle strength (MAP) and UI impact on the daily life of patients with sphincter deficiency, resulting from radical prostatectomy surgery. Three studies were carried out to achieve these objectives. A meta-analysis performed by the RevMan 5.3.A reliability study analyzed by the intraclass correlation coefficient (ICC) and typical measurement error (ETM) tests. One RCT with three groups: Group exercises of the MAP (EMAP, n = 23), this being (EE50 + EMAP, n = 19), electrostimulation group 65 Hz plus exercises of the MAP (EE65 + EMAP, n = 23). The weekly frequency was twice and the number of sessions was the one necessary to recover the urinary continence, not exceeding 20. The UI was evaluated before and after treatment by the use of disposable pads and padtest 1 hour, the strength of the MAP by the perineometer and the impact of UI on daily living by ICIQ-SF. Relative risk (RR) and 3X2 ANOVA were used for the statistical analysis of the data. The studies concluded that the most frequently used frequency in electrostimulation to recover the urinary continence of women with SUI and men with post-prostatectomy UI was 50 Hz and it was effective in the recovery of continence. However, attention is drawn to the results obtained with men, because of the very low level of evidence found. That Peritron showed high reliability to measure the strength of MAPs in men, both for clinical practice and for the production of knowledge scientific. And that the frequency of 65Hz was more effective than that of 50Hz in the recovery of urinary continence and in the decrease of the impact of UI on the ADLs of prostatectomized men Esta Tese teve por objetivos identificar a frequência mais utilizada na eletroestimulação para a recuperação da incontinência urinária (IU) em mulheres e homens; verificar a eficácia da eletroestimulação no tratamento da incontinência urinária de esforço; verificar a confiabilidade, tipo estabilidade, intraexaminador, da medida da força dos MAPs, realizada com o Peritron; e verificar o efeito da eletroestimulação de 65 Hz sobre a IU, força dos músculos do assoalho pélvico (MAP) e impacto da IU na vida diária de pacientes com deficiência esfincteriana, consequente de uma cirurgia de prostatectomia radical. Para a consecução destes objetivos foram realizados três estudos. Uma metanálise feita pelo RevMan 5.3.Um estudo de confiabilidade analisado pelos testes coeficiente de correlação intraclasse (CCI) e erro típico da medida (ETM).Um ECR com três grupos: Grupo exercícios dos MAP (EMAP, n = 23), sendo este o controle ativo, grupo eletroestimulação 50 Hz mais exercícios dos MAP (EE50+EMAP, n = 19), grupo eletroestimulação 65 Hz mais exercícios dos MAP (EE65+EMAP, n = 23). A frequência semanal foi de duas vezes e a quantidade de sessões foi aquela necessária para recuperar a continência urinária, não ultrapassando de 20.Foram avaliadas pré e pós-tratamento a IU pelo uso de protetores descartáveis e padtest 1 hora, a força dos MAP pelo perineômetro e o impacto da IU na vida diária pelo ICIQ-SF. Foram utilizados o risco relativo (RR) e ANOVA 3X2 para a análise estatística dos dados. Os estudos apresentaram como conclusão, respectivamente, que a frequência mais utilizada na eletroestimulação para recuperar a continência urinária de mulheres com IUE e homens com IU pós-prostatectomia foi a de 50Hz e se mostrou eficaz na recuperação da continência. Entretanto, recomenda-se atenção em relação aos resultados obtidos com os homens, devido ao muito baixo nível de evidência encontrado.Que o Peritron mostrou elevada confiabilidade para medir a força dos MAPs em homens, tanto para a prática clínica quanto para a produção de conhecimento científico. E que a freqüência de 65Hz foi mais eficaz que a de 50 Hz na recuperação da continência urinária e na diminuição do impacto da IU nas AVDs de homens prostatectomizados

BACKGROUND: Vitamin A and D deficiencies are common in preterm infants. Megalin is an endocytic receptor in the proximal tubule, which reabsorbs retinol-binding protein (RBP) and vitamin D-binding protein (VDBP). Although the proximal tubule is immature in preterm infants, little is known about megalin expression during kidney development. In this study, we establish the abundance of megalin in the developing human kidney and its relationship to the urinary excretion of vitamin carriers in preterm infants.METHODS: We analyzed a postmortem group (20-40 weeks gestation), where we used morphometric means of measuring megalin and its ligands in kidney tissue and a living group of patients (28-40 weeks), where urinary RBP and VDBP were measured.RESULTS: The presence of megalin, RBP, and VDBP increased in the proximal tubule through gestation. At birth the urinary concentration of RBP and VDBP were higher in the 28-32 week group compared to the 38-40 week group and a significant inverse correlation of tissue megalin and urinary loss of RBP and VDBP existed.CONCLUSIONS: Preterm infants experience vitamin carrier protein losses, which are associated with decreased megalin expression. This developmental expression of megalin in the kidney has clinical implications in the prevention of vitamin deficiencies in preterm babies.

Descriptive, quasi experimental study with pre and post-test, which aimed to investigate the effects of Water Pilates (PA) on urinary incontinence, genital self-image and sexual function of elderly women. The sample consisted of seventeen elderly women aged 60 years or over, from a city in the interior of Rio Grande do Sul. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) was used as instruments to assess the impact of UI in quality of life and qualify urinary loss, the Female Sexual Function Index (FSFI) to assess sexual function and Female Genital Self-Image Scale (FGSIS) to assess women's perception of their own genitalia. The PA protocol was performed twice a week for 50 minutes performed for eight weeks, totaling 16 sessions. The protocol was divided into warm-up, strengthening exercises and stretching. It was observed that the sample was composed of young elderly women (69.5 ± 5.9 years), overweight and with low FSFI and FGSIS scores. There was no significant change in the mean values before and after the intervention of the ICIQ-SF, FGSIS and FSFI scores. It was concluded that the PA method had no effect on urinary loss, sexual function and genital self-image.

Objective: To design the profile of active elderly women with urinary incontinence (UI) participating in a physical activity program according to sociodemographic characteristics, health conditions, life habits and conditions associated with urinary loss. Methods: A quantitative, cross-sectional, non-probabilistic study of 59 active elderly women. The elderly woman whose score was ≥ 3 according to the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) was considered incontinent. A descriptive analysis was performed by calculating the absolute and relative frequencies. Results: Predominant age between 70 and 79 years (44.1%), widows (32.2%), white (59.3%), complete high school (40.6%) and living alone (52.5%) . The largest proportion never smoked (64.4%) or drank (47.5%), it did not fall in the last year (64.4%), hypertensive (55.9%), had between one and three births (71.2%), were overweight (42.4%) and it did not use an intimate protector (67.8%). Urgency UI was more frequent (50.9%), small amount losses (54.3%), frequency ≤ 1 time per week (42.6%), complaint of nocturia (81.4%) and time of UI between 1 and 4 years (64.4%). Conclusion: The study made it possible to design the profile of active elderly women with UI, which in this study resemble those found in the literature. It is important to emphasize the importance of multidisciplinary work in the search for preventive actions and specialized treatments, aiming to maintain and/or improve the quality of life of incontinent elderly.

Objectives Oncogenic osteomalacia is a paraneoplastic syndrome in which the tumor secretes a peptide-like hormone, fibroblast growth factor, resulting in urinary loss of phosphates. Methods We present the case of a 50-year-old woman with a benign phosphaturic mesenchymal tumor (PMT) involving the ethmoid sinus with obstruction of the ostiomeatal complex causing unilateral nasal airway obstruction. Results The tumor was initially thought to be an esthesioneuroblastoma based on primary pathology interpretation and on clinical and radiographic appearance. However, a benign PMT was later confirmed by further testing. Conclusion The tumor was removed entirely by the endoscopic transnasal approach, leading to a full resolution of symptoms.

Background Urinary incontinence (UI) is a pelvic floor dysfunction that can affect nulliparous female athletes because of the effect of sports activities on pelvic floor muscles. Objectives To verify and quantify urine loss in nulliparous athletes during 1 hour of sports training using a modified pad test protocol. Design Cross-sectional. Setting Secondary, institutional practice. Participants Nulliparous athletes (N = 104). Methods Athletes completed the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-UI-SF) and underwent a maximal resistance test of the abdominal muscles followed by the new modified pad test during 1 hour of training. Outcomes Presence or absence of UI was the dependent variable; the initial hypothesis was that high-impact activities could lead to the development of UI. Results Almost 52% of athletes (n = 54) self-reported UI according to the ICIQ-UI-SF score. Of athletes who reported stress or mixed UI (n = 32), only 43.7% (n = 14) had leakage during the training pad test. Interestingly, 24% of athletes (n = 12) who did not report UI had a positive pad test result. In total, 27.9% of athletes (n = 29) presented a positive pad test during the training. Mean urinary loss was 1.57 ± 0.4 g. Conclusion Athletes did not seem to have a good knowledge of UI symptoms, and the modified pad test could be an alternative to quantify urine loss; however, it is necessary to perform accuracy tests. None of the athletes reported discomfort or decreased performance when performing the pad test. Level of Evidence II

Summary Introduction: Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). Nevertheless, there is no evidence about training parameters. Objective: To identify the protocol and/or most effective training parameters in the treatment of female SUI. Method: A literature research was conducted in the PubMed, Cochrane Library, PEDro, Web of Science and Lilacs databases, with publishing dates ranging from January 1992 to March 2014. The articles included consisted of English-speaking experimental studies in which SEPFM were compared with placebo treatment (usual or untreated). The sample had a diagnosis of SUI and their age ranged between 18 and 65 years. The assessment of methodological quality was performed based on the PEDro scale. Results: Seven high methodological quality articles were included in this review. The sample consisted of 331 women, mean age 44.4±5.51 years, average duration of urinary loss of 64±5.66 months and severity of SUI ranging from mild to severe. SEPFM programs included different training parameters concerning the PFM. Some studies have applied abdominal training and adjuvant techniques. Urine leakage cure rates varied from 28.6 to 80%, while the strength increase of PFM varied from 15.6 to 161.7%. Conclusion: The most effective training protocol consists of SEPFM by digital palpation combined with biofeedback monitoring and vaginal cones, including 12 week training parameters, and ten repetitions per series in different positions compared with SEPFM alone or a lack of treatment. Resumo Introdução: Os exercícios de fortalecimento dos músculos do pavimento pélvico (EFMPP) são considerados a primeira intervenção no tratamento da incontinência urinária de esforço (IUE); porém, não existe evidência sobre os parâmetros de treino. Objetivo: Identificar o protocolo e/ou os parâmetros de treino mais eficazes no tratamento da IUE feminina. Método: A pesquisa bibliográfica foi realizada entre janeiro de 1992 e março de 2014 nas bases de dados PubMed, Cochrane Library, PEDro, Web of Science e Lilacs. Os artigos incluídos eram de língua inglesa, estudos experimentais, comparando EFMPP com tratamento placebo, usual ou sem tratamento, com idade compreendida entre 18 e 65 anos e diagnóstico de IUE. A avaliação da qualidade metodológica foi realizada por meio da escala PEDro. Resultados: Sete artigos de elevada qualidade metodológica foram incluídos na presente revisão. A amostra foi constituída por 331 mulheres, com idade média de 44,4±5,51 anos, duração média das perdas urinárias de 64±5,66 meses e gravidade da IUE variando entre ligeira e grave. Os programas de EFMPP eram distintos relativamente aos parâmetros de treino dos MPP. Alguns estudos incluíram treino abdominal e técnicas adjuvantes. A taxa de cura da quantidade de perda urinária variou entre 28,6 e 80%, enquanto o aumento da força dos MPP variou de 15,6 a 161,7%. Conclusão: O protocolo de treino mais eficaz consiste nos EFMPP por palpação digital e supervisão combinados com biofeedback e cones vaginais, incluindo os parâmetros de treino de 12 semanas de duração, dez repetições por série e em distintas posições comparados com os EFMPP isolados ou sem tratamento.

The association between inflammation and vitamin A (VA) metabolism and status assessment has been documented in multiple studies with animals and humans. The relation between inflammation and carotenoid status is less clear. Nonetheless, it is well known that carotenoids are associated with certain health benefits. Understanding these relations is key to improving health outcomes and mortality risk in infants and young children. Hyporetinolemia, i.e., low serum retinol concentrations, occurs during inflammation, and this can lead to the misdiagnosis of VA deficiency. On the other hand, inflammation causes impaired VA absorption and urinary losses that can precipitate VA deficiency in at-risk groups of children. Many epidemiologic studies have suggested that high dietary carotenoid intake and elevated plasma concentrations are correlated with a decreased risk of several chronic diseases; however, large-scale carotenoid supplementation trials have been unable to confirm the health benefits and in some cases resulted in controversial results. However, it has been documented that dietary carotenoids and retinoids play important roles in innate and acquired immunity and in the body's response to inflammation. Although animal models have been useful in investigating retinoid effects on developmental immunity, it is more challenging to tease out the effects of carotenoids because of differences in the absorption, kinetics, and metabolism between humans and animal models. The current understanding of the relations between inflammation and retinoid and carotenoid metabolism and status are the topics of this review.

The purpose of this cross-sectional study was to assess the prevalence of self-reported urinary loss in elderly women living in the city of Porto Alegre (Rio Grande do Sul, Brazil), as well as to determine the relation between urinary incontinence (UI) and pelvic floor muscle function (PFMF). It included 270 elderly women (aged from 60 to 92 years) from a population sample, who reported the presence (n=155; 69.1±7.8 years) or absence (n=115; 67.7±7.9 years) of urine loss. Those who reported UI were asked about how long they had been experiencing urinary leakage, the amount of urine lost (drops, jets or complete micturition) and situations in which they lost urine. Out of the total number of individuals, 178 agreed to undergo the assessment of PFMF by means of a perineometry and a bidigital test. The prevalence of elderly women who reported UI (57.4%) was significantly higher, and the most common isolated situation of urine loss was being unable to get to the toilet in time (26.1%), and this occurred mainly in drops (52.3%). The UI lasted for a median of three years. The elderly women with UI had significantly lower PFMF than those without it, regardless of the type of measurement used (perineometry or bidigital test). Therefore, we conclude that, in this sample, UI had a high prevalence and was associated with decreased PFMF. Bearing these findings in mind and taking into account the data available in the literature about the impact of UI on health and quality of life, as well as the low cost of its assessment and treatment, we suggest that the management and care of this dysfunction should be carried out at the Primary Health Care level.

PURPOSE: Investigation of the efficacy of special urological rehabilitation on physical and psychological well being of patients after radical prostatectomy. PATIENTS AND METHODS: Patients were investigated using validated questionnaires to objectify the physical (WKV) and psychological state of health (MDBF) at the beginning and the end of a 3-week standardized rehabilitation program. A pad-test was used to examine the extent of urinary incontinence. RESULTS: 44 patients fulfilled all in- and exclusion criteria. Using the WKV-questionnaire a statistical significant improvement of the physical state of health could be shown. An improvement of the psychological situation was found too, however not statistically significant. Urinary incontinence was clearly improved by the physical therapy performed. CONCLUSIONS: Besides a considerably reduction of urinary loss a special urological rehabilitation allows an evident improvement of the physical state of health in prostate cancer patients. Psychological aspects also positively influenced.

Introduction: The aim of this study was to describe the occurrence of symptoms of urinary incontinence in the elderly practitioners of physical activities. Materials and Methods: The sample consisted of 123 elderly (100 women and 23 men) with mean age of 69.4±6.12 years. For data collection, a questionnaire regarding age, sex, presence of comorbidities, physical activity and questions about urinary incontinence was used. Results: There was a predominance of urinary incontinence stress (50.0%), followed by mixed urinary incontinence (26.6%) and urinary incontinence urgency (23.4%). Only 10.4% of elderly reported symptoms of loss of urine during physical activity. Discussion: The urinary incontinence stress was the predominant type in the sample, contrasting with literature. Despite the small number of participants with urinary loss during physical activity, there are no conclusive studies yet, which report pelvic floor damage associated with the practice of it.

Background. Genuine stress urinary incontinence is a very common pathologic condition among women. In order to operate this, different techniques have been introduced. Here, a new technique is described for the operation of genuine stress urinary incontinence with newly developed equipment. The present technique offers more advantages than previous techniques introduced by different authors. With this technique, the duration of operation and of the recovery period are both shorter than with previous techniques. All patients had symptoms and signs of stress urinary loss. We performed multichannel cystometry preoperatively to all patients. Method. A special valve is used with reflector having 97% reflection capacity for transvaginal burch operation technique. Twenty five women ( n = 25) having genuine stress urinary incontinence were taken under transvaginal Burch bladder neck suspension operation with fixation of suspension sutures to the Cooper (iliopectineal) ligament. Results. Following urodynamic worku...

The effects of three diets varying in their protein, fat and carbohydrate contents and of physical activity on energy and protein metabolism were investigated in eight domestic cats. The diets were based on canned food with addition either of minced cattle heart, melted swine fat or polenta. The activity-induced heat production was measured in a respiration chamber using the Doppler effect of radio-waves reflected from moving bodies. In the group receiving the high-protein diet, urinary nitrogen concentration was higher which was reflected in higher urinary loss of energy without affecting the amount of energy retained. Nitrogen utilization was not significantly influenced by nitrogen intake. Mean daily total heat production ranged between 163 and 187 kJ/kg BW/day or 215 and 270 kJ/kg BW(0.75)/day. The daily crude protein requirement of adult cats was determined to be 2.7 g/kg BW/day. The daily requirement of metabolizable energy for maintenance was estimated to be 153 kJ/kg BW/day or 226 kJ/kg BW(0.75)/day. The activity-induced heat production was 25.1 kJ/kg BW/day which corresponded to 13.5% of the total daily heat production. The daily requirement for metabolizable energy was thus reduced by 20.9 kJ/kg BW/day or 13.7%. The activity pattern of the cats was not characterized by a circadian rhythm.

This article examines the anatomy of the female continence mechanism and the traditional and newer theories relevant to the etiology and surgical correction of genuine stress incontinence. The authors review the classical theories of incontinence and unify them with more recent ones, stressing that central to all explanations is the concept that urinary loss secondary to an underactive outlet results from a relative lack of continence mechanism resistance with respect to intravesical pressure. They also propose an explanation for the success of newer techniques that involve mid-urethral suspensions. Surgical stabilization of the continence mechanism, at the bladder neck or mid-urethra, compensates for the existing loss of urethral support or function by creating a new zone that provides compression, absorbs transmitted pressure, and preserves sphincteric configuration.

To compare computer-assisted virtual urethral pressure profile changes between women with and without genuine stress incontinence.A full urogynecologic assessment including conventional urodynamic measurements and a clinical stress test were carried out. Computer-assisted virtual urethral pressure profile uses conventional urethral pressure profile measurements during stress, with the only change being that withdrawal of the catheter is stopped at distinct points along the whole urethra while the patient coughs. Cough-related changes of maximal urethral closure pressure, functional urethral length, and area under the urethral closure pressure curve were determined.Sixty-one women were enrolled in our study: 30 symptom-free women (group A) were continent, and genuine stress incontinence was present in 31 patients (group B) complaining of urinary loss. Significant differences between group A and group B women were found for all parameters of computer-assisted virtual urethral pressure profile including maximal urethral closure pressure (91.59 +/- 39.00 versus 20.70 +/- 22.61 cm H(2)O; P.001), functional urethral length (31.81 +/- 9.02 versus 10.83 +/- 10.76 mm; P.001), and the area under the urethral closure pressure curve (2036 +/- 1025.29 versus 253 +/- 206.69 cm H(2)O x mm; P.001).Computer-assisted virtual urethral pressure profile is a new application of urethral pressure profile measurements during stress. Our data show significant differences between continent women and patients with genuine stress incontinence. Further studies are needed to assess the potential of computer-assisted virtual urethral pressure profile for diagnosing genuine stress incontinence.

Hartnup disorder is an autosomal recessive disease that can be associated with neurological, psychiatric and dermatological abnormalities or be asymptomatic. Excessive intestinal and urinary loss of neutral amino acids is an essential feature of this disorder, which had been presumed to be due to hereditary abnormalities in an apical membrane-situated amino acid transporter. As anticipated, recently, mutations in the cytoplasmic and transmembrane domains of SLC6A19, the recently cloned neutral amino acid transporter, were detected in members of families with Hartnup disorder. Presumably, deficiency in neutral amino acid absorption and consequential hypoaminoacidemia is the cause of the symptoms of the disease because SLC6A19 is not expressed in the organs affected.

Various sources of crude protein (CP) were fed at three levels (14, 16, and 18% CP) in a barley-based, all concentrate diet to lambs. The objective was to evaluate the efficiency of protein use of the sources of CP. Experiment one was conducted at ad libitum intake and experiment two was conducted at 70% of ad libitum intake. The efficiency of CP use was greater (P < 0.05) for Menhaden fish meal (F) and a combination of blood and feather meals (B) than for soybean meal (S) and urea (U). Urinary loss of CP as a percent of intake CP decreased (P < 0.05) and retention of CP as a percent of intake CP increased (P < 0.05) as level of CP in the diet increased for F, B, and S. Supplements F and B were of greater biological quality than S and U and thus contribute less N to the environment via animal excretion pathways.

Revisión de literatura cuyo objetivo fue identificar las asociaciones entre la incontinencia urinaria en las mujeres y los aspectos raciales. Se utilizaron las bases de datos MEDLINE y LILACS para investigar los artículos publicados en los años 2003 a 2010. Se analizaron 30 publicaciones que indicaron diferentes relaciones entre la incontinencia y la raza. La prevalencia de la incontinencia fue mayor entre las mujeres blancas. La incontinencia urinaria de esfuerzo fue más frecuente entre blancas y de urgencia entre negras. Blancas y asiáticas tenían pérdida urinaria en menor cantidad en comparación con las negras e hispanas. El impacto en la calidad de vida está más relacionada con la severidad de la pérdida de orina y otros factores, y no específicamente a la cuestión de la racial. Blancas tuvieron un mejor conocimiento acerca de la incontinencia y con mayor frecuencia fueron sometidos a tratamiento quirúrgico por la incontinencia urinaria de esfuerzo. Las blancas y latinas tienen mayor riesgo de incontinencia cuando comparadas con las negras y asiáticas. Se resalta la necesidad de estudios brasileños para que los datos puedan ser adecuados a nuestra realidad.

Podocyturia, i.e. urinary loss of viable podocytes, may serve as a diagnostic tool for pre-eclampsia and as a marker of active renal disease. The current method to detect podocyturia is technically complex, lengthy and requires a high level of expertise for interpretation. The aim of this study was to develop a new technique for the identification of urinary podocytes, based on the detection of podocyte-specific tryptic peptides by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), which will provide an operator-independent and highly reproducible method.The diagnosis of pre-eclampsia was confirmed in the presence of hypertension (140/90 mmHg) and proteinuria0.3 g/24 h urine. The diagnosis of HELLP was confirmed based on the accepted clinical criteria of hemolysis, elevated liver enzymes and low platelet count. Random urine samples within 24 h prior to delivery were collected and centrifuged. One half of the sediment was cultured for 24 h to select for viable cells and then stained with a podocin antibody, followed by a secondary fluorescein isothiocyanate-labeled antibody to identify podocytes. The second half of the pellet was solubilized, digested and analyzed by LC-MS/MS using an internal standard. We have recruited 13 patients with pre-eclampsia and 6 patients with pre-eclampsia/HELLP syndrome. The presence of podocytes was confirmed in all patients by the podocyte culture method. In the respective samples, the presence of a podocin-specific tryptic peptide was confirmed with LC-MS/MS technology.The LC-MS/MS method is a reliable technology for the identification of urinary podocytes, based on the presence of podocyte-specific proteins in the urine.

Objective The number of women with vulvar carcinoma located in the anterior fourchette in immediate proximity to the urethral opening has increased. A retrospective analysis was performed in order to evaluate the risk of urinary incontinence after tumor-resection, standard inguinal lymphadenectomy and additional partial urethral resection. Study design Between 2002 and 2007, 19 women with vulvar carcinomas located close to the urethral opening and consequently treated by additional partial urethral resection of up to 1.5 cm, were evaluated for urinary loss postoperatively by standard incontinence questionnaire. All patients complaining about some kind of urinary loss underwent urodynamic measurement. Results were compared with 21 controls (women with anterior vulvar cancer treated without urethral resection). Results Five of 19 women (26%) of the study group complained about urinary disturbances and received urodynamic evaluation. Ninety-five percent of the patients (18/19 women) were continent by urodynamic criteria; in one woman the measurement was unreliable. One patient in the control group (1/21 women) complained of an increase of urge symptoms that had been present preoperatively. Conclusions Twenty-six percent of our patients after partial urethral resection reported incontinence symptoms, though this was not always confirmed by urodynamics. We conclude that the risk of urinary stress incontinence after partial urethral resection in anterior vulvar carcinoma is acceptable.

Various parameters of the urethral pressure profile have been developed to improve diagnosis of genuine stress incontinence. By application of micro-tip transducers, a positive correlation between "depression ratio" and degree of incontinence as had been observed by Eberhard. The aim of this study was to examine Eberhard's observations by the use of Brown-Wickham's method. Significant differences in the parameters of the urethral pressure profile during stress, such as the urethral closure pressure, depression pressure, depression ratio, transmission ratio, and the area of continence, were found between continent and incontinent patients. Although pressure transmission and transmission ratio revealed significant differences, depression pressure and depression ratio were found to be similar in patients with mild and severe degree of incontinence. According to the results of this study, depression ratio does not reflect the degree of urinary loss, when open catheters are used.

Pelvic floor muscle training (PFMT) is considered to be the first-line treatment for female stress urinary incontinence (SUI). There are few studies that have tested the efficacy of unsupervised PFMT. The aim of this study was to compare the effectiveness of intensive supervised PFMT to unsupervised PFMT in the treatment of female SUI. Sixty-two women with SUI were randomized to either supervised or unsupervised PFMT after undergoing supervised training sessions. They were evaluated before and after the treatment with the Oxford grading system, pad test, quality of life questionnaire, subjective evaluation, and exercise compliance. After treatment, there were no differences between the two groups regarding PFM strength (p = 0.20), International Consultation on Incontinence Questionnaire-Short Form score (p = 0.76), pad test (p = 0.78), weekly exercise compliance (p = 0.079), and subjective evaluation of urinary loss (p = 0.145). Both intensive supervised PFMT and unsupervised PFMT are effective to treat female SUI if training session is provided.

A incontinência urinária (IU) é vista como um problema que afeta mulheres mais velhas e multíparas. Pouca atenção tem sido dada para identificá-la em grupos mais jovens ou nulíparas. Este estudo verificou a prevalência da IU e as características da perda urinária entre mulheres jovens e nulíparas, estudantes de Educação Física. Os dados foram coletados através de um questionário. Dentre 95 estudantes, 61,1% responderam ao questionário. A idade média foi 21,4 anos e 20,7% afirmaram já ter apresentado perda involuntária de urina. Em 75% dos casos a perda de urina ocorreu durante as atividades esportivas. As estudantes que tiveram perda urinária quantificaram, em média, o problema com a nota 2,3 (variando de 0 a 6), sendo 0 nenhum problema e 10, problema grave. Conclui-se que a perda urinária durante o exercício, embora seja relativamente freqüente, não é considerada um problema relevante para as estudantes de Educação Física. Urinary incontinence (UI) is seen as a problem that affects older multiparous women. Little attention has been given to identifying UI in groups of younger or nulliparous women. This study verified the prevalence of UI and the characteristics of urinary loss among young nulliparous female physical education students. Data collection was performed using a questionnaire. Of all 95 students, 61.1% answered the questionnaire. The average age was 21.4 years and 20.7% stated having presented involuntary urine loss. In 75% of cases, urinary loss occurred during sports activities. The students who had experienced urinary loss rated the problem with a 2.3 average score (ranging form 0 to 6), with 0 being no problem and 10 being a serious problem. It is concluded that uinary loss during exercise, though relatively frequent, is not considered a relevant issue for the physical education students. La incontinencia urinaria (IU) es vista como un problema que afecta mujeres con edad avanzada y multíparas y se ha dado poca atención para identificarla en grupos más jóvenes o en nulíparas. Este estudio verificó la prevalencia de la IU y las características de la pérdida urinaria entre mujeres jóvenes y nulíparas, estudiantes de Educación Física. Los datos fueron recolectados a través de un cuestionario. Entre 95 estudiantes, 61,1% respondieron el cuestionario. La edad promedio fue 21,4 años y 20,7% afirmaron haber presentado pérdida involuntaria de orina. En 75% de los casos la pérdida de orina ocurrió durante las actividades deportivas. Las estudiantes que tuvieron pérdida urinaria cuantificaron, en promedio, el problema con la nota 2,3 (variando de 0 a 6), siendo 0 ningún problema y 10, problema grave. Se concluye que la pérdida urinaria durante el ejercicio, a pesar de ser relativamente frecuente, no es considerado un problema relevante para las estudiantes de Educación Física.

Resumo A presente pesquisa tem como objetivo investigar a qualidade de vida de idosas com incontinência urinária, residentes em uma instituição asilar filantrópica do município de Catanduva, SP. Trata-se de um estudo descritivo, de corte transversal, cuja população foi composta de mulheres com idade igual ou superior a 60 anos, conscientes e orientadas no tempo e no espaço, capazes de interagir em uma entrevista. Foram excluídas as idosas que se recusaram a participar do estudo. A coleta dos dados foi feita através de entrevista com questionário composto por informações sociodemográficas e clínicas. O instrumento International Consultation on Incontinence Questionnaire - Short From (ICIQ-SF) foi utilizado para avaliar a qualidade de vida das idosas incontinentes. A análise estatística dos dados foi feita em forma de média, desvio padrão, valores mínimos e máximos para cada variável. Encontrou-se um total de 22 idosas cuja média de idade foi de 72,9 anos +- 8,6. Todas as participantes relataram perda urinária, sendo que, destas, sete (31,8%) relataram perder urina várias vezes ao dia. A maior porcentagem de perda urinária ocorreu antes de chegar ao banheiro (21,3%), seguida de tosse ou espirro (19,1%) e ao dormir (12,8%). No que tange à interferência da perda urinária nas atividades de vida diária, a maioria (72,5%) referiu alguma interferência. Concluiu-se que a incontinência urinária tem alta prevalência entre idosas institucionalizadas e compromete a qualidade de vida das mesmas. Diante disso, medidas de intervenção devem ser adotadas, na tentativa de minimizá-las ou combatê-las. Abstract This study aims to investigate the quality of life of elderly women with UI, all living in a philanthropic health care in Catanduva, S.P. It is a cross-sectional descriptive study whose population was women aged 60 years and more, oriented and conscious in time and space, able to be interviewed. The ones who refused to participate in the study were excluded. Data collection was done through a survey with a questionnaire composed of clinic and social-demographic information. To evaluate the quality of life of incontinent elderly we used the (ICIQ-SF) short form-"International Consultation on Incontinence Questionnaire". The statistical data analisis comprised average, standard deviation, minimum and maximum values to each variable. We interviewed 22 elderly women whose average age was 72,9 years old +- 8,6. All women reported urinary loss and seven (31,8%) reported urinary loss several times a day. The higher percentage of urinary loss happened before they arrival to the bathroom (21,3%), followed by coughing and sneezing (19,1%) and sleeping (12,8%). Concerning interference in the daily life activities, most of them (72,5%) related some interference. We concluded that the Urinary Incontinence (UI) has high prevalence among institutionalized elderly and compromise their quality of live. So we believe that intervention measures should be taken in an attempt to reduce and fight then.

It has only been realized quite recently how important is the purification of hemoglobin solution for use in transfusion and several techniques have been published. We used ion exchange chromatography with which the main “contaminants” (glycoproteins, enzymes, phospholipids) are absorbed by the gel, whereas hemoglobin is not retained. The solutions studied here are non-modified hemoglobin and its homologue pyridoxylated hemoglobin (PLP-Hb). Physico-chemical analyses, usually undertaken to characterize hemoglobin solutions, show no difference before and after purification, except that the enzymatic activity almost disappears. In order to appreciate the benefits of purification, total exchange transfusions were carried out on rats. Without reperfusion, purification of the hemoglobin solution allowed a significantly longer survival time which was even more significant with PLP-Hb solution. Urinary loss did not seem to be affected by purification. With reperfusion in order to compensate these renal losses, PLP-Hb solutions gave survival times up to three days. However, the inevitable death of the animals poses the problem of instability of these purified solutions following enzyme loss.

I did not intend to revisit the discussion of the publication of Brandolini et al.1 on Ca urinary excretion attributed to the sulfate content of water but in their answers2 to my comments3, they said that ‘I accept their experimental results’ and that ‘I do not contest the difference in calciuria between milk and sulfate-rich water’. I never wrote that I agree with their results and even more with their conclusions but questioned how is it possible to evaluate a 20 mg difference in daily Ca urinary excretion from a study with subjects under uncontrolled dietary intakes, unbalanced experimental study design and without analytical results on acid–base balance and sulfate to support their acidogenic hypothesis of sulfate. I did not find any convincing explanations in their answers but I want to raise several points of disagreement, which are either repeated or new.

Hematopoietic and non-hematopoietic effects of recombinant erythropoietin (Epo) given to preterm infants are controversially discussed. Because renal loss of Epo was significantly higher after intravenous versus subcutaneous Epoetin-beta administration, we suggest a reconsideration of whether subcutaneous recombinant Epo is more efficient and safer because of lower peaks of circulating Epo.

A Incontinência Urinária (IU) é um grave problema de saúde, o qual se refere à queixa de qualquer perda involuntária de urina. Esta patologia acomete grande parte da população mundial, em especial as mulheres, todavia homens podem também apresentar esta disfunção no decorrer do envelhecimento. Em decorrência da falta de informação quanto a esta doença por Educadores Físicos, o objetivo deste estudo foi debater sobre quais práticas estão associadas diretamente aos episódios de IU, assim como prevenir e/ou melhorar os sinais e sintomas de indivíduos incontinentes através de atividades físicas adequadas. Recentes pesquisas têm demonstrado que atividades físicas/exercícios físicos de alto impacto parecem enfraquecer a musculatura do períneo ou do assoalho pélvico – principal músculo responsável pelo sistema de continência, resultando em afastamento das atividades físicas e de lazer. De forma inversa, outras pesquisas sugerem que a prática de atividades físicas de baixa a moderada intensidade podem ser eficazes tanto na prevenção quanto na redução das perdas urinárias através do fortalecimento de determinados grupos musculares, assim como na musculatura responsável pelo sistema de continência de forma sinérgica. Relationship Between Physical Activity and Urinary Incontinence: Useful Information to The Physical Trainer ABSTRACT: Urinary Incontinence (UI), the involuntary loss of urine, is a serious health problem. The pathology is present in a great section of people worldwide, especially women, although males may also suffer the dysfunction due to aging. Due to lack of information on the disease by Physical Educators, current paper discusses which practices are directly associated with episodes of UI and how to prevent and/or improve the symptoms of incontinent people through proper physical activities. Recent research has shown that high impact physical activities/physical exercises weaken the perineum or the pelvic muscles, or rather, the main muscle that controls the continence system, and thus tends to prevent physical and recreational activities. Contrastingly, other research works suggest that the practice of low and medium impact physical activities are efficient for the prevention and the decrease of urinary loss through the synergic strengthening of certain muscular groups and muscles responsible for the urinary continence system.

OBJETIVO: Verificar a influência dos exercícios perineais e dos cones vaginais, em associação aos exercícios posturais corretivos para a normalização estática da pelve, no tratamento da incontinência urinária feminina. MÉTODOS: Foram avaliadas 12 mulheres apresentando queixa de incontinência urinária, com idade média de 52,3 ± 9,7, submetidas a 10 sessões fisioterapêuticas, duas vezes na semana, divididas em dois grupos: Grupo A: n = 6, utilizando exercícios perineais e Grupo B: n = 6, utilizando cones vaginais. Ambos os grupos realizaram exercícios posturais para correção estática da pelve, conforme alterações de cada participante. Foram coletados os seguintes dados, antes e após intervenção: grau de contração muscular do períneo, pela Avaliação Funcional do Assoalho Pélvico (AFA); perda quantitativa de urina, mensurada pelo teste da almofada (Pad-Test), e sensações de umidade e desconforto, verificadas pelas Escalas Visuais Análogas (EVA). Os dados posturais foram coletados através do exame estático da pelve, exame de flexibilidade das cadeias musculares e avaliação postural. RESULTADOS: Na comparação dos dados pré e pós-intervenção, foi observado, para ambos os grupos, diminuição estatisticamente significativa da perda urinária (p < 0,05), ganho de contração muscular do assoalho pélvico e diminuição significativa da sensação de umidade. O grau de sensação de desconforto, pós-intervenção, foi significativamente menor para o grupo de exercícios perineais. O equilíbrio estático pélvico foi corrigido na maioria das voluntárias e houve ganho de flexibilidade das cadeias musculares. CONCLUSÃO: A correção estática da pelve, através dos exercícios posturais, constitui uma modalidade efetiva de intervenção na IU feminina, quando associada à reeducação perineal.