São Paulo medical journal = Revista paulista de medicina
-
Human immunodeficiency virus (HIV)-infected women have higher incidence, prevalence, persistence and recurrence of pre-invasive cervical lesions (CIN II or III). The aim here was to investigate the risk of recurrence of CIN II/III among HIV-infected women (HIV+) and uninfected women in a cohort treated by means of large-loop excision of the transformation zone (LLETZ). ⋯ The HIV+ women in our cohort presented a risk of CIN II/III recurrence at least 42% higher than among the HIV-negative women. These patients should form part of a rigorous screening and follow-up protocol for identification and appropriate treatment of cervical cancer precursor lesions.
-
CONTEXT AND OBJECTIVE Evidence-based clinical practice emerged with the aim of guiding clinical issues in order to reduce the degree of uncertainty in decision-making. The Cochrane Collaboration has been developing systematic reviews on randomized controlled trials as high-quality intervention study subjects. Today, physiotherapy methods are widely required in treatments within many fields of healthcare. ⋯ Only 0.5% of the reviews concluded that the intervention presented a positive effect and that further studies were not recommended; 45.9% found that there seemed to be a positive effect but recommended further research; and 46.9% found that the evidence was insufficient for clinical practice and suggested that further research should be conducted. CONCLUSION Only one systematic review ("Pulmonary rehabilitation for chronic obstructive pulmonary disease") indicated that the intervention tested could be used with certainty that it would be effective. Most of the systematic reviews recommended further studies with greater rigor of methodological quality.
-
There is uncertainty in the literature regarding the theory that obstetric events and pelvic floor injuries give rise to lower risk of subsequent urinary incontinence among women delivering via cesarean section than among women delivering vaginally. The objective of this study was to assess the two-year postpartum prevalence of urinary incontinence and pelvic floor muscle dysfunction and the factors responsible for them. ⋯ Gestational urinary incontinence was a crucial precursor of postpartum urinary incontinence. Weight gain during pregnancy increased the subsequent risk of pelvic floor muscle dysfunction, and elective cesarean section did not prevent urinary incontinence.
-
Arterial thrombosis may occur consequent to hereditary thrombophilia and increased lipoprotein(a) [Lp(a)] and fibrinogen. Our aim was to study the prevalence of common thrombophilia markers in 85 consecutive cases of arterial thrombosis. ⋯ An association was found between low levels of protein C, protein S and AT and arterial thrombosis, but only elevated fibrinogen levels, smoking, positive family history and hyperlipidemia showed statistical significance.
-
Accelerated atherosclerosis has become a major problem in rheumatic inflammatory disease. The aim here was to analyze carotid intima-media thickness (IMT) in spondyloarthritis (SpA) patients and correlate this with clinical parameters and inflammatory markers. ⋯ SpA patients have a higher degree of subclinical atherosclerosis than in controls, thus supporting clinical evidence of increased cardiovascular risk in rheumatic patients.