OBJETIVO: Investigar a etiologia, o perfil epidemiológico de pacientes com candidíase vulvovaginal (CVV) e possíveis fatores predisponentes. MÉTODOS: Secreção vaginal das pacientes foi semeada em ágar Sabouraud e amostras de leveduras foram isoladas e identificadas por Polymerase Chain Reaction (PCR). Dados demográficos, clínicos e fatores predisponentes foram obtidos por meio de questionário. Para análise estatística, foram utilizados os testes t de Student, Fischer e do χ², com auxílio do software Statistical Package for the Social Sciences (SPSS), com nível de significância de 5%. RESULTADOS: Foram avaliadas 69 pacientes, com idade entre 15 e 52 anos, predominando mulheres brancas (79,7%), com escolaridade de nível superior completo (58%), casadas (56,5%) e com vida sexual ativa (97,1%). Dentre elas, 34,8% eram gestantes, 7,2% diabéticas, 1,4% soropositivas para AIDS e 36,2% usavam anticoncepcional oral. Antibioticoterapia recente foi citada por 13% das pacientes, uso de antifúngico por 5,8% e de antitricomonas por 1,4%. Uso de corticosteroides foi relatado por 2,9% das participantes e de antineoplásicos, por 1,4%. Fluxo vaginal e prurido foram as principais queixas apresentadas, respectivamente, por 97,1 e 73,9% das pacientes, seguido de ardência (63,8%) e hiperemia (63,8%). Quando presente, o fluxo foi majoritariamente branco (88,1%) ou grumoso (86,6%). O diagnóstico foi confirmado pela cultura em 55 (79,7%) pacientes, sendo 4 casos de infecção mista. A espécie prevalente foi C. albicans, seguida por um caso de C. glabrata, que foi encontrada em mais duas pacientes em associação com C. albicans. Nas outras duas infecções polimicrobianas, C. lusitaniae foi isolada com C. albicans. CONCLUSÕES: Embora a positividade da cultura tenha sido alta e os dados clínicos de CVV sejam característicos, a sintomatologia não é patognomônica. C. albicans é a espécie prevalente, mas deve-se atentar para a ocorrência de outras espécies na etiologia de CVV, como a emergência de C. lusitaniae.

PURPOSE: To investigate the etiology and the epidemiological profile of patients with vulvovaginal candidiasis (VVC) and predisposing factors. METHODS: Vaginal secretions were streaked in Sabouraud agar and yeast samples were isolated and identified by Polymerase Chain Reaction (PCR). Demographic and clinical data were obtained with a questionnaire. For statistical analysis, the Student's t-test, the χ² and Fischer tests were applied as needed using the Statistical Package for Social Sciences (SPSS) software, with the level of significance set at 5%. RESULTS: Sixty-nine patients aged from 15 to 52 years were evaluated. They were predominantly white (79.7%), with higher education (58%), married (56.5%) and sexually active (97.1%). Among them, 34.8% were pregnant, 7.2% diabetic, 1.4% seropositive for AIDS, and 36.2% were using oral contraceptives. Recent antibiotic therapy was mentioned by 13% of the patients, and antifungal or anti-trichomonas therapy was mentioned by 5.8 and 1.4% of the patients, respectively. Corticosteroid use was reported by 2.9% and antineoplastic by 1.4%. Vaginal discharge and itching were the main complaints (97.1 and 73.9%), followed by burning (63.8%) and erythema (63.8%). When present, the vaginal flow was predominantly white (88.1%) or lumpy (86.6%). The diagnosis was confirmed by culture in 55 (79.7%) patients, with mixed infections in 4 patients. The most prevalent species was C. albicans, followed by C. glabrata (one monoinfection and two mixed infections with C. albicans). C. lusitaniae and C. albicans were also identified in mixed infections (two patients). CONCLUSION: Despite the high culture positivity and clinical data characteristic of VVC, the symptoms were not pathognomonic. C. albicans is the most prevalent species, but other species are also involved in VVC etiology, such as the emergence of C. lusitaniae.

Foi avaliado o nível de conhecimento de médicos e enfermeiros obstetras sobre a utilização de ácido fólico (AF) para a prevenção dos defeitos do fechamento do tubo neural (DFTN). Estudo descritivo transversal no qual 118 voluntários (95 médicos e 23 enfermeiros), responderam um questionário com 21 perguntas sobre a prevenção dos DFTN. Os dados foram analisados em função do conhecimento relatado, das recomendações preconizadas pelo Ministério da Saúde (MS) e das evidências científicas (EC) disponíveis sobre o assunto investigado. O nível de conhecimento baseado nas EC e nas recomendações do MS foi diferente (4,64 ± 0,20 vs 5,55 ± 0,15; p < 0,001; Média ± EPM). Não houve diferença entre o nível de conhecimento quando comparado à formação dos mesmos, ao tempo que realizam atendimento pré-natal e entre as duas classes de profissionais avaliados. Houve diferença entre o nível de conhecimento relatado e o baseado nas EC (6,76 ± 0,18 vs 4,64 ± 0,15; p < 0,001) e o baseado nas recomendações do MS (6,76 ± 0,18 vs 5,55 ± 0,20; p < 0,001), 94,1% dos profissionais conhecem o papel do ácido fólico, contudo, 64,2% relataram não saber quando iniciar a suplementação no pré-natal. Frente ao exposto foi verificado que a grande maioria dos avaliados relatou conhecer a importância do AF na prevenção do DFTN, porém, existe ainda desconhecimento sobre o assunto investigado.

The scope of this study was to evaluate the knowledge of obstetricians and obstetric nurses about folic acid in the prevention of neural tube defects (NTD). A cross-sectional study was conducted in which 118 volunteers (95 physicians and 23 nurses) answered a questionnaire with 21 questions about prevention of NTD. The data were analyzed according to the reported knowledge, the recommendations made by the Brazilian Ministry of Health (MOH) and the scientific evidence (SE) available in the literature on the topic. The knowledge based on the SE and recommendations of MOH was different (4.64 ± 0.20 vs. 5.55 ± 0.15, p <0.001, Mean ± SEM). There was no difference between the knowledge of respondents compared to their training, the time spent in prenatal care and between the two classes of professionals evaluated. There were differences between the reported knowledge and that based on SE (6.76 ± 0.18 vs. 4.64 ± 0.15, p <0.001) and based on the MOH recommendations (6.76 ± 0.18 vs. 5.55 ± 0.20, p <0.001). Thus, the conclusion reached was that 94.1% of those evaluated reported knowing the importance of folic acid in preventing NTD, though 64.2% reported that they did not know when to begin administration of the supplement.

Foi avaliado o nível de conhecimento de médicos e enfermeiros obstetras sobre a utilização de ácido fólico (AF) para a prevenção dos defeitos do fechamento do tubo neural (DFTN). Estudo descritivo transversal no qual 118 voluntários (95 médicos e 23 enfermeiros), responderam um questionário com 21 perguntas sobre a prevenção dos DFTN. Os dados foram analisados em função do conhecimento relatado, das recomendações preconizadas pelo Ministério da Saúde (MS) e das evidências científicas (EC) disponíveis sobre o assunto investigado. O nível de conhecimento baseado nas EC e nas recomendações do MS foi diferente (4,64 ± 0,20 vs 5,55 ± 0,15; p < 0,001; Média ± EPM). Não houve diferença entre o nível de conhecimento quando comparado à formação dos mesmos, ao tempo que realizam atendimento pré-natal e entre as duas classes de profissionais avaliados. Houve diferença entre o nível de conhecimento relatado e o baseado nas EC (6,76 ± 0,18 vs 4,64 ± 0,15; p < 0,001) e o baseado nas recomendações do MS (6,76 ± 0,18 vs 5,55 ± 0,20; p < 0,001), 94,1% dos profissionais conhecem o papel do ácido fólico, contudo, 64,2% relataram não saber quando iniciar a suplementação no pré-natal. Frente ao exposto foi verificado que a grande maioria dos avaliados relatou conhecer a importância do AF na prevenção do DFTN, porém, existe ainda desconhecimento sobre o assunto investigado.

The scope of this study was to evaluate the knowledge of obstetricians and obstetric nurses about folic acid in the prevention of neural tube defects (NTD). A cross-sectional study was conducted in which 118 volunteers (95 physicians and 23 nurses) answered a questionnaire with 21 questions about prevention of NTD. The data were analyzed according to the reported knowledge, the recommendations made by the Brazilian Ministry of Health (MOH) and the scientific evidence (SE) available in the literature on the topic. The knowledge based on the SE and recommendations of MOH was different (4.64 ± 0.20 vs. 5.55 ± 0.15, p <0.001, Mean ± SEM). There was no difference between the knowledge of respondents compared to their training, the time spent in prenatal care and between the two classes of professionals evaluated. There were differences between the reported knowledge and that based on SE (6.76 ± 0.18 vs. 4.64 ± 0.15, p <0.001) and based on the MOH recommendations (6.76 ± 0.18 vs. 5.55 ± 0.20, p <0.001). Thus, the conclusion reached was that 94.1% of those evaluated reported knowing the importance of folic acid in preventing NTD, though 64.2% reported that they did not know when to begin administration of the supplement.

OBJETIVOS: Avaliar a correlação entre a circunferência abdominal materna, medida antes da 12ª semana de gestação, e os níveis séricos de leptina durante a gravidez, bem como, comparar os níveis médios de leptina entre gestantes com e sem obesidade abdominal, diagnosticada no início da gestação. MÉTODOS: Estudo prospectivo incluindo 40 gestantes atendidas no pré-natal de baixo risco, superiores a 20 anos, não tabagistas, com gestação única, e sem doenças crônicas intercorrentes. A circunferência abdominal foi medida antes da 12ª semana, e os níveis séricos de leptina dosados entre a 9ª e a 12ª, a 25ª e a 28ª e entre a 34ª e a 37ª semanas de gestação. De acordo com a circunferência abdominal, a coorte foi dividida em dois grupos: com e sem obesidade abdominal. Os testes de Mann-Whitney e do χ² avaliaram as diferenças entre os grupos. A correlação de Pearson verificou a associação entre a circunferência abdominal e os níveis séricos de leptina durante a gestação. Considerou-se o valor de p<0,05. RESULTADOS: A média do peso e do índice de massa corpórea das pacientes com obesidade abdominal (74,4±11,0 kg/28,99±4,1) foi maior do que naquelas sem obesidade abdominal (55,6±5,9 kg/21,1±2,40) (p=0,001). A média dos níveis séricos de leptina no grupo das gestantes com obesidade abdominal (41,9±3,5 ng/mL) foi superior ao grupo das pacientes sem obesidade abdominal (23,6±2,7 ng/mL) (p<0,0002). Verificou-se, também, correlação entre a medida da circunferência abdominal e a média dos níveis séricos de leptina (r=0,7; p<0,0001). CONCLUSÕES: A circunferência abdominal medida antes da 12ª semana de gestação é um método válido e simples para se predizer os níveis séricos de leptina durante todo o período gestacional. Gestantes com obesidade abdominal diagnosticada antes da 12ª semana apresentam níveis médios de leptina sérica, durante a gravidez, superiores àquelas sem obesidade abdominal.

PURPOSE: To evaluate the correlation between maternal waist circumference measured before the 12th week of gestation and serum leptin levels during pregnancy, as well as to compare the leptin levels of women with and without abdominal obesity diagnosed in early pregnancy. METHODS: Prospective study including 40 pregnant women receiving low-risk prenatal care, older than 20 years, nonsmokers, with singleton pregnancies and without chronic disease. Waist circumference was measured before the 12th week and serum leptin levels were measured between the 9th and 12th, 25th and 28th and 34th and 37th weeks of gestation. According to waist circumference measurement, the cohort was divided into two groups: with and without abdominal obesity. The Mann-Whitney and χ² tests were used to assess the differences between groups. The Pearson correlation coeffient was used to assess the association between waist circumference and serum leptin levels during pregnancy. The level of significance was set at p<0.05. RESULTS: The mean weight and body mass index of patients with abdominal obesity (74.4±11.0 kg/28.9±4.1) was higher than that of patients without abdominal obesity (55.6±5.9 kg/21.1±2.4) (p=0.001). The mean leptin levels in pregnant patients with abdominal obesity (41.9±3.5 ng/mL) was higher than in patients without abdominal obesity (23.6±2.7 ng/mL) (p<0.0002). A positive correlation was obtained between the waist circumference measured during the same period and the mean serum leptin levels (r=0.7; p<0.0001). CONCLUSIONS: Waist circumference measured before the 12th week of pregnancy is a valid and simple method to predict the serum leptin levels throughout pregnancy. Pregnant women with abdominal obesity diagnosed before 12th week have higher mean serum leptin levels during pregnancy than those without abdominal obesity.

Group B Streptococcus (GBS) is still not routinely screened during pregnancy in Brazil, being prophylaxis and empirical treatment based on identification of risk groups. This study aimed to investigate GBS prevalence in Brazilian pregnant women by culture or polymerase chain reaction (PCR) associated to the enrichment culture, and to determine the antimicrobial susceptibility patterns of isolated bacteria, so as to support public health policies and empirical prophylaxis. After an epidemiological survey, vaginal and anorectal specimens were collected from 221 consenting laboring women. Each sample was submitted to enrichment culture and sheep blood agar was used to isolate suggestive GBS. Alternatively, specific PCR was performed from enrichment cultures. Antimicrobial susceptibility patterns were determined for isolated bacteria by agar diffusion method. No risk groups were identified. Considering the culture-based methodology, GBS was detected in 9.5% of the donors. Twenty five bacterial strains were isolated and identified. Through the culture-PCR methodology, GBS was detected in 32.6% specimens. Bacterial resistance was not detected against ampicillin, cephazolin, vancomycin and ciprofloxacin, whereas 22.7% were resistant to erythromycin and 50% were resistant to clindamycin. GBS detection may be improved by the association of PCR and enrichment culture. Considering that colony selection in agar plates may be laboring and technician-dependent, it may not reflect the real prevalence of streptococci. As in Brazil prevention strategies to reduce the GBS associated diseases have not been adopted, prospective studies are needed to anchor public health policies especially considering the regional GBS antimicrobial susceptibility patterns.