• Shortcomings in the training program of medical residency during the COVID-19 pandemic in Brazil. How will they be repaired? Editorial

    Sá, Marcos Felipe Silva de
  • History of Maternal Mortality in the City of Ribeirão Preto, in its Regional Health Department, and in the State of São Paulo after the Establishment of the Maternal Committees from 1998 to 2017 Original Article

    Berezowski, Aderson Tadeu; Rodrigues, Antonio Luiz

    Abstract in Portuguese:

    Resumo Objetivo Descrever a evolução da mortalidade materna após a instituição dos comitês de morte materna na região de Ribeirão Preto. Métodos Este estudo descreveu a distribuição espacial e temporal das frequências e da razão demortalidadematerna, utilizando dados do estado de São Paulo, do Departamento Regional de Saúde de Ribeirão Preto (DRS-XIII), e domunicípio de Ribeirão Preto, no período de 1998 a 2017. O estudo ecológico considerou frequências de mortes maternas e de nascidos vivos disponibilizadas pelo Departamento de Informática do Sistema Único de Saúde (DATASUS)/Ministério da Saúde, que foramagrupadas por ano e pela referida divisão político-administrativa. A taxa de mortalidade materna (TMM) foi calculada e apresentada por medidas descritivas, gráficos e cartogramas. Resultados O total observado para o município de Ribeirão Preto foi uma TMM de 39,1; para o DRS-XIII, TMM de 40,4; e, para o estado de São Paulo, uma TMM de 43,8 por 100 mil habitantes. No período do estudo, a RMM do município de Ribeirão Preto variou de 0% até 80,0% do total de mortes maternas, e de 40,7% a 47,2% dos nascidos vivos no DRS-XIII. O município de Ribeirão Preto apresentou TMM de 76,5 no biênio 1998-1999, que progressivamente diminuiu para 12,1 em 2012-2013, e aumentou para 54,3 por 100mil habitantes nos últimos 4 anos. O estado de São Paulo apresentou TMM de 54,0 em 1998-1999, tendo variado ao longo do período com valores de 48,0 no período 2008-2009, e 54,1 no período 2016-2017. Várias vezes antes de 2015, o município de Ribeirão Preto e o DRS-XIII atingiramas Metas domilênio. Recentemente, porém, a TMM aumentou, o que pode ser explicado pela melhoria da vigilância da mortalidade materna. Conclusão O estudo descreveu um acentuado declínio da morte materna na região de Ribeirão Preto até o final do biênio 2012-2013, e um subsequente e aflitivo aumento em anos recentes, que precisa ser enfrentado.

    Abstract in English:

    Abstract Objective To describe the evolution of maternal mortality right after the establishment of maternal death committees in the region of the city of Ribeirão Preto, state of São Paulo, Brazil. Methods The present study describes the spatial and temporal distribution of maternal mortality frequencies and rates, using data from the state of São Paulo, the municipality of Ribeirão Preto, and its Regional Health Department (DRS-XIII) from 1998 to 2017. The present ecological study considered the maternal mortality and live birth frequencies made available by the Computer Science Department of the Brazilian Unified Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS, in the Portuguese acronym)/Ministry of Health, which were grouped by year and political-administrative division (the state of São Paulo, the DRS-XIII, and the city of Ribeirão Preto). The maternal mortality rate (MMR) was calculated and presented through descriptive measures, graphs, and cartograms. Results The overall MMR observed for the city of Ribeirão Preto was of 39.1; for the DRS-XIII, it was of of 40.4; and for the state of São Paulo, it was of 43.8 for every 100 thousand live birhts. During this period, the MMR for the city of Ribeirão Preto ranged from 0% to 80% of the total maternal mortalities, and from 40.7% to 47.2% of live births in the DRS-XIII. The city of Ribeirao Preto had an MMR of 76.5 in 1998and 1999, which decreased progressively to 12.1 until the years of 2012 and 2013, and increased to 54.3 for every 100 thousand live births over the past 4 years. The state of São Paulo State had an MMR of 54.0 in 1998-1999, which varied throughout the study period, with values pregnancy of 48.0 in 2008-2009, and 54.1 for every 100 thousand live births in 2016-2017. Several times before 2015, the city of Ribeirão Preto and the DRS-XIII reached the Millennium Goals. Recently, however, the MMR increased, which can be explained by the improvement in the surveillance of maternal mortality. Conclusion The present study describes a sharp decline in maternal death in the region of Ribeirão Preto by the end of 2012-2013, and a subsequent and distressing increase in recent years that needs to be fully faced.
  • Disease Progression and Obstetric Outcomes of Women with Multiple Sclerosis at a Reference Center in Northeastern Brazil Original Article

    Barros, Gabrielle Maria Carvalho de; Oliveira, Bianca Etelvina Santos de; Oliveira, Gabriela Januário; Silva, Rômulo Kunrath Pinto; Cardoso, Thiago Nóbrega; Maia, Sabina Bastos

    Abstract in Portuguese:

    Resumo Objetivo Descrever os desfechos obstétricos de pacientes com esclerose múltipla (EM) e o impacto da gravidez e do período pós-parto na progressão da doença. Métodos Uma série de casos realizada entre dezembro de 2019 e fevereiro de 2020, que retrata gestações ocorridas entre 1996 e 2019. As pacientes incluídas neste estudo foram mulheres com EM, que realizam acompanhamento em um centro de referência em EM no Nordeste do Brasil, e que tiveram ao menos uma gestação após o início dos sintomas da EM, ou tiveram o primeiro surto da doença no ano posterior ao parto. Resultados No total, 26 mulheres e 38 gestações foram avaliadas – dentre as quais, 32 resultaram em partos, e 6, em abortamentos. Houve um aumento significativo na prevalência de surtos durante o pós-parto quando comparado com o período gestacional. Em 16 (42,1%) das gravidezes, houve exposição a terapias modificadoras da doença (TMDs) – 14 (36,8%) a β-interferona, e 2 (5,3%) a fingolimode. As taxas de abortamento, prematuridade e baixo peso ao nascer foram mais elevadas no grupo exposto às TMDs quando comparado com o não exposto. Conclusão Na amostra deste estudo, houve um aumento significativo na taxa de surtos da EM durante o período pós-parto quando comparado com o período gestacional. Além disso, a exposição às TMDs durante a gestação pode afetar os desfechos obstétricos das pacientes.

    Abstract in English:

    Abstract Objective To describe the obstetric outcomes of patients withmultiple sclerosis (MS) and the impact of pregnancy and the postpartum period on the progression of the disease. Methods A case series study performed between December 2019 and February 2020, reporting pregnancies occurred between 1996 and 2019. The subjects included were women with MS undergoing follow-up at an MS referral center in Northeastern Brazil, and who had at least one pregnancy after the onset of MS symptoms, or who had their first relapse in the first year after delivery. Results In total, 26 women and 38 pregnancies were analyzed - 32 of them resulted in delivery, and the remaining 6, in miscarriages. There was a significant increase in the prevalence of relapse during the postpartum period when compared with the gestational period. In 16 (42.1%) of the pregnancies, there was exposure to diseasemodifying therapies (DMTs) - 14 (36.8%), to interferon β, and 2 (5.3%), to fingolimod. Higher rates of abortion, prematurity and low birth weight were reported in the group was exposed to DMT when compared with the one who was not. Conclusion In the sample of the present study, there was a significant increase in the rate of MS relapse during the postpartum period when compared with the gestational period. Additionally, it seems that exposure to DMTs during pregnancy may affect the obstetric outcomes of the patients.
  • Postplacental Placement of Intrauterine Devices: Acceptability, Reasons for Refusal and Proposals to Increase its Use Original Article

    Kraft, Maria Beatriz de Paula Leite; Miadaira, Mariana; Marangoni, Marcos; Juliato, Cássia Raquel Teatin; Surita, Fernanda Garanhani

    Abstract in Portuguese:

    Resumo Objetivo Avaliar a taxa de aceitação do dispositivo intrauterino pós-placentário (DIUPP); os motivos de recusa e propor medidas que aumentem sua aceitação. Métodos Estudo de corte transversal realizado no Hospital daMulher da Universidade Estadual de Campinas, Campinas, SP, Brasil. O DIUPP foi oferecido amulheres admitidas em trabalho de parto que não apresentavam: infecções,malformação uterina, gravidez gemelar, parto prematuro e com idade mínima de 18 anos. Em caso de recusa, perguntou-se o motivo, e as respostas foram agrupadas em informações equivocadas sobre contracepção ou outros motivos. Considerou-se informação equivocada: medo de dor, sangramentos, falha da contracepção e prejuízo da fertilidade. Análises bivariadas foram realizadas. Resultados Entre 241 mulheres, a taxa de recusa foi de 41,9%. A desinformação correspondeu a 50,5% de todos osmotivos de recusa, que foram:medo da dor (39,9%); medo da falha da contracepção (4,9%); medo de sangramento (3,9%), medo de o dispositivo intrauterino (DIU) prejudicar a fertilidade (1,9%). Outros motivos de recusa atingem 49,5%. Parturientes com idade entre 18 e 27 anos recusaram o PPIUD com mais frequência devido a desinformação (67,4%), e as mais velhas (com idade entre 28 e 43 anos) recusaram com frequência devido a outros motivos (63,6%) (p=0,002). Houve diferença entre a idade média de quem recusou o PPIUD por desinformação (27,3 ± 6,4 anos) em comparação com outras razões (29,9 ± 5,9 anos), (p=0,017). Além disso, ambos os grupos apresentaram altas taxas de recusa por desinformação, de 67,4 e 36,4%, respectivamente. Conclusão A recusa do DIUPP foi alta, principalmente entre as mulheres jovens e por desinformação. Diante disso, é necessário o desenvolvimento de medidas educativas durante o pré-natal e aconselhar as mulheres sobre contracepção, saúde reprodutiva e gravidez indesejada.

    Abstract in English:

    Abstract Objective To evaluate the acceptability of postplacental placement of intrauterine devices (PPIUD), reasons for refusal and suggested policies to increase its use. Methods Cross-sectional study conducted at the Women Hospital of the Universidade de Campinas, Campinas, SP, Brazil. Postplacental placement of intrauterine devices was offered to women admitted in labor who did not present infections, uterinemalformation, twin pregnancy, preterm birth, and were at least 18 years old. In case of refusal, the parturient was asked to give their reasons and the answers were classified as misinformation about contraception or other reasons. The following were considered misinformation: fear of pain, bleeding, contraception failure and future infertility. Bivariate analysis was performed. Results Amongst 241 invited women, the refusal rate was of 41.9%. Misinformation corresponded to 50.5% of all refusals, and the reasons were: fear of pain (39.9%); fear of contraception failure (4.9%); fear of bleeding (3.9%); fear of future infertility (1.9%); other reasons for refusal were 49.5%. Parturients aged between 18 and 27 years old refused the PPIUD more frequently due to misinformation (67.4%), and older parturients (between 28 and 43 years old) refused frequently due to other reasons (63.6%) (p=0.002). Themean age of those who declined the PPIUD due to misinformation was 27.3 ± 6.4 years old, while those who declined for other reasons had a mean age of 29.9 ± 5.9 years old (p=0.017). Conclusion The refusal of the PPIUD was high, especially amongst young women and due to misinformation. It is necessary to develop educative measures during antenatal care to counsel women about contraception, reproductive health and consequences of unintended pregnancy.
  • Awareness about Vulvovaginal Aesthetics Procedures among Medical Students and Health Professionals in Saudi Arabia Original Article

    Iqbal, Shazia; Akkour, Khalid; Bano, Bushra; Hussain, Ghaiath; Elhelow, Manal Khalid Kamal Ali; Al-Mutairi, Atheer Mansour; Aljasim, Balqees Sami Khaza’l

    Abstract in English:

    Abstract Objective The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. Methods This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value<0.05. Results There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. Themajority of the participants considered that vaginal rejuvenation, “G-spot” augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds. Conclusion The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.
  • Switching of Hormone Therapies in Breast Cancer Women Original Article

    Medeiros, Luana Moreira de; Stahlschmidt, Rebeca; Ferracini, Amanda Canato; Souza, Cinthia Madeira de; Juliato, Cassia Raquel Teatin; Mazzola, Priscila Gava

    Abstract in Portuguese:

    Resumo Objetivo O objetivo do presente estudo foi analisar os motivos que levaram às mudanças no esquema hormonioterápico (HT) em mulheres com câncer de mama. Métodos Estudo transversal retrospectivo realizado no Hospital da Mulher de Campinas e consequente pesquisa de prontuários de mulheres diagnosticados com câncer de mama entre janeiro de 2012 e janeiro de 2017. Resultados De 1.555 mulheres em tratamento com HT, 213 (13,7%) mulheres tiveram HT alterado, tamoxifeno para anastrozol ou vice-versa. A maioria das mulheres incluídas no presente estudo que tiveram mudança de HT tinha > 50 anos, estava na pós-menopausa, era caucasiana e tinha pelo menos uma comorbidade. Os principais motivos de troca de HT foram devido a ’progressão da doença’, ocorrendo em 124 (58,2%) casos e a ’presença de efeitos colaterais’ (n = 65; 30,5%). Das mulheres que sofreram efeitos colaterais, 24 (36,9%) apresentaram comorbidades. Conclusão O presente estudo demonstrou uma baixa taxa na alteração de tamoxifeno para anastrozol. Entre as razõesmais comuns para alterar a HT estava a progressão da doença, que inclui recorrência do câncer, metástase ou aumento do tumor. Os efeitos colaterais foram a segunda causa e, além disso, a idade e as comorbidades foram fatores de risco para efeitos colaterais.

    Abstract in English:

    Abstract Objective The objective of the present study was to analyze the reasons that led to hormone therapies (HTs) regimen changes in women with breast cancer. Methods This was a retrospective cross-sectional study from a single-institution Brazilian cancer center with patient records diagnosed with breast cancer between January 2012 and January 2017. Results From 1,555 women who were in treatment with HT, 213 (13.7%) women had HT switched, either tamoxifen to anastrozole or vice-versa. Most women included in the present study who switched HT were > 50 years old, postmenopausal, Caucasian, and had at least one comorbidity. From the group with therapy change, ‘disease progression’ was reason of change in 124 (58.2%) cases, and in 65 (30.5%) patients, ‘presence of side effects’ was the reason. From those women who suffered with side effects, 24 (36.9%) had comorbidities. Conclusion The present study demonstrated a low rate of HT switch of tamoxifen to anastrozole. Among the reasons for changing therapy, the most common was disease progression, which includes cancer recurrence, metastasis or increased tumor. Side effects were second; furthermore, age and comorbidities are risk factors for side effects.
  • Comparison of Automated Breast Ultrasound and Hand-Held Breast Ultrasound in the Screening of Dense Breasts Original Article

    Philadelpho, Fernanda; Calas, Maria Julia Gregorio; Carneiro, Gracy de Almeida Coutinho; Silveira, Isabela Cunha; Vaz, Andréia Brandão Ribeiro; Nogueira, Adriana Maria Coelho; Bergmann, Anke; Lopes, Flávia Paiva Proença Lobo

    Abstract in Portuguese:

    Resumo Objetivo Comparar a ultrassonografia convencional das mamas (US) com a ultrassonografia automatizada das mamas (ABUS) no rastreio do câncer. Métodos Realizamos um estudo transversal com pacientes com mamas mamograficamente densas, sendo avaliadas pela US e pela ABUS. A US foi realizada por radiologistas e a ABUS por técnicos de mamografia e analisada por radiologistas especializados em mama. A classificação Breast Imaging Reporting and Data System (BIRADS) do exame e das lesões o tempo de leitura e de aquisição foram avaliados. A análise estatística foi realizada através de medidas de tendência central, dispersão e frequências, teste t de Student e regressão logística univariada, através do odds ratio, com intervalo de confiança de 95%, e com p<0,05 sendo considerado estatisticamente significante. Resultados Foram avaliadas 440 pacientes. Em relação às lesões, a US detectou 15 (7,7%) BI-RADS 2, 175 (89,3%) BI-RADS 3 e 6 (3%) BI-RADS 4, das quais 3 foram confirmadas, por biópsia, como carcinomas ductais invasivos e 3 falso-positivos. A ABUS identificou 12 (12,9%) BI-RADS 2, 75 (80,7%) BI-RADS 3 e 6 (6,4%) BI-RADS 4, incluindo 3 lesões detectadas pela US e confirmadas como carcinomas ductais invasivos, além de 1 carcinoma lobular invasivo e 2 lesões de alto risco não detectadas pela US. O tempo de leitura dos exames da ABUS foi estatisticamente inferior ao tempo do radiologista para realizar a US (p<0,001). A concordância foi de 80,9%. Um total de 219 lesões foram detectadas, das quais 70 por ambos os métodos, 126 observadas apenas pela US (84,9% não eram lesões suspeitas no ABUS) e 23 apenas pela ABUS. Conclusão Comparado à US, a ABUS permitiu adequado estudo complementar no rastreio do câncer de mamas heterogeneamente densas e extremamente densas.

    Abstract in English:

    Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p<0.05 considered of statistical significance. Results Atotal of 440 patientswere evaluated. Regarding lesions,HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p<0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS. Conclusion Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.
  • Comparison of Laboratory and Radiological Findings of Pregnant and Non-PregnantWomen with Covid-19 Original Article

    Ozer, Kadir Burak; Sakin, Onder; Koyuncu, Kazibe; Cimenoglu, Berk; Demirhan, Recep

    Abstract in English:

    Abstract Objective Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. Methods Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. Results Themean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when agewas compared between the groups, a statistically significant difference (p=0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p=0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p=0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 x 109/mcL and 232.00 ± 71.04 x 109/mcL respectively; p=0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p<0.05). Conclusion The laboratory findings and imaging studiesmay differ between pregnant and non-pregnant populations. It is important to properly interpret these studies. Future studies with a higher number of patients are required to confirm these preliminary data.
  • Vertical Transmission of SARS-CoV-2: A Systematic Review Systematic Review

    Barcelos, Ionara Diniz Evangelista Santos; Penna, Ivan Andrade de Araújo; Soligo, Adriana de Góes; Costa, Zelma Bernardes; Martins, Wellington Paula

    Abstract in Portuguese:

    Resumo Objetivo Avaliar a evidência disponível acerca da transmissão vertical do coronavírus da síndrome respiratória aguda grave 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, em inglês). Fontes de Dados Foi realizada uma busca eletrônica em 13 de junho de 2020 nas plataformas Embase, PubMed e “Scopus utilizando os seguintes termos de busca: (Coronavirus OU COVID-19 OU COVID19 OU SARS-CoV-2 OU SARS-CoV2 OU SARSCoV2) E (vertical OU pregnancy OU fetal). Seleção dos Estudos A busca eletrônica resultou em um total de 2.073 registros. Títulos e resumos foram revisados por dois autores (WPM, IDESB), que verificaram a ocorrência de duplicidade e utilizaram critérios preestabelecidos para o rastreamento (estudos publicados em inglês sem limitações quanto à data ou à situação da publicação). Aquisição dos Dados A extração de dados foi realizada de forma padrão, e a eligibilidade final foi definida poir meio da leitura do artigo completo. Foram coletados dados dos partos de casos com potencial transmissão vertical, bem como os principais achados e conclusões de revisões sistemáticas. Síntese dos Dados Foram revisados os 2.073 registros; 1.000 duplicatas e 896 registros claramente não elegíveis foram excluídos. Avaliamos os artigos completos de 177 registros, e identificamos apenas 9 casos de potencial transmissão vertical. O único caso com evidência suficiente de transmissão vertical foi relatado na França. Conclusão O risco de transmissão vertical pelo vírus SARS-CoV-2 é provavelmente muito baixo. Apesar de milhares de gestantes afetadas, identificamos apenas um caso que preencheu critérios suficientes para que fosse confirmado como um caso de transmissão vertical. Estudos observacionais bem desenhados que avaliem grandes amostras ainda são necessários para se determinar o risco de transmissão vertical, a depender da idade gestacional na infecção.

    Abstract in English:

    Abstract Objective The evaluation of the available evidence on vertical transmission by severe acute respiratory syndrome coronavirus 2 (SARS-CoV)-2. Data Sources An electronic search was performed on June 13, 2020 on the Embase, PubMed and Scopus databases using the following search terms: (Coronavirus OR COVID-19 OR COVID19 OR SARS-CoV-2 OR SARS-CoV2 OR SARSCoV2) AND (vertical OR pregnancy OR fetal). Selection of Studies The electronic search resulted in a total of 2,073 records. Titles and abstracts were reviewed by two authors (WPM, IDESB), who checked for duplicates using the pre-established criteria for screening (studies published in English without limitation regarding the date or the status of the publication). Data Collection Data extraction was performed in a standardized way, and the final eligibility was assessed by reading the full text of the articles. We retrieved data regarding the delivery of the potential cases of vertical transmission, as well as themain findings and conclusions of systematic reviews. Data Synthesis The 2,073 records were reviewed; 1,000 duplicates and 896 clearly not eligible records were excluded. We evaluated the full text of 177 records, and identified only 9 suspected cases of possible vertical transmission. The only case with sufficient evidence of vertical transmission was reported in France. Conclusion The risk of vertical transmission by SARS-CoV-2 is probably very low. Despite several thousands of affected pregnant women, we have identified only one case that has fulfilled sufficient criteria to be confirmed as a case of vertical transmission. Well-designed observational studies evaluating large samples are still necessary to determine the risk of vertical transmission depending on the gestational age at infection.
  • Evaluation of the Seroprevalence of Infectious Diseases in 2,445 in vitro Fertilization Cycles Short Communication

    Anjos, João Guilherme Grassi dos; Carvalho, Newton Sergio de; Saab, Karam Abou; Araujo, Edward; Kulak, Jaime

    Abstract in Portuguese:

    Resumo Objetivo Avaliar a soroprevalência de marcadores positivos para sífilis, vírus da imunodeficiência humana (HIV) I e II, vírus linfotrópicos de células T humanas (HTLV) I e II e hepatite B e C em mulheres submetidas a fertilização in vitro (FIV). Métodos Realizamos uma análise retrospectiva entre as pacientes submetidas a FIV, entre janeiro de 2013 e fevereiro de 2016, e que possuíam prontuários completos. Resultados Foram analisadas 1.008 pacientes submetidas a FIV, totalizando 2,445 ciclos. Duas pacientes (0,2%) apresentaram resultado positivo para HIV I e II, e nenhuma para HTLV I e II. Três pacientes (0,3%) apresentaram triagem positiva para sífilis, e duas (0,2%) apresentaram teste de pesquisa de anticorpos anti-HCV (anti-HCV) positivo. Um teste de antígeno de superfície do vírus da hepatite B (HbsAg) positivo foi observado em 4 pacientes (0,4%), enquanto 47 (4,7%) pacientes foram positivas para anticorpos IgG contra o antígeno de superfície da hepatite B (IgG anti-HbC), e apenas 1 (0,1%) foi positiva para anticorpos IgM contra o antígeno central da hepatite B (IgM anti-HbC). O teste de anticorpos contra hepatite B (anti-HbS) foi negativo em 659 pacientes (65,3%). Apenas 34,7% das pacientes tinham imunidade contra o vírus da hepatite B. Pacientes comresultado negativo anti-HbS erammais velhas do que aquelas com resultado positivo anti-HbS (36,3 versus 34,9; p<0,001). Conclusão Este estudo mostrou taxas de infecção inferiores às taxas brasileiras para as doenças estudadas em pacientes submetidas à FIV. Apenas alguns pacientes foram imunizados contra a hepatite B.

    Abstract in English:

    Abstract Objective To evaluate the seroprevalence of positive markers for syphilis, human immunodeficiency virus (HIV) I and II, human T cell lymphotropic virus (HTLV) I and II, and hepatitis B and C among women undergoing in vitro fertilization (IVF). Methods We conducted a retrospective analysis among patients who underwent IVF, between January 2013 and February 2016, and who had complete screening records. Results We analyzed 1,008 patients who underwent IVF, amounting to 2,445 cycles. Two patients (0.2%) tested positive for HIV I and II and none for HTLV I and II. Three patients (0.3%) had positive screening for syphilis, and two (0.2%) had positive hepatitis C antibody test (anti-HCV). A positive hepatitis B virus surface antigen (HbsAg) test was observed in 4 patients (0.4%), while 47 (4.7%) patients were positive for IgG antibody to hepatitis B core antigen (anti-HbC IgG), and only 1 (0.1%) was positive for IgM antibody to hepatitis B core antigen (anti-HbC IgM). The anti-HbS test was negative in 659 patients (65.3%). Only 34.7% of the patients had immunity against the Hepatitis B virus. Patients with an anti-HbS negative result were older than those with a hepatitis B test (anti-HbS) positive result (36.3 versus 34.9; p<0.001). Conclusion The present study showed lower infection rates than the Brazilian ones for the diseases studied in patients undergoing IVF. Only a few patients were immunized against hepatitis B.
  • Familial Chylomicronemia Syndrome-Induced Acute Necrotizing Pancreatitis during Pregnancy Case Report

    Arroyo, Julia Cristina Coronado; Zavaleta, Marcio José Concepción; Villasante, Eilhart Jorge García; Lam, Mikaela Kcomt; Urteaga, Luis Alberto Concepción; Gutiérrez, Francisca Elena Zavaleta

    Abstract in English:

    Abstract Acute pancreatitis is a rare condition in pregnancy, associated with a high mortality rate. Hypertriglyceridemia represents its second most common cause.We present the case of a 38-year-old woman in the 24th week of gestation with a history of hypertriglyceridemia and recurrent episodes of pancreatitis. She was admitted to our hospital with acute pancreatitis due to severe hypertriglyceridemia. She was stabilized and treated with fibrates. Despite her favorable clinical course, she developed a second episode of acute pancreatitis complicated by multi-organ dysfunction and pancreatic necrosis, requiring a necrosectomy. The pregnancy was ended by cesarean section, after which three plasmapheresis sessions were performed. She is currently asymptomatic with stable triglyceride levels. Acute pancreatitis due to hypertriglyceridemia represents a diagnostic and therapeutic challenge in pregnant women, associated with serious maternal and fetal complications. When primary hypertriglyceridemia is suspected, such as familial chylomicronemia syndrome, the most important objective is preventing the onset of pancreatitis.
  • Ex vivo Retrieval of Mature Oocytes for Fertility Preservation in a Patient with Bilateral Borderline Ovarian Tumor Case Report

    Carvalho, Bruno Ramalho de; Cintra, Geórgia Fontes; Franceschi, Taise Moura; Cabral, Íris de Oliveira; Resende, Leandro Santos de Araújo; Gumz, Brenda Pires; Pinto, Thiago David Alves

    Abstract in Portuguese:

    Resumo Relatamos um caso de obtenção ex vivo de óvulos, guiada por ultrassonografia, para preservação da fertilidade em uma mulher com tumor ovariano borderline bilateral, para quem a recuperação transvaginal convencional foi considerada insegura, devido ao aumento do risco de disseminação de célulasmalignas. Foi realizada estimulação ovariana com gonadotrofinas. A cirurgia foi agendada de acordo com a resposta ovariana à estimulação gonadotrófica exógena; após ooforectomia por laparoscopia, ~ 37 horas após a maturação folicular, procedeu-se à recuperação extracorpórea de oócitos. Umtotal de 20 folículos ovarianos foi aspirado e 16 complexos cumulus foramobtidos, resultando na vitrificação de 12 oócitos maduros e de 3 oócitos imaturos amadurecidos in vitro. Nosso resultado enfatiza a viabilidade da recuperação ex vivo de oócitos maduros após estimulação ovariana controlada para mulheres com alto risco de disseminação maligna pela captação oocitária realizada convencionalmente pela via transvaginal.

    Abstract in English:

    Abstract We report a case of ultrasound-guided ex vivo oocyte retrieval for fertility preservation in a woman with bilateral borderline ovarian tumor, for whom conventional transvaginal oocyte retrieval was deemed unsafe because of the increased risk of malignant cell spillage. Ovarian stimulation with gonadotropins was performed. Surgery was scheduled according to the ovarian response to exogenous gonadotropic stimulation; oophorectomized specimens were obtained by laparoscopy, and oocyte retrieval was performed ~ 37 hours after the ovulatory trigger. The sum of 20 ovarian follicles were aspirated, and 16 oocytes were obtained.We performed vitrification of 12 metaphase II oocytes and 3 oocytes matured in vitro. Our result emphasizes the viability of ex vivo mature oocyte retrieval after controlled ovarian stimulation for those with high risk of malignant dissemination by conventional approach.
  • Are Endocan Plasma Levels Altered in Preeclampsia? Letter to the Editor

    Lopes, Ana Cristina dos Santos; Martins, Suellen Rodrigues; Dusse, Luci Maria SantAna; Pinheiro, Melina de Barros; Alpoim, Patrícia Nessralla
  • Advanced Cervical Cancer: Leveraging the Historical Threshold of Overall Survival Letter to Editor

    Paulino, Eduardo; Melo, Andreia Cristina de
  • COVID-19 in Brazil: A Message to the World Letter to the Editor

    Carvalho, Bruno Ramalho de
  • HPV infection - Screening, diagnosis and management of HPV-induced lesions FEBRASGO POSITION STATEMENT

    Oliveira, Ana Katherine da Silveira Gonçalves de; Jacyntho, Claudia Marcia de Azevedo; Tso, Fernanda Kesselring; Boldrini, Neide Aparecida Tosato; Speck, Neila Maria de Góis; Peixoto, Raquel Autran Coelho; Zanine, Rita Maira; Melo, Yara Lucia Mendes Furtado de
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