Abstract Objective To evaluate the efficacy of the hormonal and nonhormonal approaches to symptoms of sexual dysfunction and vaginal atrophy in postmenopausal women. Data Sources We conducted a search on the PubMed, Embase, Scopus, Web of Science, SciELO, the Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, as well as on clinical trial databases. We analyzed studies published between 1996 and May 30, 2020. No language restrictions were applied. Selection of Studies We selected randomized clinical trials that evaluated the treatment of sexual dysfunction in postmenopausal women. Data Collection Three authors (ACAS, APFC, and JL) reviewed each article based on its title and abstract. Relevant data were subsequently taken from the full-text article. Any discrepancies during the review were resolved by consensus between all the listed authors. Data Synthesis A total of 55 studies were included in the systematic review. The approaches tested to treat sexual dysfunction were as follows: lubricants and moisturizers (18 studies); phytoestrogens (14 studies); dehydroepiandrosterone (DHEA; 8 studies); ospemifene (5 studies); vaginal testosterone (4 studies); pelvic floor muscle exercises (2 studies); oxytocin (2 studies); vaginal CO2 laser (2 studies); lidocaine (1 study); and vitamin E vaginal suppository (1 study). Conclusion We identified literature that lacks coherence in terms of the proposed treatments and selected outcome measures. Despite the great diversity in treatment modalities and outcome measures, the present systematic review can shed light on potential targets for the treatment, which is deemed necessary for sexual dysfunction, assuming that most randomized trials were evaluated with a low risk of bias according to the Cochrane Collaboration risk of bias tool. The present review is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

Resumo Objetivo Avaliar a eficácia das abordagens hormonais e não hormonais para os sintomas de disfunção sexual e atrofia vaginal em mulheres na pós-menopausa. Fontes de Dados Pesquisamos as bases de dados PubMed, Embase, Scopus, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), e Cumulative Index to Nursing and Allied Health Literature (CINAHL), assim como bancos de dados de ensaios clínicos. Foram analisados estudos publicados entre 1996 e 30 de maio de 2020. Nenhuma restrição de idioma foi aplicada. Seleção dos Estudos Foram selecionados ensaios clínicos randomizados que avaliavam o tratamento das disfunções sexuais em mulheres na pós-menopausa. Coleta de Dados Três autores (ACAS, APFC e JL), revisaram cada artigo com base em seu título e resumo. Os dados relevantes foram posteriormente retirados do texto completo do artigo. Quaisquer discrepâncias durante a revisão foram resolvidas por consenso entre todos os autores listados. Síntese dos Dados Ao todo, 55 estudos foram incluídos na revisão sistemática. As abordagens testadas para tratar a disfunção sexual foram: lubrificantes e hidratantes (18 estudos); fitoestrogênios (14 estudos); deidroepiandrosterona (DHEA; 8 estudos); ospemifeno (5 estudos); testosterona vaginal (4 estudos); exercícios para os músculos do assoalho pélvico (2 estudos); oxitocina (2 estudos);laser de CO2 vaginal (2 estudos); lidocaína (1 estudo), e vitamina E vaginal (1 estudo). Conclusão Identificou-se falta de coerência na literatura quanto aos tratamentos propostos e medidas de resultados selecionadas. Apesar da grande diversidade de modalidades de tratamento e medidas de resultados, esta revisão sistemática pode lançar luz sobre alvos potenciais para o tratamento, que é considerado necessário para a disfunção sexual, assumindo que a maioria dos estudos randomizados foi avaliada com baixo risco de viés de acordo com a ferramenta de avaliação de risco de viés de Cochrane Collaboration. Esta revisão tem cadastro no International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100488).

SUMMARY BACKGROUND: Although much has been studied about the SARS-Cov-2 virus, its effects, and the effectiveness of possible treatments, little is known about its interaction with other infectious diseases. OBJECTIVE: The aim is to study its clinical features and morbidity, and mortality outcomes of COVID-19 patients with HIV/AIDS coinfection. DATA SOURCES: MEDLINE, Web of Science, Embase, CINAHL, LILACS, Scopus, ClinicalTrials.gov, and Cochrane. STUDY ELIGIBILITY CRITERIA: Atudies in any language, published after 2019, were describing COVID-19 patients with HIV/AIDS. STUDY APPRAISAL: JBI Levels of Evidence, Joanna Briggs Institute. SYNTHESIS METHODS: As shown in the PRISMA flow diagram, two authors separately screened the search results from the obtained titles and abstracts. RESULTS: Chest CT was observed in patients with pneumonia by SARS-CoV-2 with findings of multiple ground-glass opacities (GGO) in the lungs, there is a need for supplemental oxygenation. One patient developed encephalopathy and complicated tonic-clonic seizures; four patients were transplanted (two, liver; two, kidneys), one patient developed severe SARS-CoV-2 pneumonia and 30 patients died (mortality rate, 11%). CONCLUSION: HIV did not show any relevance directly with the occurrence of COVID-19. Some studies suggest that HIV-1 infection through induction levels of IFN-I, may to some extent, stop the apparent SARS-CoV-2 infection, thus leading to undetectable RNA. Moreover, some authors suggest retroviral therapy routinely used to control HIV infection could be used to prevent COVID-19 infection.

Resumo Objetivo: Avaliar a influência da capacidade funcional (CF) sobre a qualidade de vida (QV) de mulheres sobreviventes de câncer de mama. Método: 400 mulheres sobreviventes de câncer de mama foram avaliadas -118 sem metástases, 160 com metástases locorregionais e 122 com metástases a distância. Para avaliar a capacidade funcional e a qualidade de vida, os seguintes instrumentos foram utilizados: European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), Breast Cancer-Specific (EORTC QLQ-BR23) e Karnofsky Performance Scale (KPS). Resultados: Mulheres com metástases a distância apresentaram menor KPS 75,3 (DP=12,5) (p<0,001). Quanto ao QLQ-C30, a média da escala funcional para pacientes com metástases a distância foi de 57 (DP=19) (p<0,001). A média da escala de sintomas das pacientes com metástase a distância foi de 37 (DP=20) (p<0,001). A escala de dor e fadiga apresentou a maior média nos grupos. Em relação à Escala Global de Saúde, as pacientes sem metástase tinham uma média de 62 (DP=24); com metástase locorregional, 63 (DP=21,4); e com metástase a distância, 51,3 (DP=24). Para o grupo com metástase a distância, 105 (87%) tiveram dor, e a média do KPS foi de 74 (DP=2,0) (p=0,001). Conclusão: O câncer de mama foi associado com diminuição da capacidade funcional, comprometendo a qualidade de vida das mulheres sobreviventes do câncer de mama com metástases locorregional ou a distância, quando comparadas àquelas sem metástases.

Summary Objective: To evaluate the influence of functional capacity (FC) and how it affects quality of life (QoL) in breast cancer survivors. Method: A total of 400 breast cancer survivors were studied - 118 without metastasis, 160 with locoregional metastasis and 122 with distant metastasis. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire--Core 30 (EORTC QLQ-C30), Breast Cancer-Specific (EORTC QLQ-BR23), and the Karnofsky Performance Scale (KPS) were used to evaluate FC and QoL. Results: Women with distant metastases presented lower KPS 75.3 (SD=12.5) (p<0.001). For QLQ-C30, the mean of the Functional Scale for patients with distant metastasis was 57 (SD=19) (p<0.001), and the mean of the Symptom Scale for patients with distant metastasis was 37 (SD=20) (p<0.001). Both the scales for pain and fatigue showed the highest mean in the groups. For the Global Health Scale, patients without metastasis scored a mean of 62 (SD=24) points, while those with locoregional metastases scored a mean of 63 (SD=21.4), and distant metastasis scored 51.3 (SD=24) points. In the group with distant metastases, 105 (87%) had pain, and the average KPS was 74 (SD=12.0) (p=0.001). Conclusion: Breast cancer was associated with decreased FC, compromised QoL in women with locoregional and distant metastases compared to those without metastasis.

RESUMO Objetivo: Avaliar a utilidade diagnóstica da expressão da proteína p16ink4a como marcador de adenocarcinoma do colo. Métodos: Em estudo transversal, a expressão de p16ink4a foi avaliada em 30 biópsias cervicais de pacientes diagnosticadas com adenocarcinoma invasivo de colo uterino provenientes de dois serviços de referência no Brasil, comparando com achados em 18 biópsias de pólipos endocervicais (grupo de controle). Para avaliar a performance do teste, foi utilizada tabela de contingência convencional, e para avaliar a concordância com o diagnóstico, foi aplicado o índice de Kappa (k). Resultados: No total, 66% dos casos de adenocarcinoma invasivo foram positivos para p16ink4a. Todos os pólipos adenomatosos foram negativos para p16ink4a. O marcador mostrou uma alta sensibilidade e alto valor preditivo negativo. O índice de Kappa foi bom para p16ink4a (k 1/4 0.6). Conclusion: Considerando a forte associação entre o marcador p16ink4a e o adenocarcinoma cervical, seu uso representa uma ferramenta importante para reduzir o risco de diagnóstico incorreto de adenocarcinoma e, por conseguinte, evitar o excesso de tratamentos.

ABSTRACT Objective: To evaluate the diagnostic utility of the p16ink4a protein expression as a marker for adenocarcinoma of the cervix. Methods: In a cross-sectional study, p16ink4a expression was evaluated in 30 cervical biopsies from patients diagnosed with invasive adenocarcinoma from 2 reference clinics in Brazil, and compared with 18 biopsies of endocervical polyps (control cases). The performance of the tests for p16ink4a was evaluated using a conventional contingency table, and the Kappa (k) index was used to evaluate the agreement of the marker with the tissue diagnosis. Results: In total, 66% of the invasive adenocarcinoma cases were positive for p16ink4a. All of the adenomatous polyps cases used as negative controls were shown to be negative for p16ink4a. The marker showed a high sensitivity and a high negative predictive value. The Kappa index was good for p16ink4a (k 1/4 0.6). Conclusion: Considering the strong association between the p16ink4a marker and the cervical adenocarcinoma, its use represents an important tool for reducing incorrect diagnoses of adenocarcinoma and thereby avoiding overtreatment.

Abstract The purpose of this study was to assess the risk of abnormal anal cytology in women with known genital squamous intraepithelial lesion. This study evaluated 200 women with and without genital squamous intraepithelial lesion who were recruited for anal Pap smears. Women who had abnormal results on equally or over atypical squamous cells of undetermined significance were classified as having abnormal anal cytology. A multiple logistic regression analysis (stepwise) was performed to identify the risk for developing abnormal anal cytology. Data were analyzed using the SPSS 20.0 program. The average age was 41.09 (±12.64). Of the total participants, 75.5% did not practice anal sex, 91% did not have HPV-infected partners, 92% did not have any anal pathology, and 68.5% did not have anal bleeding. More than half (57.5%) had genital SIL and a significant number developed abnormal anal cytology: 13% in the total sample and 17.4% in women with genital SIL. A significant association was observed between genital squamous intraepithelial lesion and anal squamous intraepithelial lesion (PR = 2.46; p = 0.03). In the logistic regression model, women having genital intraepithelial lesion were more likely to have abnormal anal Pap smear (aPR = 2.81; p = 0.02). This report shows that women with genital squamous intraepithelial lesion must be more closely screened for anal cancer.

OBJETIVO: Avaliar o impacto da prática de atividade física na qualidade de vida de mulheres de meia idade. MÉTODOS: Estudo de base populacional e corte transversal, que incluiu uma amostra estratificada de 370 mulheres de meia idade entre 40 a 65 anos, recrutadas a partir de uma população de 20.801 mulheres atendidas no período de um ano nas redes básicas de saúde, inseridas nos quatro distritos (Norte, Sul, Leste e Oeste) que compõem o sistema de saúde da cidade de Natal, Rio Grande do Norte, de junho a setembro de 2011. O cálculo da amostra teve por base um nível de confiança de 95%, com poder do teste de 80%, erro de estimativa de 5% e considerou-se a proporção de pacientes classificadas com qualidade de vida adequada (indicador >26) da amostra piloto. Os dados foram coletados enquanto as mulheres aguardavam na sala de espera para a consulta de rotina. Para avaliar a qualidade de vida geral, utilizou-se a versão abreviada do WHOQOL (WHOQOL-Bref-WHO Quality of Life - BREF), e sua relação com os sintomas do climatério foi avaliada por meio do Menopause Rating Scale (MRS). O nível de atividade física foi avaliado pelo questionário International Physical Activity Questionnaire (IPAQ), versão curta, semana usual. Para obter-se a classificação dos níveis de atividade física, utilizaram-se três categorias: sedentária, moderadamente ativa e muito ativa. A análise estatística foi realizada utilizando o programa estatístico Minitab, versão 16. RESULTADOS: A média de idade das mulheres foi de 49,8 anos (±8.1), foram predominantemente caucasianas (72,7%), casadas (61,6%), não fumantes (93,5%) e com o Ensino Médio completo (47,8%). Considerando os domínios presentes no WHOQOL-Bref para avaliar qualidade de vida, os escores foram significativamente diferentes entre os grupos de mulheres sedentárias, moderadamente ativas e muito ativas (p<0,01). Em relação à atividade física e aos sintomas do climatério, foram observadas diferenças significativas para todos os domínios: psicológico (p<0,01), somático-vegetativo (p<0,01) e urogenital (p<0,01). CONCLUSÕES: A prática de atividade física melhora significativamente a qualidade de vida das mulheres de meia idade.

PURPOSE: To evaluate the influence of physical activity on the quality of life of middle-aged women. METHODS: A population-based cross-sectional study was conducted on 370 women aged 40 to 65 years-old recruited from a population-based sample. Enrollment took place in Basic Health Units in each health district of the city (North, South, East, and West) from June to September 2011. According to the Municipal Health Department of the City, 20,801 women were assisted at the Basic Health Units during a one-year period. The sample size calculation was stratified by district and based on a 95% confidence level with a power of 80%, as well as an error estimate of 5% and it was considered proportional to the number of patients classified as having adequate quality of life (indicator >26) in the general population. Data were collected while women waited for their routine appointment at the Health Unit. WHOQOL-Bref was used to evaluate the quality of life, and menopause rating scale (MRS) was used to determine climacteric symptoms. The level of physical activity was assessed by means of the International Physical Activity Questionnaire (IPAQ). To obtain the classification of PA levels, we used three categories: sedentary, moderately active, and very active. Statistical analysis was performed using the Minitab software, version 16. RESULTS: The mean age of the subjects was 49.8 years-old (±8.1) and they were predominantly Caucasian (72.7%), married (61.6%), non-smokers (93.5%), and had High School education (47.8%). Using the WHOQOL, mean scores were found to be significantly different between the groups (low, moderate, and vigorous physical activity), classified according to the domains of quality of life (p<0.01). Concerning physical activity and climacteric symptoms, significant differences were found for all domains: psychological (p<0.01), vegetative-somatic (p<0.01), and urogenital (p<0.01). CONCLUSIONS: Physical activity improves quality of life in middle-aged women.