Objectives: To evaluate the efficacy and safety of topical treatments and therapeutic techniques used to reduce the symptoms of Lichen Sclerosus (LS) and to improve the quality of life of women diagnosed with the condition. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A comprehensive search was conducted in the PubMed, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Clinical Trial Databases on June 18, 2025. Randomized clinical trials comparing topical interventions and therapeutic techniques for LS were included. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB 2.0). Results: A total of 2,240 articles were retrieved. Of these, 28 studies met the eligibility criteria and were included in the systematic review, comprising 1,054 participants. The mean age of patients ranged from 34 to 67 years. The most frequently used interventions were: laser therapy (Nd:YAG and CO₂), followed by clobetasol, hormonal treatments (testosterone and progesterone), tacrolimus, pimecrolimus, and phototherapy. Compared to other interventions (tacrolimus, phototherapy, progesterone, and testosterone), clobetasol proved to be superior or equally effective. Regarding laser therapy, the studies showed greater improvements in clinical scores, higher patient satisfaction, and better quality of life compared to clobetasol. However, in some studies, no statistically significant difference was observed when compared to placebo. Most of the included studies presented a low risk of bias. Conclusions: Clobetasol remains the most effective and safest treatment for LS. However, laser therapy and phototherapy have shown promising results, with good efficacy and patient acceptance, especially in refractory cases or in those intolerant to corticosteroids.

Introduction: Among the types of urinary incontinence (UI), stress urinary incontinence (SUI) is the most prevalent and, may be associated with anterior vaginal wall pelvic organ prolapse (POP). Pelvic floor muscle training (PFMT) has been the first-line recommendation to strengthen and increase the endurance of the pelvic floor muscles (PFM) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in general. Objective: To evaluate the effectiveness of PFMT on quality of life (QoL) and functionality in women with SUI and POP. Methods: A randomized controlled clinical trial. The sample consisted of 32 women diagnosed with SUI and anterior vaginal wall POP. Participants were assessed at three time points: baseline, immediately post-intervention, and one month after the final assessment, following the same protocol: assessment form, functional assessment of the pelvic floor muscles (using the Modified Oxford Scale and vaginal manometry), and administration of the following questionnaires: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire - Overactive Bladder (ICIQ-OAB), Pelvic Floor Distress Inventory (PFDI-20), World Health Organization Quality of Life (WHOQOL), Female Sexual Function Index (FSFI), and Patient Global Impression of Improvement (PGI-I). Participants were allocated into two groups: the PFMT group (GPFMT), which received supervised in-person PFMT (16 sessions, twice a week), and the control group (CG), which received informational material and guidance on UI and exercises to be performed at home. Results: Findings showed improvements in PFM function in both groups, with a 39.2% improvement in the GPFMT group and 13.6% in the CG. Participants in the GPFMT group also demonstrated positive impacts on quality of life, particularly in the physical, emotional, and social domains. Conclusion: The findings of this study suggest that supervised PFMT contributes more significantly to improvements in muscle functionality, reduction of urinary symptoms, and pelvic discomfort when compared to unsupervised home-based exercises. These results highlight the importance of physiotherapy as an effective conservative approach for women with stress urinary incontinence and anterior vaginal wall prolapse.

Human milk is also the recommended food for preterm newborns (gestational age below 37 weeks), as it is a complex fluid containing several bioactive factors, in addition to specific macro- and micronutrients appropriate to each stage of lactation. For low birth weight preterm newborns (LBW-PTN, below 1,800 g) it is even more relevant, given its effect on reducing severe morbidities that affect them due to the physiological fragility resulting from premature birth. Colostrum milk is recommended as an early oropharyngeal exposure for these newborns, but data in the literature are still scarce regarding the impact of nutritional therapy with donated human milk on nutritional outcomes of LBW-PTN. Thus, the aim of this study was to analyze the effect of therapy with donated human milk (colostrum + hypercaloric human milk) on growth outcomes and gastrointestinal complications in LBW- PTN admitted to the neonatal intensive care unit (NICU). To this end, we used two methodological models: Study 1, a systematic review and meta- analysis (CRD420251056373) on the effect of an exclusive human milk diet versus the use of human milk fortifiers and infant formulas based on bovine protein on the development of gastrointestinal complications in preterm infants. The review showed that feeding tolerance was similar between exclusive human milk diets and those supplemented with bovine milk-derived products. The meta-analysis for the outcome necrotizing enterocolitis (281 versus 214 participants) did not show a significant difference between groups (OR = 1.47; 95% CI: 0.80–2.72); however, the studies presented moderate heterogeneity and only two compared with the use of infant formula. Study 2 was a randomized controlled clinical trial with 94 LBW-PTN enrolled up to 96 hours postpartum or after 48 hours of initiation of enteral feeding, admitted to the NICU of a high-risk referral maternity hospital. After eligibility criteria, participants were randomly allocated in a 1:1 ratio to the control group (standard nutritional therapy with pasteurized human milk of transition or mature type + expressed mother’s own milk) and the intervention group (nutritional therapy with pasteurized colostrum-type human milk until reaching 100 ml/kg/day, followed by pasteurized hypercaloric milk + expressed mother’s own milk). LBW-PTN received the intervention until discharge from the NICU or until a change in specific diet prescription by the healthcare team. Data related to volume and type of pasteurized milk ingested, type of prescribed diet, anthropometric measurements, and duration of intervention were collected throughout the follow-up period. The primary clinical outcomes were weight-for-age gain velocity (g/kg/day and change in weight-for-age Z- score) from birth to the end of the intervention. Secondary outcomes were time to regain birth weight (days), length-for-age velocity (Z-score), presence of growth failure, extrauterine growth restriction, and length of stay in the NICU. Pearson’s chi-square test was used to analyze the association between categorical variables. The effect size for significant associations was assessed by calculating prevalence ratios (PR) and their 95% confidence intervals (95% CI). The clinical and anthropometric characterization of the groups showed similar profiles between them; however, the outcome related to weight gain velocity (g/kg/day) was higher in the intervention group (p < 0.006), demonstrating the positive impact of nutritional therapy with pasteurized colostrum-type and hypercaloric human milk on the growth of LBW-PTN.

It is known that the occurrence of maternal clinical conditions during pregnancy is a determining factor for premature birth, directly impacting fetal development. Preterm newborns (PTNBs) exposed to adverse contexts are more vulnerable to complications such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and extrauterine growth restriction (EUG), which can significantly compromise growth and development and trigger neonatal death. Despite the clinical relevance and prognostic potential of these morbidities, evidence exploring the relationship between the burden of maternal morbidities and the evolution of premature infants in the neonatal intensive care unit (NICU) is still scarce. Therefore, the objective of this study is to evaluate the relationship between the burden of maternal morbidities and the main clinical complications in PTNBs admitted to the NICU. This research was considered a prospective cohort study, including premature newborns admitted to a public maternity hospital and their mothers, from October 2021 to November 2023. Maternal data (age, morbidities during pregnancy) and data on the preterm newborn during their stay in the NICU (gestational age at birth, birth weight and weight at discharge, days of parenteral nutrition use, length of stay, and clinical outcomes) were collected. Data were analyzed using normality tests (Shapiro-Wilk) and association tests (Chi-square and Fisher's exact test), as well as non-parametric tests (Mann-Whitney and Kruskal-Wallis) for comparisons between groups, considering p<0.05 as the significance level. 160 mother-child pairs were included; the majority of postpartum women (72.5%) presented at least one morbidity, the most frequent being hypertensive syndromes of pregnancy (HSP) (42.5%) and urinary tract infection. (UTI) (28.7%). Among preterm newborns, we identified that 61.3% had more severe degrees of prematurity, 48% had a birth weight below 1500g, and 74.8% had adequate weight for corrected gestational age at NICU discharge. The prevalences of NEC were 6%, BPD 14%, UGIB 25.9%, and death 9.4%. No statistically significant association was found between the burden of maternal morbidities and the clinical outcomes evaluated. Furthermore, we found a significant association between maternal age and the presence and burden of morbidities (p < 0.001), with women aged 35 years or older showing a higher prevalence (91.5%) and a higher frequency of morbidity burden (40.4%). Final considerations: Despite the higher prevalence of maternal morbidities in pregnant women of advanced age (≥35 years), no significant association was found with neonatal outcomes. However, UTI was associated with shorter hospital stays and a lower incidence of bronchopulmonary dysplasia. This finding highlights the complexity of the relationship between maternal and neonatal outcomes, justifying further research.

Anger is a basic, adaptive, and inherent human emotion that, when expressed in a dysregulated manner, can lead to negative health impacts, making it a relevant---yet still under- explored---component of perinatal mental health. During the pregnancy-puerperal cycle, its manifestation is associated with impairments in maternal health and the mother-infant bond. Studies suggest a possible relationship between anger and adverse obstetric outcomes, such as prematurity and other complications, the etiologies of which remain partially unknown and are of high relevance to public health. Despite this, anger remains neglected in both clinical practice and scientific literature, reinforcing the need for investigations that evaluate its association with obstetric and perinatal complications. The objectives of the present study were to investigate the relationship between the expression of anger and the occurrence of prematurity, miscarriage or fetal death, newborn admission to the intensive care unit, birth weight, and the presence of maternal illnesses. This is a longitudinal study conducted with low-risk pregnant women treated at Family Health Units in the eastern zone of Natal/RN, aiming to analyze the expression of anger throughout the pregnancy-puerperal cycle and its relationship with sociodemographic, clinical, obstetric, and neonatal characteristics. Participants were followed at three distinct moments: up to the 19th gestational week, up to the 36th week, and in the postpartum period or following a miscarriage or fetal death. Anger expression was assessed using the State- Trait Anger Expression Inventory (STAXI-1), a validated instrument translated into portuguese. The results showed a predominance of young adult pregnant women with a high school education, a family income between one and three minimum wages, and a high percentage of unplanned pregnancies. No statistically significant association was observed between the expression of anger and adverse obstetric outcomes, such as prematurity, birth weight, and newborn admission to the intensive care unit, possibly due to the low absolute number of these events within the cohort. Furthermore, no consistent association was identified between most dimensions of anger and the occurrence of gestational hypertension or diabetes, a finding that partially diverges from literature based on non-pregnant populations.

Programmed cell death protein-1 (PD-1) inhibitors have been extensively investigated and established as a promising therapeutic strategy in the treatment of cervical cancer (CC), particularly as immune checkpoint inhibitors capable of restoring endogenous anti-tumor immunity. Pembrolizumab, a humanized monoclonal antibody that acts as an immune checkpoint inhibitor, received accelerated FDA approval in 2018 and subsequent expanded approvals for the treatment of recurrent or metastatic CC with positive PD-L1 expression. Phase III clinical trials have demonstrated substantial and clinically significant improvement in overall survival (OS) when pembrolizumab is combined with chemotherapy, with or without bevacizumab. The aim of this systematic review was to comprehensively evaluate the efficacy, safety, and certainty of evidence for pembrolizumab, alone or in combination with bevacizumab and chemotherapy, in the treatment of advanced, recurrent, or metastatic cervical cancer, with detailed subgroup analyses according to PD-L1 expression and concomitant bevacizumab use. A systematic review and meta-analysis of phase III randomized controlled trials (RCTs) was conducted in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with prospective registration in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024531233). Phase III RCTs comparing pembrolizumab-based regimens versus standard care/placebo were included. The databases searched were PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library (up to July 2025). The primary outcomes were overall survival (OS) and progression-free survival (PFS), expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Secondary outcomes included objective response rate (ORR), complete response (CR), partial response (PR), and adverse events (AEs) of any grade and grade ≥3. Certainty of evidence was systematically assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Four RCTs (n = 2,911 participants), including the paradigmatic KEYNOTE-826 and KEYNOTE-A18 trials, were analyzed. Pembrolizumab significantly improved OS (HR 0.66; 95% CI 0.59–0.73; I² = 12%; high certainty of evidence) and PFS (HR 0.65; 95% CI 0.59–0.71; I² = 8%; high certainty). Benefits were consistent and of clinically relevant magnitude across subgroups with PD-L1 combined positive score (CPS) ≥1 (subgroup HR 0.63) and ≥10 (subgroup HR 0.58), demonstrating benefit independent of PD- L1 expression level or concomitant bevacizumab use. Clinically significant increases in ORR (OR 1.74; 95% CI 1.47–2.05) and complete response rates (OR 1.61; 95% CI 1.27–2.05) were observed. The incidence of grade ≥3 adverse events was moderately elevated in the pembrolizumab group (79.1% vs. 72.7%; OR 1.42), predominantly hematologic toxicities, with a safety profile considered clinically manageable in the context of survival benefit. Pembrolizumab-based therapeutic regimens substantially and significantly improve overall survival and treatment response in advanced cervical cancer, with high- certainty evidence, establishing them as first-line standard of care in accordance with recent FDA approvals. These robust findings strongly support the integration of pembrolizumab into multidisciplinary treatment protocols, particularly for patients with PD-L1-positive cervical cancer, representing a significant milestone in the evolution of gynecologic oncology treatment.

Endometriosis is a complex condition characterized by significant symptoms and complications, such as chronic pelvic pain and infertility. Current therapeutic options, including medications and surgical procedures, often do not provide complete relief and may be associated with unwanted side effects. Objectives: 1) To evaluate the effectiveness of non-pharmacological methods in relieving chronic pelvic pain compared to placebo therapies in women with endometriosis. 2) To assess the effectiveness of transcranial direct current stimulation (tDCS) for pain relief in women with endometriosis. Methods: 1) A systematic review with meta-analysis was conducted. Searches were performed in the databases Web of Science, PubMed, Scielo, Embase, and Pedro. Randomized controlled trials using non-pharmacological therapies and assessing chronic pelvic pain as a primary outcome were included. The risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. 2) Ten sessions of tDCS were applied to 10 women, with 10 active and 10 sham treatments in the M1 area. Visual analog scale for pain and functional tests were applied before and after the intervention. Descriptive statistics and 2x2 ANOVA were used. Results: Nine studies were included, comprising 432 women aged 13 to 50 years. The analyzed interventions included acupuncture, yoga, integrative psychotherapy, aerobic training, cardiorespiratory training, telerehabilitation, and virtual reality. All studies reported a reduction in pain after the interventions compared to baseline. The intervention group demonstrated greater effectiveness in pain reduction compared to the control group, except in one study. Five studies showed a high risk of bias, while four showed a low risk. Secondary outcome analysis and meta-analysis will be conducted during the defense phase. In the clinical trial, there were no differences in sociodemographic data between groups. No differences were observed in pain levels or functional assessments before and after the intervention. Conclusions: The systematic review and meta- analysis will aid in understanding the most effective non-pharmacological therapies for pain relief in women with endometriosis, supporting the development of new research and public policies to ensure access to evidence-based therapies. The clinical trial remains preliminary and requires a larger sample size for more conclusive results.

Introduction: Preeclampsia (PE) is a pregnancy-specific disease that develops from the 20th week of gestation characterized by increased blood pressure (≥ 140 x 90 mmHg) accompanied by proteinuria and/or target organ dysfunction. PE is associated with both maternal and neonatal morbidity and mortality, being the main cause of elective prematurity in Brazil. Neonatal outcomes commonly related to PE are prematurity, low birth weight, respiratory distress syndrome (RDS), sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage. Objective: To evaluate neonatal outcomes, clinical, ultrasound, biochemical and hematological parameters of pregnant women with early and late PE. Method: This is a longitudinal, observational and prospective study in which 32 pregnant women diagnosed with PE, as well as their respective neonates, were allocated in two groups: early PE (n=21) and late PE (n=11). For the evaluation of biochemical and hematological parameters, fasting blood samples were collected from pregnant women. Maternal and neonatal data were also obtained from electronic medical records. Results: The early PE group had the lowest number of prenatal consultations (p = 0.032), higher values of maternal diastolic blood pressure at admission (p = 0.049) and maternal urea (p = 0.029), as well as lower gestational age (p = 0.004) and birth weight (p = 0.021), higher rate of admission to the neonatal intensive care unit (p < 0.001), sepsis (p = 0.014), SDR (p = 0.003) and need for ventilatory support (p = 0.027). Conclusion: Early pre-eclampsia has an important impact on neonatal outcomes.

Cancer is associated with high-risk HPV. E6/E7 oncoproteins are highly expressed in high-risk HPV. Self-collection is a screening method that allows women to collect their own samples for HPV detection, and has been considered a promising alternative to screening for cervical cancer. This study aimed to evaluate the association between HPV E6/E7 mRNA and cervical cancer in self-collected samples. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed in the PubMed, Embase, Scopus, Web of Science and LILACS databases, with no restrictions on language or publication period. Cross-sectional studies involving the detection of HPV E6/E7 mRNA in self-collected cervical cancer samples were included. Study selection and data extraction were conducted independently by two reviewers. Risk of bias assessment was performed using the Joanna Briggs Institute (JBI) tool for cross-sectional studies. This systematic review aims to assess whether mRNA expression of E6 and E7 oncoproteins via cervical self- collection can be used in cervical cancer screening.

The objective of this study is to evaluate the quality of life and pelvic floor muscle function in women undergoing surgery for isolated urinary incontinence and incontinence associated with bladder prolapse correction. A prospective cohort study was conducted with women who were indicated for pelvic organ prolapse correction surgery (POPg = 47) and those undergoing surgery for both prolapse and urinary incontinence (IU+POPg = 53). All participants were assessed before surgery (T1) and followed up at 3 months (T3), 6 months (T4), and 12 months (T5) postoperatively. The assessment included a sociodemographic data form, a functional examination of the pelvic floor muscles (vaginal manometry), and the application of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). An unpaired Student’s t-test was used to compare sociodemographic and clinical data, while a one-way repeated measures ANOVA was performed to assess differences in questionnaire scores and manometry across the four time points. The Bonferroni post-hoc test was applied when a statistically significant difference was identified. A significance level of 5% was adopted for all analyses. The results showed a similar improvement in urinary symptoms in both groups. However, women who underwent surgery exclusively for urinary incontinence demonstrated better pelvic floor muscle function (PFMF) over one year post-surgery. In conclusion, pelvic floor muscle function decreased after surgery, with greater impairment observed in those who underwent correction for both prolapse and urinary incontinence. Based on these findings, immediate postoperative pelvic floor muscle training is suggested.

Maintaining a healthy oral cavity contributes to good general health, however, periodontal disease and tooth decay are pathologies commonly present in pregnant women and may be associated with unfavorable gestational outcomes. Pathophysiology of these diseases in pregnant women. The objective of this work is to evaluate the impact of oral health and its risk factors on pregnant women attended at Maternidade Escola Januário Cicco (MEJEC). A cross-sectional study with a quantitative nature will be carried out with the objective of studying the possible variables associated with the development of periodontal diseases and dental caries, and the profile of apoptotic cells in pregnant women treated at MEJEC. It is considered that, by studying the activation pathways of inflammation and cell death generated in these conditions during pregnancy, we will be able to open several fronts for study and collaborate with informative and educational interventions that generate knowledge and benefits for the population. We also hope to contribute to the monitoring and evaluation of the oral health of study participants, directing referrals for comprehensive treatment of the oral cavity, thus generating numerous benefits for the mother-baby binomial.

Preeclampsia (PE) occurs in pregnancy with hypertension and proteinuria, or target organ failure, and is associated with maternal and fetal morbidity and mortality. Among the risk factors for PE is maternal obesity. In pathophysiology, vascular and placental inflammatory dysfunction occurs, altering serum and biophysical markers. Acetyl Salicylic Acid (AAS) can prevent the disease by reducing the inflammatory process. The objective of the study was to analyze, in pregnant women in the second trimester of pregnancy, whether the use of AAS interferes with the Doppler of the uterine arteries and serum PE markers, and observe how they behave in obese pregnant women. This was a cross-sectional study, involving 71 pregnant women between 20 and 24 weeks and 06 days of gestation, recruited in two municipalities in Rio Grande do Norte between December 2022 and October 2023. Questionnaires were applied to characterize the population; morphological ultrasound of the 2nd trimester with Doppler assessment of the uterine arteries and measurement of serum PlGF (Placental Growth Factor) levels. The data were tabulated in SPSS (Statistical Package for the Social Sciences – version 4.2.2) to perform descriptive analysis, Shapiro-Wilk test and Spearman correlation. The significance level was 5%. The average body mass index (BMI) of the sample was 31.02. 38 pregnant women confirmed the use of AAS and in this group the mean pulsatility index (PI) values of the uterine arteries were 1.03 and PlGF 307.80, and in those who did not use it, the values were 0.95 and 325. 3, respectively. In this study, using AAS did not contribute to reducing the PI of the uterine arteries and there was no significant difference in the mean PIGF. Larger studies are important to confirm these results. 

Understanding the intricate relationship between pregnancy and the pelvic floor is crucial to managing potential problems related to pelvic floor dysfunction during and after pregnancy. Appropriate prenatal care, including exercises and interventions to support pelvic health, can help mitigate complications and promote overall well-being for pregnant women. The objective of this case series was to analyze the function of the pelvic floor muscles of pregnant women after pelvic mobility exercises using surface electromyography (EMG). The methodology was a cross-sectional, case series observational study, which evaluated seven (7) pregnant women in the third trimester. Data collection consisted of functional assessment of the pelvic floor through surface electromyography, with the following protocol: thirty seconds of rest to record basal activity, three maximal voluntary contractions maintained for two seconds, with a one-minute interval between each one. and three sustained contractions, maintained for six seconds, with a one-minute interval between each one. After the evaluation, pelvic exercises of lateral hip tilt, pelvic antero- and retroversion and circumduction were performed and, subsequently, all were reevaluated by EMG following the same evaluation protocol. The collected data were analyzed using SPSS software, version 13.0. The results indicated a significant improvement in maximum voluntary contraction, in the adjusted mean variable (p 0.040). In the other parameters evaluated, although there was no significant statistical difference, the values found may indicate an improvement in the functionality of the pelvic floor muscles after pelvic movement exercise. The pelvic exercise applied in this series of cases caused changes in all variables evaluated in the studied group, considering the myoelectric response and the functionality of the pelvic floor muscles in pregnant women in the third trimester. Studies with a larger sample and higher level of evidence are needed to confirm these results.

Introduction: The gestational period is marked by physiological changes that seek to meet the demands of mother-baby interaction for the balanced development of the baby. A pregnancy accompanied by Diabetes Mellitus enhances oxidative stress mediated by the inflammatory response that culminates in the production of reactive oxygen and nitrogen species, generating a maternal and placental imbalance characterized by damaging molecules such as DNA and RNA. Therefore, the impact caused by Diabetes Mellitus on cells and its outcomes have been investigated in pregnant women. Objective: To analyze the cellular profile and characteristics together with the inflammatory process of Diabetes Mellitus during pregnancy in a teaching maternity hospital. Methodology: This is an observational and descriptive study, with a quantitative approach, operationalized in two stages: cross-sectional study and case-control study. 240 diabetic and 12 non-diabetic pregnant women were characterized sociodemographically. Of the 240 diabetic pregnant women, 23 were analyzed for the degree of apoptosis in the lymphocyte, monocyte and granulocyte populations of whole blood, incubated with the fluorochromes annexin V FIT-C and/or propidium iodide and characterized by Cytoflex flow cytometry (Beckman Coulter) for detection of apoptosis. Results: Of the population studied, 46.25% were between 30 and 39 years old, 57.08% were brown, 50% had a salary income ≤ 01 minimum wage, 57.08% had high school education, 62.92% lived in rural areas; 65.83% had sanitation, 97.92% had electricity and 71.25% lived on paved streets. 67.74% did not notice symptoms of diabetes before diagnosis, 77.41% were diagnosed during pregnancy, 57.14% had a family history of diabetes and 67.86% had a family history of hypertension. Of the 240 pregnant women, 79.17% had GDM, 5.83% had DM1 and 15.00% had DM2. In addition, 40.42% had hypertension and 19.58% reported having other associated comorbidities. The characterization of the cellular profile in the study population showed a greater quantity of live cells in the distribution of lymphocytes and granulocytes between the control population and women with GDM (p=0.001/p=0.04) and with DM1/DM2 (p=0.04). Also in the lymphocyte population, early apoptosis showed a greater statistical difference than late apoptosis. Necrosis showed a statistically significant difference between the control group and the group of women with GDM (p=0.03). Monocytes did not show a statistically significant difference between the groups regarding live cells in early and late apoptosis. The diabetic participants whose blood was analyzed were between the 12th and 38th gestational week and apoptosis was present in all of them. Final considerations: In general, there was a greater quantity of live cells in the control population when compared to the groups of pregnant women with diabetes in the lymphocyte and granulocyte population. In addition, the difference in the expression of apoptosis between the groups of women with GDM only and the group of women with type 1 and 2 diabetes was minimal. Therefore, regardless of the type of diabetes, the pregnant woman suffered cell loss throughout the pregnancy.

The immune response of pregnant women with COVID-19, as well as the histopathological changes in the placenta caused by the infection, have not yet been elucidated. The characterization of lymphocyte subpopulations and natural killer (NK) cells, via flow cytometry, in the peripheral blood of pregnant and postpartum women infected or not by SARS-CoV-2, together with placental histopathological analysis, can contribute with more evidence on the effects caused by COVID-19 during the puerperal pregnancy period. In this cross-sectional study, the peripheral levels of total T lymphocytes, TCD4+ lymphocytes (ThL), TCD8+ lymphocytes (TcL), B lymphocytes and NK cells, in pregnant and postpartum women with positive and negative PCR for SARS-CoV-2 were compared. In addition, a comparison of placental histopathological findings was performed, using the Hematoxylin/Eosin staining method, of part of the parturients included in the study. The collection of peripheral blood and placental tissue samples took place between May 2021 and March 2022, in a teaching hospital in the northeast region of Brazil. Immunophenotyping was performed in 99 women, of which 78 (78.8%) had a confirmed diagnosis of COVID-19. Pregnant women and postpartum women infected with SARS-CoV-2 had higher levels of cytotoxic T cells, median (ME) = 574.2; interquartile range (IIQ) = 382.4, when compared with uninfected patients, ME = 404.7; IIQ = 363.5); p = 0.032. Histopathological analysis was performed on 30 placentas, of which 10 parturients had a diagnosis of COVID-19 confirmed by PCR (33.3%). Results revealed higher levels of congestion, focal chronic villitis, and acute funisitis in placentas from COVID-19 positive parturients. Negative parturients had a higher percentage of intervillous hemorrhage with thrombus formation, dystrophic calcification, placental infarction except marginal and acute capsular deciduitis. However, there was no statistically significant difference between the groups, nor a predominant histopathological pattern in pregnant women infected by the virus in the sample studied for comparison of placental findings. Pregnant women and postpartum women with COVID-19 had significantly higher levels of cytotoxic T cells in peripheral blood, but there was no difference in placental histopathological findings, although the group with confirmed infection had a higher percentage of congestion, focal chronic vilitis and acute funisitis.

Introduction: Skin aging in women is mainly correlated with exposure to solar radiation with menopausal events, such as hypoestrogenism. In parallel with the increase in life expectancy, both are associated with the induction of oxidative stress, motivating the signs and symptoms of senescence. The development of phytotherapics based on polyphenols can minimize the unwanted effects of skin wear, highlighting flavonoids. Despite its probable beneficial potential, there are limitations in the literature. Objective: To develop a systematic review of clinical trials, addressing the effectiveness of polyphenol compounds in delaying skin aging in women, comparing oral and topical routes. Methodology: A literature search was carried out in the electronic databases MEDLINE (via PubMed), Cochrane, Embase and Web of Science, published between the years 2012 and 2022. Eligible studies were randomized, double-blind, controlled trials, with the exception of one study that did not include a comparator group. Studies were selected that evaluated the effectiveness of an isolated or combined herbal medicine, which reported the following outcomes: elasticity (R2) and roughness or volume of wrinkles (visiometer or Primos). Results: After retrieving the articles, 13 studies were selected, with a total number of participants ranging from 20 to 120 individuals, composed of healthy women aged between 30 and 65 years, with the predominant inclusion criterion being the presence of wrinkles (usually the Wrinkles score ≥ 3) and with intervention protocol applied on the face. Four studies with low risk of bias and high heterogeneity regarding the plants used were identified. Favorable results were shown in elasticity and roughness, being attested after eight weeks of topical administration, and twelve orally. Conclusion: We emphasize that herbal medicines based on polyphenols have a positive impact on skin elasticity and roughness. In addition to the biomolecule, we emphasize the importance of time and route of administration to achieve the expected effect, since the topical route revealed brevity in the response compared to the oral route. Furthermore, we identified in the literature the diversity of tested compounds and methodological weaknesses, making more methodologically consolidated tests necessary.

Preeclampsia (PE) for a long time was diagnosed based on the triad of edema, proteinuria and hypertension; with the advance of studies, edema and proteinuria became criteria related to severity and not necessarily to diagnosis, thus the presence of hypertension together with isolated proteinuria are not decisive criteria for the diagnosis of PE. In this sense, this study aimed at identifying the correlation between worsening of the clinical picture of pregnant women diagnosed with preeclampsia and neonates, considering that proteinuria is nowadays an unnecessary diagnostic criterion for the disease.

This is a longitudinal, prospective, observational study carried out from January to October 2022 at the Januário Cicco Maternity School. The study population consisted of 32 pregnant women and their newborns (NB), classified according to the assessment of qualitative proteinuria in the strip, being Proteinuria negative or traces (n=13) and Proteinuria ≥ 1+ (n=19). Blood samples were collected from fasting pregnant women in a tube without anticoagulant for biochemical evaluation (10ml), analyzed using the Dimension RxL equipment (Siemens, São Paulo, SP, Brazil) and collected (4ml) in a tube with anticoagulant ethylenediaminetetraacetic acid (EDTA) in order to assess hematological parameters, analyzed by Advia 2120i equipment (Siemens, São Paulo, SP, Brazil). Proteinuria was measured at admission by qualitative evaluation in isolated urine sample (Uri-Color Check reactive strip from WAMA Diagnóstica, São Carlos, SP, Brazil).

Data were collected from the electronic medical records of pregnant women and their respective neonates in the University Hospitals Management Application (AGHU). The distribution of continuous variables was assessed by the Shapiro-Wilk test, and all variables were considered nonparametric. Non-parametric data were 

analyzed by the Mann-Whitney test and correlated by Spearman. Regarding differences between categorical variables, these were tested by chi-square analysis.  The evaluations were performed using SPSS Statistics version 20.0 (IBM, New York, USA). P values lower than 0.05 were considered statistically significant.

 Among the results obtained we can highlight that 28 (87.5%) of the pregnant women were admitted to the high-risk sector, 12 (92.3%) from the negative or trace proteinuria group and 16 (84.2%) from the proteinuria ≥1+ group, the predominant route of delivery was cesarean section, most of the NB presented prematurity, low birth weight, and most of them required hospitalization (p=0.007). In addition, 15 (78.9%) RNs in the proteinuria ≥ 1+ group required ventilatory support (p=0.020). Differences were observed between groups regarding diastolic blood pressure at the time of delivery (p<0.018), uric acid (p<0.012), urea (p<0.030), AST (p<0.001), ALT (p<0.033), LDH (p<0.005), total protein (p<0.004), albumin (p<0.001). The main positive correlations observed were between maternal age and total proteins (r=0.404; p<0.024), birth weight and total protein (r=0.511; p<0.009) and LDH and AST (r=0.727;p=0.001), the negative correlations observed were blood pressure at delivery and total proteins (r=0.670; p=0.001), total proteins and AST (r=0.719;p=0.001), albumin and AST (r=0.728;p=0.001), Albumin and total proteins (r=0.882;p=0.001), urea and GI at birth (r=0.721;p=0.001), Urea and birth weight (r=0.667;p<0.001).Thus, proteinúria was associated to poorer mother and neonatal outcomes.

Introduction - Congenital heart defects are the most common congenital anomalies and account for 8% of infant mortality, causing a great impact on morbidity and mortality in the pediatric age group. However, in Brazil, underreporting of cardiac malformations suggests that the diagnosis is made late, which prevents early surgical treatment. In Rio Grande do Norte (RN) the dimension of this situation is unknown, requiring greater detail, so that public policies to reduce morbidity and mortality due to cardiac malformations can be implemented at the state level. Given this scenario, the objective of this study was to describe the prevalence of surgical congenital heart defects in children from the cases observed at Hospital Rio Grande, the only reference center in pediatric cardiac surgery in the state. Methodology - After approval by the Research Ethics Committee, a cross-sectional study was started with analysis of electronic medical records of patients with surgical congenital heart disease admitted to the state's pediatric cardiology ICU, which operates at Hospital Rio Grande, from October 2018 to December 2022. The collected data were analyzed, firstly, through descriptive statistics using the JAMOVI 2.3.21 software. The frequency of cases by municipality and Health Region (HR) was represented by maps, using the Qgis 3.22.6 software. A generalized linear model using binomial distribution was also performed. Results –There were 594 admissions of children, with a mean age at admission of 2 years and 1 month, with 86% of the procedures performed by the SUS. It was observed that 41.7% of the patients resided in the VII HR, which includes the state capital and adjacent municipalities. There was a higher prevalence of surgical congenital heart diseases in the Health Regions located in the territorial strip to the south of the state. There was a predominance of procedures classified as severity score RACHS-1 categories 2 (38.6%) and 3 (33.7%). There were 59 deaths, 77.9% of which were patients with cyanotic defects, with a mean age of 6.9 months. Higher mortality was observed in category 6 RACHS-1 procedures. Risk factors for postoperative death were length of stay in the ICU (p<0.001), level of surgical complexity (p<0.01), need for reoperation (p<0.005) and diagnosis of cyanotic heart disease (p<0.05). On the other hand, municipal HDI and distance to the service were not associated with risk of death. The total length of hospital stay was a protective factor for death. Evaluation of DATASUS data from 2019 to 2022 indicated a scenario of underreporting and deficit of surgical procedures in RN. Conclusion – The results found serve as potential support for the development and implementation of public policies that allow improving care for children with heart defect, from prenatal care to clinical and surgical treatment, in the state of RN and in other locations in Brazil. Furthermore, the finding of a specific territorial area with a higher prevalence of surgical congenital heart disease calls for further investigation into the genetic and environmental factors involved in the etiology of congenital heart defect in this region and in adjacent territorial areas of the semi-arid region in other states.

Background: Vulvodynia is described as pain in the vulvar region that impacts dramatically women's lives leading to sexual dysfunction, reduction in self-esteem and decrease in the quality of life. Neurologic (central and peripheral) mechanisms may be associated to this condition, thus systematic reviews focusing the efficacy and benefits of physiotherapy on this population are necessary for consolidated evidence to aid clinical practice. Objectives: To assess the efficacy of physiotherapy for vulvodynia. Methods: The present systematic review was designed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). PubMed, Embase, Scopus, Web of Science, SciELO, PEDro, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 2023. Two authors selected and extracted the data independently. The risk of bias was assessed using the Cochrane Risk of Bias tool (Rob 2). Due to the high heterogeneity presented between the studies, it was not possible to carry out the qualitative analysis. The results were presented in narratively. PROSPERO registration: CRD42023394207. Results: A total of 2.274 articles were retrieved from the databases. Seven studies met the criteria and were included in a systematic review, a total of 477 patients. The interventions included were electromyography biofeedback (n= 2), Transcutaneous electrical nerve stimulation TENS (n= 1), Transcranial direct current stimulation (TDSC) (n= 1), LowIntensity Shockwave (LISWT) (n= 1), physiotherapy treatment (n= 1), and pelvic floor exercise more behavioral modifications (n= 1). Of the seven studies present in the article, all evaluated pain reduction, five evaluated sexual function, and two evaluated qualities of life. All interventions were effective for the main outcomes; only the TDSC intervention had no significant difference when compared to the placebo group (Sham). Three studies presented a high risk of bias due to the lack of studies blinding. Conclusions: The studied interventions (electromyography biofeedback, TENS, Shockwave, physiotherapy, and pelvic floor exercise) seem to improve pain, sexual function, and quality of life. However, the heterogeneity of the studies prevented the metaanalysis. Additionally, well-designed trials are needed to improve the certainty of the evidence.

The high consumption of ultra-processed foods (UPF) has caused unfavorable effects on the health of the population and on the nutritional quality of the diet, however, there are still few studies that evaluate the impact of this consumption on metabolic outcomes of mother-child pairs in Gestational Diabetes Mellitus (DMG). Thus, the objective of the study was to evaluate the association between UPF consumption and the glycemic profile of women with GDM followed at a high-risk prenatal clinic and the occurrence of hypoglycemia in their newborns. The study was observational, longitudinal, prospective, cohort, with women diagnosed with GDM and their newborns. Data collection took place at least two times during prenatal care (during the 2nd and 3rd trimester of pregnancy) and immediately after birth. The assessment of food consumption was carried out according to the NOVA classification, with pairs grouped according to tertiles of energy contribution of UPF in the diet. The glycemic profile was assessed by fasting blood glucose, self-monitoring of capillary blood glucose (fasting, one hour after breakfast, one hour after lunch and one hour after dinner) in pregnant women, and according to capillary blood glucose levels in their newborns in the first 48 hours of life. Binary logistic regression analyzes were performed to evaluate the relationship between the increase in UPF participation, considering the highest tertile of UPF consumption as a reference category, in the control of glycemia in women with GDM at the time of the research and the occurrence of hypoglycemia in their neonates (&lt;50 mg/dL). 94 couples participated in the study, whose average caloric intake for women was 1,936 Kcal (1228 - 3124 Kcal), with 15% of the energy coming from UPF. Regarding the glycemic profile, 33.3% (n=30) and 52.3% (n=45) of them presented hyperglycemia in the second and third trimester of pregnancy, respectively. It was observed that UPF consumption had no significant association with maternal glycemic control, but showed a positive association with the occurrence of neonatal hypoglycemia (OR: 1.14; 95% CI: 1.037-1.262; p=0.007). Thus, the data suggest that the consumption of UPF can impact the occurrence of neonatal hypoglycemia in newborns of high-risk pregnant women, reinforcing the inclusion of guidelines for promoting healthy eating during pregnancy in nutritional assistance protocols for pregnant women with GDM.

Preeclampsia is a multifactorial and multisystem disease, specific to pregnancy, which manifests itself in previously normotensive pregnant women after the 20th week of pregnancy. Due to its systemic character, it is associated with maternal, perinatal and neonatal severity situations. Hypovitaminosis D is related to preeclampsia, increases the risk of premature birth, low birth weight, metabolic bone disease, bronchopulmonary dysplasia,  respiratory distress syndrome and neonatal sepsis, suggesting a protective role for this vitamin in the maternal-fetal interface. The aim of the study is to determine the association between 25-hydroxyvitamin D concentrations in pregnant women with preeclampsia and neonatal outcomes. So far, 7 pregnant women and their newborns have been included in the study, whose mothers, aged over 18 years, were previously diagnosed with preeclampsia and were followed up by the research group. Vitamin D was measured by chemiluminescence and data collected from electronic medical records. For statistical analysis, Spearman's aid was applied. For continuous variables, the median value was determined within the interquartile range referring to the 25th and 75th percentiles. P value < 0.05 was considered statistically significant. As the maternal profile data had a mean age of 28.4 years. The pregnant women's body mass index was classified as obese and the average time of sun exposure was 2.7 hours. The mean serum concentration vitamin D in pregnant women was 29.1 ng/mL. All newborns were born by cesarean delivery, 57.1% were female, gestational age and mean birth weight were 35.4 weeks and 2580g, respectively. All RNs were admitted to the MEJC. The mean length of stay in the NICU and in the other wards was 32.3 and 7.4 days, respectively. No deaths were recorded among maternal and neonatal participants. Due to insufficient sample size to date, it has not been possible to correlate maternal vitamin D levels with preeclampsia and neonatal deaths. Thus, the characterization of the sample was carried out.

Cervical cancer (CCU) is a public health problem that affects many women around the world and its etiology and pathogenesis are intrinsically linked to Human Papillomavirus (HPV), representing the fourth cause of death among women. Estimates report that about 80% of sexually active women will acquire an infection in their lifetime. It is known that the host's immune system, in most cases, is able to eliminate the HPV virus, but in some cases the patient will develop a persistent infection, which will culminate in the emergence of cervical cancer. Considering the importance of the immune system in this process, it is necessary to understand the cells and mechanisms involved. Therefore, evaluating the T helper cell pattern 1, 2 and 17 (Th1, Th2 and Th17) via cytokine quantification and associating the gene polymorphism of the IL-17-RA17 axis is the objective of the present study. This is a case-control observational study, with retrospective data and samples acquisition, having been collected from 2015 to 2019, and the study population consisted of 428 samples from a group of patients with indication of intraepithelial lesion and cervical cancer at the Cervical Pathology and Oncology outpatient clinic of the Januário Cicco Maternity School and the Hospital Luiz Antônio da Liga Contra o Câncer, they were stratified into 104 (24 %) with cervical cancer (CC), 125 (29 % ) with high-grade lesions, 86 (20%) with low-grade lesions, 104 (24%) were NILM, and 9 (3%) had indeterminate lesions, and the patients identified as NILM were classified as controls in this study. The execution of this work involves carrying out the gene polymorphism of IL17A and IL17RA in the following steps: DNA extraction and quantification; Polymerase Chain Reaction (PCR); and electrophoresis, while cytokine quantification was performed using the BD™ Cytometric Bead Array (CBA) Human Th1/Th2/Th17 cytokine kit. In our series, the data showed that there seems to be no association between the gene polymorphism of the IL-17-RA17 axis and the diagnosis of CC, in addition, in our study, the cytokines presented values below the detection limit, which can be justified by the action of HPV being a little cytopathic virus, imperceptible to the immune system.

Introduction: Newborns in critical condition hospitalized in Neonatal Intensive Care Units often need prolonged intravenous therapy for the recovery of their health and the peripherally inserted central catheter is the most indicated for the safe infusion of these solutions. However, the placement of this catheter in newborns can be difficult, becoming a challenge for the nursing team, predisposing the baby to multiple peripheral punctures, stress and pain. A particularly important aspect for this population is the lack of data on prediction equations for successful insertion of this device. Thus, this study aims to develop a prediction equation for success in peripherally inserted central catheter insertion in newborns. Methods: This is an observational, retrospective study carried out with the medical records of newborns admitted to the neonatal intensive care unit who used peripherally inserted central catheters between August 2018 and July 2021, whose sample was 359 newborns. Data on duplicated or incompletely and/or incorrectly completed newborns were excluded. Catheter insertion was considered successful when the tip of the catheter was inserted into the lower third of the superior vena cava from an upper extremity and into the upper third of the inferior vena cava from a lower extremity. Binary association tests and logistic regression were applied. Variables with p<0.05 remained in the final regression model. Results: 359 newborns were included between 23 and 41 weeks (median of 31 weeks and 4 days), 284 were on mechanical ventilation (invasive or non-invasive) and 70 progressed to successful PICC insertion. Being extremely premature, very premature and premature reduced the probability of PICC success by an average of 31.2% (95%CI: 25.5 to 38.1%), 21.4% (95%CI: 17.8 to 25. 7%) and 16.7% (95%CI: 14.0 to 19.8%) respectively. In addition, being on invasive and noninvasive ventilation reduced the probability of PICC success by an average of 82.4% (95%CI: 72.3 to 93.9%) and 85.3% (95%CI: 75.0 to 97.1%), respectively. The newborn's weight above 1500 grams and the access performed in the upper body region favored the success of the PICC in 2.5 and 2.93 times, respectively. Weight classification, gestational age, insertion site and being or not on mechanical ventilation were variables that were kept in the equation. The predictive equation for PICC success found was: OR PICC success = 0.178 x (IG classification) x (region) x (sup. vent.) x (weight classification). Conclusion: Gestational age classification and being on mechanical ventilation reduce the probability of successful introduction of PICC. While weight > 1500 grams and insertion of the catheter in the upper region increase the chance of success of the PICC. The predictive equation found is a practical and reproducible tool that can reduce the risk and complications related to unsuccessful catheter insertion.

The puerperium is a period of vulnerability due to the emotional and physical changes that occur after childbirth and that can influence a woman's quality of life. In this context, the decrease in physical andmental capacity associated with a persistent lack of energy, deficiencies in concentration, decreased rest and sleep time can favor the installation of physical and mental fatigue. The prevalence and incidence of postpartum fatigue has not been studied extensively and is considered an inevitable, temporary and frequently experienced symptom. This study aims to assess the level of fatigue of women in the immediate and late postpartum period and to associate it with sociodemographic and clinical factors. Through a prospective cohort study, 469 women were recruited from a public maternity hospital in the city of Natal-RN, from May to December 2021. The evaluations took place in the immediate postpartum period (between 24-48 hours) and in the puerperium. late (in the 1st and 3rd month after delivery). An evaluation form containing information on sociodemographic, clinical, gynecological-obstetric and newborn data was applied in the first evaluation along with three questionnaires for fatigue assessment: Global Short Form of selfreported global health from the Information System of Measurement of Outcomes by patient (PROMIS-GSF); multidimensional fatigue inventory (MFI) and fatigue pictogram. These data, with the exception of sociodemographic information, were applied one month after the assessment (AV2) and three months after delivery (AV3). Descriptive analysis of variables was used with mean, standard deviation, median, 25th and 75th percentiles, absolute and relative frequencies. Repeated measures ANOVA was used to compare the results of the three fatigue assessments. The multivariate model was adjusted for independent variables with significance ≤ 0.20 in the bivariate analysis and considering the clinical relevance for the occurrence of the outcome. The most prevalent age group was 26 to 34 years old, 59.5% completed elementary school, 47.6% had a salary income of up to one minimum wage and 76.1% reported having a partner. In obstetric information, 70.6% were multiparous with a median gestational age of 38 weeks, 60.5% had normal delivery, 95.7% breastfed after delivery, and 80.2% breastfed in past pregnancies. in the three evaluations showed a significant difference in the PROMIS-GSF (p < 0.01), general fatigue domains, physical fatigue and reduced motivation of the MFI (p < 0.01) and the fatigue pictogram (p < 0.01). In AV3, the PROMIS-GSF showed an association between fatigue and premature births (RR = 1.18; 95%CI: 1.02–1.37), absence of a support network (RR = 1.14; 95%CI: 1, 02–1.27), poor breastfeeding performance (RR = 1.16; 95%CI: 1.03– 1.31) and higher body mass index (BMI), (RR = 1.01; 95%CI: 1.005 –1.018). From the analysis of the results of this study, one can observe the presence of fatigue in the immediate postpartum period and its increase over three months postpartum. Prematurity, lack of a support network, poor performance in breastfeeding and higher BMI were factors associated with the persistence of fatigue in the late postpartum period.