Redução da morbi-mortalidade na síndrome de hellp completa com o uso de altas doses de dexametasona

Objective: To determine the clinical maternal and neonatal outcomes in HELLP syndrome patients treated with dexamethasone who either developed renal injury or renal insufficiency and to identify predictive values of urea and creatinine for the identification of subjects with HELLP syndrome at risk of developing renal insufficiency. Methods: Non-radomized intervention study of dexamethasone use in HELLP syndrome. A total of 62 patients were enrolled at Maternidade Escola Januário Cicco (MEJC). Patients received a total of 30 mg of dexamethasone IV, in three doses of 10 mg every 12 hours. A clinical and laboratory follow up were performed at 24, 48 and 72 hours. Patients were followed up to 6 months after delivery. Patients were grouped in accordance to renal function, i.e, normal and some type of renal lesion. Renal lesion was considered when creatinine was equal or greater than 1.3 mg/dl and diuresis less than 100 ml in 4 hours period and renal insufficiency was defined when dialysis was needed. Results: A total of 1230 patients with preeclampsia were admitted at MEJC. Of those 62 (5%) developed HELLP syndrome. There was no statistical difference in the groups with renal involvement or normal renal function with respect to the demographics, type of anesthesia used and delivery, and weight of the newborn. An improvement in the AST, ALT, LDH, haptoglobine, antithrombine, fibrinogenen and platelets was observed within 72 hours after dexamethosone use. There was a significant increase in the diuresis within the interval of 6 hours before the delivery and 24 hours after it. Of the 62 patients, 46 (74. 2%) had normal renal function and 16 (25.8%) evolved with renal lesion, with 5 (8.1%) needing dialysis. These 5 patients who received dialysis recovered the xi renal function. The delay in administering dexamethasone increased in 4.6% the risk of development of renal insufficiency. Patients with renal insufficiency had received significantly more blood products than subjects without renal lesion (p=0.03). Diuresis, leukocytes, uric acid, urea, creatinine were significantly different between the groups with normal renal function, renal lesion and renal insufficiency. The levels of creatinine 1.2mg/dl and uric acid 51mg/dl, at admission are predictive of subjects who will evolve with renal lesion (p<0.001). Maternal mortality was 3.2%. None of the subjects with renal insufficiency evolved with chronic renal disease. Conclusions: Dexamethasone in patients with HELLP syndrome seems to reduce significantly the hepatic microthrombosis and normalize hemostasis as seen by improvement of liver function. Renal injury can be considered, in HELLP syndrome, when creatinine levels are greater than 1.3 mg/dl and diuresis less than 100 ml/h in interval of 4 hours. The level of creatinine greater than 1.2 mg/dl and urea greater than 51mg/dl are predictive of subjects with HELLP syndrome who will develop renal injury. Patients who receive more red cell packs develop renal insufficiency. Finally, the delay in administering dexamethasone increases the risk of developing renal insufficiency

Escola e gênero : representações de gênero na escola

The study Escola e Gênero: representações de gênero na escola show us the social man made, starting of an analysis in the having fun time in the children´s life and how it´s an important aspect of the building childish universe simbolic. My analysis started in a children´s daily at school and how they noticed the play value od dominant society. Our propouse is think about the linking between ideology, representations and gender like the children´s knowledge in the school activities. The toy, an instrument which is noticed and exist in the funny activities, is full of cultural concepts of male and female parts. Your color, lines, functions and the way you manipulate is driven of gender cathegories. In the scool, the ideological concepts have it´s important way which is to domesticate the feelings, the desires; categorize and normalize them without be known by the educational employers. In the children´s education, the funny time is noticed by others ways and turned as important as others subjects. By the way it´s not noticed by the school, like another thing which isn´t a funny moment. And it´s exactly here in the school funny time, the school did your cultural power of separete the gender and your extencions, feed by the society, generaly, in favor of the man whose woman is your subordinate. This ways of analysis help the society and the school universe about the funny time e how they are important in the Man made life. And how the toys bring the concepts and addicted thinking, ideological which put the power in the stages, without equal, addicted feelings around the gender concepts. I read and used the theories of Kishimoto, Berger & luckmann, Brougère, Sousa Filho, Bourdieu, Badinter, Geertz, Grossi, Louro, Foucault, among others