Intervenções benéficas durante o parto para a prevenção da mortalidade materna

O caráter multifatorial das complicações e da mortalidade materna torna difícil e demorada a tarefa de seu controle a longo prazo. A atenção profissional à mulher gestante e/ou parturiente representa seguramente elemento chave para a obtenção de bons resultados, tanto maternos quanto perinatais. Partindo-se do pressuposto de que atenção médica profissional ao parto de maneira adequada tem a capacidade de diminuir a ocorrência de complicações associadas à morbidade e mortalidade materna, são apresentadas resumidamente as evidências sobre algumas intervenções incluídas nesta atenção. São enfocadas as evidências derivadas de estudos realizados com extremo rigor metodológico e científico, os ensaios controlados randomizados, sobre intervenções capazes de reduzir as complicações e a mortalidade materna. Estas principais intervenções referem-se basicamente a: atenção institucional ao parto, atendimento profissional capacitado, utilização de parteiras tradicionais em determinados contextos, uso de tecnologias apropriadas incluindo o partograma, local do parto, posição para o parto, uso de episiotomia, tipo de parto, uso de ocitócicos na fase ativa do parto, realização de esforços de puxo no período expulsivo, manejo da dequitação e profilaxia da hemorragia puerperal. Ainda que o efeito de prevenir mortes seja difícil de ser avaliado pela baixa freqüência, sua utilização de forma racional e padronizada, por meio de manuais e normatizações de condutas de serviços, tem um efeito positivo sobre a qualidade da atenção ao nascimento. Isso faz parte do contexto técnico e humano do direito que toda mulher tem ao melhor atendimento possível nesse momento tão especial de sua vida.

Expression of cell cycle regulatory proteins in epithelial components of dental follicles

Dental follicle is a component of tooth germs, which remain adjacent to the crown of unerupted or impacted teeth. Under the influence of pathologic changes, however, dental follicles that possess reduced epithelium can proliferate into stratified squamous epithelium as far as originate dental cysts. In order to clarify the role of apoptosis and cellular proliferation herein, expression of p53 and PCNA was examined in epithelial components of dental follicles associated with impacted third molars by means of immunohistochemistry. A total of 40 cases was included in this study being 22 cases with reduced epithelium and 18 cases with stratified epithelium. Expression of p53 expression was weak or not detected in dental follicles with reduced and stratified squamous epithelium. By contrast, PCNA positive cells were evidenced in basal and supra basal layers of the stratified squamous epithelium and in reduced epithelium of dental follicles, but without any significant statistically differences between them (P > 0.05). In conclusion, these data suggest that dental follicles possess proliferative activity as depicted by PCNA-positive nuclei in some epithelial cells. However, the biological behavior of dental follicles during the late stage of dental eruptive process may not be associated with deregulation of death and/or cell proliferation.

A function to predict the risk for death in the neonatal sepsis

This was a prospective study of 43 septic neonates at the NICU of the School of Medicine of Botucatu, São Paulo State University. Clinical and laboratory data of sepsis were analyzed based on outcome divided into two groups, survival and death. We calculated the discriminatory power of the relevant variables for the diagnosis of sepsis in each group, and using software for Discriminant Analysis, a function was proposed. There were 43 septic cases with 31 survivals and 12 deaths. The variables that had the highest discriminatory power were: n(o) of compromised systems, the SNAP, FiO2, and (A-a)O2. The study of these and others variables, such as birth weight, n(o) of risk factors, and pH using a Linear Discriminant Function(LDF) allowed us to identify the high-risk neonates for death with a low error rate (8.33%). The LDF was: F = 0.00043 (birth weight) + 0.30367 (n(o) of risk factors) - 0.1171 (n(o) of compromised systems) + 0.33223 (SNAP) + 2.27972 (pH) - 14.96511 (FiO2) + 0.01814 ((A-a)O2). If F > 22.77 there was high risk of death. This study suggests that the LDF at the onset of sepsis is useful for the early identification of the high-risk neonates that need special clinical and laboratory surveillance.

Hematological and biochemical profiles and histopathological evaluation of experimental intoxication by sodium fluoroacetate in cats

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

POST-MORTEM LESIONS of UROLITHIASIS IN A LESSER SEED FINCH (Sporophila angolensis).

Urolithiasis is a disease that despite being a commonly observed problem in veterinary practice is uncommon in birds. Such disease was not reported in passeriforms to date. Accordingly, the aim of the present article is to describe a case of urolithiasis in an adult female lesser seed finch (Sporophila angolensis) pet bird which presented abdominal distension, respiratory distress, and apathy prior to death. The bird had history of being fed with a diet rich in protein. After the bird death, a necropsy was conducted in order to determine the cause of death. At necropsy, accentuated ascites, hydropericardium, and ureteral stones in the left ureter could be grossly observed. Additional tests related with viral and bacterial microbiological testing and with the determination of calculi composition could not be performed since the owner did not consent with the procedures because of the cost. Since the bird was fed on a high protein diet, a relationship between the ureteroliths and dietary imbalance was suggested with participation of protein in calculi development by providing the organic nuclei. Additionally, we conclude that the presence of calculi in the ureter resulted in urinary flow blockage, ascites, and consequent acute respiratory failure due to filling of air sacs with liquid.

Replacing egg yolk with soybean lecithin in the cryopreservation of stallion semen

The objective of this study was to determine whether replacing the egg yolk with soybean lecithin in the Botu-Crio (R) cryodiluent would maintain the fertility of cryopreserved stallion sperm. Two experiments were performed to evaluate cell freezability. In experiment 1, sperm from 15 stallions were frozen in Botu-Crio (R) (BC) or Botu-Crio (R) which contained 45 g/L soybean lecithin (BCLS45) in place of the egg yolk. In experiment 2, we compared different concentrations of soybean lecithin: 0, 10.0, 12.5, 15.0, 17.5 and 20.0 g/L (BC, BCLS10, BCLS12.5, BCLS17.5 and BCLS20, respectively). In experiment 1, sperm frozen in BC and BCLS45 exhibited similar (P > 0.05) percentages of total motile sperm (61% and 61%, respectively); progressively motile sperm (27% and 27%, respectively) and sperm with intact plasma membranes (IMP; 53% and 57%, respectively). Similarly, sperm frozen in BC or BC containing any concentration of soybean lecithin maintained similar (P > 0.05) percentages of total motile sperm (61-68%) and progressively motile sperm (27-31%). In the first fertility trial, we used cryopreserved semen from a single stallion was inseminated into mares. The semen from the sperm that were frozen in BC diluent resulted in a higher fertility rate (66%, 16/24) compared to the sperm that were frozen in BCLS45 diluent (17%, 5/29; P < 0.01). Similarly, in a second fertility trial, the mares that were inseminated with the sperm that were frozen in BC diluent exhibited a higher fertility rate (66%, 16/24) compared to the mares that were inseminated with the sperm that were frozen in BCLS20 (40%, 10/25; Pc 0.05). Finally, in a third trial, the sperm that were frozen in BC resulted in a higher fertility rate in mares (75%, 18/24) compared to the sperm that were frozen in BCLS10 (41%, 10/24; P < 0.05). Although replacing the egg yolk in the BC cryodiluent with soybean lecithin provided similar laboratory results for stallion sperm, after cryopreservation, the sperm that was frozen with soybean lecithin in the diluent correlated with lower fertility rates. Based on these results, we concluded that the use of BCLS can be used as an alternative diluent for cryopreserving stallion sperm. However, the resulting reduced fertility rate is a matter of concern. Further studies are necessary to clarify the reasons for this decrease in fertility and to determine the optimal lecithin concentration for diluents to freeze stallion sperm. (C) 2011 Elsevier B.V. All rights reserved.

Logistic regression analysis of potential prognostic factors for pulmonary thromboembolism

Objective: To identify potential prognostic factors for pulmonary thromboembolism (PTE), establishing a mathematical model to predict the risk for fatal PTE and nonfatal PTE.Method: the reports on 4,813 consecutive autopsies performed from 1979 to 1998 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the 512 patients found with macroscopically and/or microscopically,documented PTE, data on demographics, underlying diseases, and probable PTE site of origin were gathered and studied by multiple logistic regression. Thereafter, the jackknife method, a statistical cross-validation technique that uses the original study patients to validate a clinical prediction rule, was performed.Results: the autopsy rate was 50.2%, and PTE prevalence was 10.6%. In 212 cases, PTE was the main cause of death (fatal PTE). The independent variables selected by the regression significance criteria that were more likely to be associated with fatal PTE were age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00 to 1.03), trauma (OR, 8.5; 95% CI, 2.20 to 32.81), right-sided cardiac thrombi (OR, 1.96; 95% CI, 1.02 to 3.77), pelvic vein thrombi (OR, 3.46; 95% CI, 1.19 to 10.05); those most likely to be associated with nonfatal PTE were systemic arterial hypertension (OR, 0.51; 95% CI, 0.33 to 0.80), pneumonia (OR, 0.46; 95% CI, 0.30 to 0.71), and sepsis (OR, 0.16; 95% CI, 0.06 to 0.40). The results obtained from the application of the equation in the 512 cases studied using logistic regression analysis suggest the range in which logit p > 0.336 favors the occurrence of fatal PTE, logit p < - 1.142 favors nonfatal PTE, and logit P with intermediate values is not conclusive. The cross-validation prediction misclassification rate was 25.6%, meaning that the prediction equation correctly classified the majority of the cases (74.4%).Conclusions: Although the usefulness of this method in everyday medical practice needs to be confirmed by a prospective study, for the time being our results suggest that concerning prevention, diagnosis, and treatment of PTE, strict attention should be given to those patients presenting the variables that are significant in the logistic regression model.

Structure of chorismate synthase from Mycobacterium tuberculosis

In bacteria, fungi, plants, and apicomplexan parasites, the aromatics compounds, such as aromatics amino acids, are synthesized through seven enzymes from the shikimate pathway, which are absent in mammals. The absence of this pathway in mammals make them potential targets for development of new therapy against infectious diseases, such as tuberculosis, which is the world's second commonest cause of death from infectious disease. The last enzyme of shikimate pathway is the chorismate synthase (CS), which is responsible for conversion of the 5-enolpyruvylshikimate-3-phosphate to chorismate. Here, we report the crystallographic structure of CS from Mycobacterium tuberculosis (MtCS) at 2.65 angstrom resolution. The MtCS structure is similar to other CS structures, presenting beta-alpha-beta sandwich structural topology, in which each monomer of MtCS consists of a central helical core. The MtCS can be described as a tetramer formed by a dimer of dimers. However, analytical ultracentrifugation studies suggest the MtCS is a dimer with a more asymmetric shape than observed on the crystallographic dimer and the existence of a low equilibrium between dimer and tetramer. Our results suggest that the MtCS oligomerization is concentration dependent and some conformational changes must be involved on that event. (c) 2005 Elsevier B.V. All rights reserved.

Ultrastructural Analysis of the Oocytes of Female Rhipicephalus sanguineus (Latreille, 1806) (Acari: Ixodidae) Ticks Subjected to the Action of Azadirachta indica A. Juss (Neem)

The present study provides ultrastructural information about the acaricidal effects of neem (Azadirachta indica A. Juss) on the ovaries of R. sanguineus engorged females. In general, the main damage caused in the oocytes was alteration in the shape of the cell and of the germinal vesicle, ring-shaped nucleolus, cytoplasmic vacuolation, and disorganization of the organelles and of the cell membranes (including the chorion), all of which indicate that these cells could be in the process of death. The results showed that azadirachtin would be an efficient acaricide agent for inhibiting and/or neutralizing the reproduction process of R. sanguineus females, impairing the reproductive ability of this species.

Molecular models of tryptophan synthase from Mycobacterium tuberculosis complexed with inhibitors

The development of new therapies against infectious diseases is vital in developing countries. Among infectious diseases, tuberculosis is considered the leading cause of death. A target for development of new drugs is the tryptophan pathway. The last enzyme of this pathway, tryptophan synthase (TRPS), is responsible for conversion of the indole 3-glycerol phosphate into indol and the condensation of this molecule with serine-producing tryptophan. The present work describes the molecular models of TRPS from Mycobacterium tuberculosis (MtTRPS) complexed with six inhibitors, the indole 3-propanol phosphate and five arylthioalkyl-phosphonated analogs of substrate of the a-subunit. The molecular models of MtTRPS present good stereochemistry, and the binding of the inhibitors is favorable. Thus, the generated models can be used in the design of more specific drugs against tuberculosis and other infectious diseases.

Recognition of altered segments in Brazilian Sign Language

The purpose of this study was to verify discriminative control by segments of signs in adolescents with deafness who use Brazilian Sign Language (BSL). Four adolescent with bilateral deafness, with 3 years of BSL teaching, saw a video presenting a children's tale in BSL. After showing accurate understanding of the story, participants saw another video of the same story with 12 signs altered in one of their segments (hand configuration, place of articulation, or movement). They apparently did not detect the alterations. However, when the signs were presented in isolation in a matching-to-sample test, they virtually always selected the picture corresponding to the unaltered signs. Three participants selected an unfamiliar picture in 50% or more trials with an altered sign as a sample, showing that they could detect the majority of the altered signs.

Advancements in the knowledge of induced tooth movement: idiopathic osteosclerosis, cortical bone and orthodontic movement

Movimentar ortodonticamente os dentes por áreas densas do trabeculado ósseo e pelas corticais pode requerer uma redução na intensidade e/ou na concentração das forças aplicadas. em parte, as forças ortodônticas aplicadas são dissipadas e reduzidas pela deflexão óssea que ocorre pelo discreto grau de elasticidade do tecido ósseo em condições de normalidade. Nas áreas de trabeculado denso e nas corticais, essa deflexão deve ser irrisória ou inexistente. Se não houver uma redução na intensidade das forças nessas regiões citadas, toda a força incidirá sobre a estrutura do ligamento periodontal, aumentando o risco de morte dos cementoblastos, hialinização e reabsorções radiculares. Novos trabalhos poderiam avaliar a prevalência dessas consequências em casuísticas selecionadas para essa finalidade, que, assim, deixariam de ser observações aleatórias.

Breastfeeding knowledge and practice of health professionals in public health care services

Objetivou-se avaliar conhecimentos e práticas sobre aleitamento materno de profissionais que atendem lactentes em unidades de atenção básica, ou maternidades públicas, de município do interior paulista, Brasil. É estudo epidemiológico, sendo a população composta por 89 enfermeiros e médicos. Suas respostas a um questionário estruturado foram analisadas no total e segundo o local de trabalho, aplicando-se o teste de diferença de proporções (qui-quadrado), considerando-se p<0,05 como nível crítico. Como parâmetros de acertos foram consideradas as recomendações do Ministério da Saúde. As diferenças significativas para conhecimentos e práticas, segundo o local de trabalho, foram restritas a alguns aspectos, com resultados discretamente melhores dos escores médios de acertos dos profissionais das unidades de atenção básica. Independente do local de trabalho, verificou-se desempenho regular e ruim em diferentes aspectos estudados, indicando que possíveis intervenções para a capacitação nessa temática deverão incluir profissionais de todos os níveis de atenção à saúde.

Description of an injury in a human caused by a false tocandira (Dinoponera gigantea, Perty, 1833) with a revision on folkloric, pharmacological and clinical aspects of the giant ants of the genera Paraponera and Dinoponera (sub-family Ponerinae)

A partir de um acidente causado pela picada de uma formiga falsa tocandira na mão de um pescador amador, os autores descrevem os achados clínicos locais observados, tais como edema, eritema e dor excruciante e a evolução do envenenamento, que cursou com fenômenos sistêmicos imediatos, como sudorese fria, náuseas, vômitos, mal estar, taquicardia e linfadenopatia axilar à esquerda. Após três horas, a dor intensa persistia e o paciente apresentou um episódio de hematoquesia, sem história anterior de enfermidades do trato digestivo, hematológicas ou vasculares. O uso de analgésicos (Tramal® 300 mg/dia), água quente e gelo não melhorou a dor, que arrefeceu em oito horas, tendo permanecido por cerca de 24 horas. São apresentados ainda os aspectos folclóricos, farmacológicos e clínicos relacionados às picadas de tocandiras.

EFFECTS OF CYCLOSPORINE-A IMMUNOSUPPRESSION ON PANCREATICODUODENAL TRANSPLANTATION IN ALLOXAN-DIABETIC RATS

1. Forty-five outbred Wistar rats were randomly assigned to three experimental groups: GI, 10 non-diabetic control rats; GII, 10 alloxan-diabetic control rats; GIII, 25 alloxan-diabetic tats which received pancreaticoduodenal transplantation (PDT) from normal Wistar donor rats and were immunosuppressed with cyclosporin A (Cy-A), 10 mg kg body weight-1 day-1, administered intraperitoneally for 30 days.2. In parallel, 15 alloxan-diabetic inbred Wistar rats received isogeneic PDT from normal Wistar donor rats.3. Cy-A prevented graft rejection in the 15 surviving animals in group III. These observations were confirmed by clinical and biochemical parameters (body weight, urine output, water and food intake, blood and urinary glucose and plasma insulin) and by histology and immunohistochemistry of the pancreas.4. However, Cy-A was associated with 60% of the infectious complications in transplanted rats leading to 40% mortality. Pulmonary infections were the main cause of death. There were no side effects of immunosuppression on the pancreas. Infections were not significant in inbred rats submitted to PDT.