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.

Elevated progesterone concentrations enhance prostaglandin F-2 alpha synthesis in dairy cows

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Prolonged interval between parturition of normal live pups in a bitch

On day 64 after artificial insemination, a six-year-old primiparous briard bitch whelped three live pups between 05.00 and 08.00. It was presented at 11.00 on the same day with failure to complete parturition. on ultrasound examination, a normal live fetus was observed and the bitch was treated with oxytocin three times during the day (1(.)0, 2(.)0 and 2(.)0 iu intramuscularly), with no effect. The following day, a higher dose of oxytocin (5(.)0 iu) was administered intramuscularly at 11.00, after a uterine ultrasound examination confirmed viability of the fetus. At 18.00 of the same day, the bitch whelped the fourth normal live pup, 37 hours after initiation of parturition and 34 hours after expulsion of the last fetus. Effectiveness of oxytocin and normal versus prolonged parturition due to uterine inertia are discussed.

Water deprivation and the double- depletion hypothesis: common neural mechanisms underlie thirst and salt appetite

Water deprivation-induced thirst is explained by the double-depletion hypothesis, which predicts that dehydration of the two major body fluid compartments, the extracellular and intracellular compartments, activates signals that combine centrally to induce water intake. However, sodium appetite is also elicited by water deprivation. In this brief review, we stress the importance of the water-depletion and partial extracellular fluid-repletion protocol which permits the distinction between sodium appetite and thirst. Consistent enhancement or a de novo production of sodium intake induced by deactivation of inhibitory nuclei (e.g., lateral parabrachial nucleus) or hormones (oxytocin, atrial natriuretic peptide), in water-deprived, extracellular-dehydrated or, contrary to tradition, intracellular-dehydrated rats, suggests that sodium appetite and thirst share more mechanisms than previously thought. Water deprivation has physiological and health effects in humans that might be related to the salt craving shown by our species.

Role of serotonergic 5-HT1A and oxytocinergic receptors of the lateral septal area in sodium intake regulation

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

On a possible dual role for the lateral septal area 5-HT1A receptor system in the regulation of water intake and urinary excretion

The 5-hydroxytryptamine (5-HT)(1A) receptor system plays a prominent role in a variety of physiological functions and behavior and regulation of this responsiveness of the receptor system has been implicated in the central regulation of water intake and urinary excretion. The lateral septal area (LSA) exhibits a high density of 5-HT1A receptors, as well as a subpopulation of oxytocin (OT) receptors. Here we report the effects of pMPPF (a selective 5-HT1A antagonist), d(CH2)(5)[Tyr(Me)(2)Thr(4), Orn(5), Tyr(NH2)(9)]-vasotocin (an OT antagonist), and that 5-HT1A receptor system is regulated as a consequence of activation of the Na+ channel by veratridine. Cannulae were implanted into the LSA of rats to enable the introduction of the drugs. Injections of 8-OH-DPAT (a 5-HT1A agonist) blocked water intake and increased urinary excretion, while pMPPF or the OT antagonist injected bilaterally before 8-OH-DPAT blocked its inhibitory effect on water intake and its diuretic effect. In contrast, increases in extracellular sodium levels induced by the sodium channel modulator, veratridine, enhanced 5-HT1A responsiveness for water intake and reduced the diuretic effects induced by 8-OH-DPAT. These trials demonstrated that the responsiveness of the 5-HT1A receptor system in the LSA can be enhanced or depressed as a consequence of an induced rise in extracellular sodium. (C) 2010 Elsevier B.V. All rights reserved.

Activation of the serotonergic 5-HT1A receptor in the paraventricular nucleus of the hypothalamus inhibits water intake and increases urinary excretion in water-deprived rats

The paraventricular nucleus (PVN) may be considered as a dynamic mosaic of chemically-specified subgroups of neurons. 5-HT1A is one of the prime receptors identified and there is expressed throughout all magnocellular regions of the PVN. Several reports have demonstrated that a subpopulation of the magnocellular neurons expressing 5-HT1A receptors are oxytocin (OT) neurons and activation of 5-HT1A receptors in the PVN increases the plasma OT. Increasing evidence shows that OT inhibits water intake and increases urinary excretion in rats. The aim of this study was to investigate the role of serotonergic 5-HT1A receptors in the lateral-medial posterior magnocellular region of the PVN in the water intake and diuresis induced by 24 h of water deprivation. Cannulae were implanted in the PVN of rats. 5-HT injections in the PVN reduced water intake and increased urinary excretion. 8-OH-DPAT (a 5-HT1A agonist) injections blocked the water intake and increased urinary output in all the periods of the observation. pMPPF (a 5-HT1A antagonist) injected bilaterally before the 8-OH-DPAT blocked its inhibitory effect on water intake and its diuretic effect. We suggest that antidipsogenic and diuretic responses seem to be mediated via 5-HT1A receptors of the lateral-medial posterior magnocellular region of the PVN in water-deprived rats. (C) 2008 Elsevier B.V. All rights reserved.

Moxonidine into the lateral parabrachial nucleus reduces renal and hormonal responses to cell dehydration

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Central nitrergic system regulation of neuroendocrine secretion, fluid intake and blood pressure induced by angiotensin-II

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influência do transporte e mudança de local de manejo nas variáveis fisiológicas e produtivas de cabras Alpinas

Estudaram-se o efeito do transporte e a mudança de local de manejo sobre a produção e a composição do leite e sobre as variáveis fisiológicas, utilizando-se 12 cabras da raça Alpina em final de lactação. Semanalmente, foram mensuradas a produção e composição do leite e a contagem de células somáticas, além do volume do leite residual após administração de ocitocina. Foram colhidas amostras de sangue para dosagem hormonal (cortisol) e enzimática (glicose) no plasma no dia do transporte: antes (7h10min) e após (8h20min, 8h30min e 10h30min) o transporte. Nas três semanas subsequentes ao transporte, também foram colhidas amostras de sangue às 8h20min. Obtiveram-se teores mais elevados (P<0,05) de cortisol e glicose após o transporte e a mudança de local de manejo, e menor produção de leite (P<0,05) um dia após o evento. Porcentagem de gordura (P<0,05) e contagem de células somáticas apresentaram diferenças significativas (P<0,05) após o transporte. Os resultados permitem concluir que o transporte é um agente estressor que pode, momentaneamente, influenciar a produção animal.

Serotonergic mechanisms of the lateral parabrachial nucleus in renal and hormonal responses to isotonic blood volume expansion

This study investigated the involvement of serotonergic mechanisms of the lateral parabrachial nucleus (LPBN) in the control of sodium (Na+) excretion, potassium (K+) excretion, and urinary volume in unanesthetized rats subjected to acute isotonic blood volume expansion (0.15 M NaCl, 2 ml/100 g of body wt over 1 min) or control rats. Plasma oxytocin (OT), vasopressin (VP), and atrial natriuretic peptide (ANP) levels were also determined in the same protocol. Male Wistar rats with stainless steel cannulas implanted bilaterally into the LPBN were used. In rats treated with vehicle in the LPBN, blood volume expansion increased urinary volume, Na+ and K+ excretion, and also plasma ANP and OT. Bilateral injections of serotonergic receptor antagonist methysergide (1 or 4 mu g/200 eta 1) into the LPBN reduced the effects of blood volume expansion on increased Na+ and K+ excretion and urinary volume, while LPBN injections of serotonergic 5-HT2a/HT2c receptor agonist, 2.5-dimetoxi-4-iodoamphetamine hydrobromide (DOI;1 or 5 mu g/200 eta 1) enhanced the effects of blood volume expansion on Na+ and K+ excretion and urinary volume. Methysergide (4 mu g) into the LPBN decreased the effects of blood volume expansion on plasma ANP and OT, while DOI (5 mu g) increased them. The present results suggest the involvement of LPBN serotonergic mechanisms in the regulation of urinary sodium, potassium and water excretion, and hormonal responses to acute isotonic blood volume expansion.

Produção de leite, leite residual e concentração hormonal de vacas Gir × Holandesa e Holandesa em ordenha mecanizada exclusiva

In a machine milking system in which calves were not present, oxytocin concentration (OT), cortisol release (CORT), milk yield and residual milk were evaluated for cows of three genetic groups: 1/2Gir x 1/2Holstein (n=6, genetic group F2), 1/4Gir x 3/4Holstein (n=6, genetic group F3) and Holstein (n=6, genetic group H). Group H had higher milk yield than groups F2 and F3, whereas OT was similar among groups. The increase in OT during milk-ing was greater for H and F3 than for F2. Residual milk for F2 was' higher than for F3 and H. The CORT for F2 was higher than for cows of the other two genetic groups. Cows from F2 and F3 were more stressed than H cows during machine milking, but the Gir x Holstein groups did release suffficient OT to induce an effective milk letdown response.

Effectiveness and safety of a new vaginal misoprostol product specifically labeled for cervical ripening and labor induction

Objective. The purpose of this study was to evaluate the effectiveness and safety of misoprostol in two different formulations: vaginal tablets of 25 mu g and one-eighth of a 200-mu g oral tablet, also administered intravaginally, for cervical ripening and labor induction of term pregnancies with an indication for that. Methods. A single-blind, randomized, controlled clinical trial was carried out in 120 pregnant women who randomly received one of the two formulations. The main dependent variables were mode of delivery, need for additional oxytocin, time between beginning of induction and delivery, perinatal results, complications, and maternal side effects. Student's t, Mann-Whitney, chi(2), Fisher's Exact, Wilcoxon and Kolmogorov-Smirnoff tests, as well as survival analysis, were used in the data analysis. Results. There were no significant differences between the groups in terms of general characteristics, uterine contractility, and fetal well-being during labor, cesarean section rates, perinatal outcomes, or maternal adverse events. The mean time between the beginning of cervical ripening and delivery was 31.3 h in the vaginal tablet group and 30.1 h in the oral tablet group, a difference that was not statistically significant. Conclusion. The results showed that the 25-mu g vaginal tablets of misoprostol were as effective and safe for cervical ripening and labor induction as the dose-equivalent fraction of 200-mu g oral tablets.

Skin water uptake and renal function in the toad

1. 1. Water balance in the toad Bufo marinus ictericus was studied by evaluating cutaneous water uptake and renal excretion. 2. 2. The permeability of the skin to water was 78 ± 6 nl min -1 cm -2 atm -1 in 60 toads anaesthetized by chloralose and preincubated in water for 3 hr. Injection of Ringer's solution did not reduce the water uptake by the skin, while hemorrhage, or injection of vasopressin, or oxytocin approximately doubled the rates of water transport. In vivo values of skin water permeability were similar to those observed in vitro. 3. 3. The renal parameters of the water balance were significantly reduced by hemorrhage and by injection of vasopressin. Injection of Ringer's solution promoted a significant increase of the urinary flow and osmolar clearance. 4. 4. It is suggested that the fight against water deprivation could proceed initially by the triggering of the urinary mechanisms of water retention, while the increase of the skin water permeability would occur in a later stage. © 1981.

Biomolecular information, brain activity and cognitive functions

Molecular neurobiology has provided an explanation of mechanisms supporting mental functions as learning, memory, emotion and consciousness. However, an explanatory gap remains between two levels of description: molecular mechanisms determining cellular and tissue functions, and cognitive functions. In this paper we review molecular and cellular mechanisms that determine brain activity, and then hypothetize about their relation with cognition and consciousness. The brain is conceived of as a dynamic system that exchanges information with the whole body and the environment. Three explanatory hypotheses are presented, stating that: a) brain tissue function is coordinated by macromolecules controlling ion movements, b) structured (amplitude, frequency and phase-modulated) local field potentials generated by organized ionic movement embody cognitive information patterns, and c) conscious episodes are constructed by a large-scale mechanism that uses oscillatory synchrony to integrate local field patterns. © by São Paulo State University.