Contribution Of Antepartum And Intrapartum Hemorrhage To The Burden Of Maternal Near Miss And Death In A National Surveillance Study

Objective To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.Design Multicenter cross-sectional study.Setting Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.Population A total of 9555 women categorized as having obstetric complications.Methods The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.Main outcome measures The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.Results Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).Conclusion Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.

Clinical management for epidermolysis bullosa dystrophica

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.

Management of a complex dentoalveolar trauma: a case report

This paper describes the case of a 12-year-old male patient who presented a severe lateral luxation of the maxillary central incisors due to a bicycle fall. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment and periodontal surgery. After a 2-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.

A retrospective study of Traumatic Dental Injuries in a Brazilian dental urgency service

Epidemiologic aspects of traumatic dental injuries (TDI) were evaluated in the permanent dentition in a sample of 847 patients treated at the Dental Urgency Service of the Dental School of the Federal University of Goiás, Brazil, between May 2000 and May 2008. The statistical treatment analyzed data from frequency distribution and chi-square test. The level of significance was set at 5% for all analyses. The results showed a higher incident among males (610; 72.01%) with mean age of 6-10 year-old. Uncomplicated crown fracture (without pulp exposure) (502; 26.95%), avulsion (341; 18.30%) and complicated crown fracture (with pulp exposure) (330; 17.71%) were the most prevalent TDI. The prevalence of trauma throughout the years showed proportionality, being observed a larger number of cases between July and September (249; 29.39%). The most affected teeth were the maxillary central incisors (65.65%), followed by the maxillary left lateral incisors (19.67%). In 311 participants (18.25%), only one tooth was involved, while in most patients (536; 81.75%), TDI occurred in more than one tooth. Significant proportion (82.27%) of traumatized teeth presented completely formed root apex. The main etiologic factors involved in TDI were falls (51.71%), traffic accidents (22.90%) and violence (5.67%). Based on the obtained data, it may be concluded that accurate policies of TDI prevention must be established, capable of stimulating the exposure of appropriate protocols for management of these lesions. The prevalence of TDI in Goiânia subpopulation is compared to the prevalence reported in epidemiological studies in others populations.

Changes in ruminal fermentation and mineral serum level in animals kept in high temperature environments

In order to evaluate the effect of environmental temperature on ruminal fermentation and on mineral levels of growing ruminants, it was used 12 male calves (initial average weight 82.9 ± 7.7 kg, 100 days of age), were employed in a randomized block design (by weight) experiment, with repeated weight measurement and two environmental temperatures: thermoneutral (24ºC) and heat-stressed (33ºC), during 38 days. The animals exposed to 33ºC presented lower dry matter ingestion, lower T3 (triiodothyronine) serum level, higher ammoniacal nitrogen (NH3-N) level in the rumen liquid, and higher rectal and body temperatures during all the experimental period when compared to the animals kept in thermoneutral environment (24ºC). The animals kept under heat stress environment (33ºC) presented higher calcium serum level, which was the highest on 31st day and the lowest on the 38th day of the experiment; phosphorus level was the lowest during all the experimental period; sodium level was lower on the 17th, 31st and 38th experimental days. Potassium and zinc levels were lower after 24 days; copper level was lower until the 24th day; magnesium level was higher until the 17th day, if compared to the ones from the animals kept in thermoneutral environment (24ºC). The heat-stressed animals presented higher levels of ammoniacal nitrogen in the ruminal liquid and a decrease in the phosphorus, sodium, potassium and zinc serum levels. These results show the necessity of changes on feed management to ruminants in temperatures over the thermal comfort limits so that performance loss is decreased.

Tratamento farmacológico da DPOC

Aproximadamente sete milhões de brasileiros acima de 40 anos são acometidos pela DPOC. Nos últimos anos, importantes avanços foram registrados no campo do tratamento medicamentoso dessa condição. Foi realizada uma revisão sistemática incluindo artigos originais sobre tratamento farmacológico da DPOC publicados entre 2005 e 2009, indexados em bases de dados nacionais e internacionais e escritos em inglês, espanhol ou português. Artigos com tamanho amostral menor de 100 indivíduos foram excluídos. Os desfechos sintomas, função pulmonar, qualidade de vida, exacerbações, mortalidade e efeitos adversos foram pesquisados. Os artigos foram classificados segundo o critério da Global Initiative for Chronic Obstructive Lung Disease para nível de evidência científica (grau de recomendação A, B e C). Dos 84 artigos selecionados, 40 (47,6%), 18 (21,4%) e 26 (31,0%) foram classificados com graus A, B e C, respectivamente. Das 420 análises oriundas desses artigos, 236 referiam-se à comparação de fármacos contra placebo nos diversos desfechos estudados. Dessas 236 análises, os fármacos mais frequentemente estudados foram anticolinérgicos de longa duração, a combinação β2-agonistas de longa duração + corticosteroides inalatórios e corticosteroides inalatórios isolados em 66, 48 e 42 análises, respectivamente. Nas mesmas análises, os desfechos função pulmonar, efeitos adversos e sintomas geraram 58, 54 e 35 análises, respectivamente. A maioria dos estudos mostrou que os medicamentos aliviaram os sintomas, melhoraram a qualidade de vida, a função pulmonar e preveniram as exacerbações. Poucos estudos contemplaram o desfecho mortalidade, e o papel do tratamento medicamentoso nesse desfecho ainda não está completamente definido. Os fármacos estudados são seguros no manejo da DPOC, com poucos efeitos adversos.

Fire management and the nesting of Athene cunicularia (Aves, Strigidae) in grasslands in central Cerrado, Brazil

Fire management is a common practice in several reserves in the Cerrado, but its influences on bird reproduction remain unknown. In addition, the nesting biology of the Burrowing Owl (Athene cunicularia) has been studied in numerous environments, but not in tropical grasslands managed by fire. This study examined the effects of fire management on the nesting biology of A. cunicularia in Emas National Park, State of Goias, central Brazilian Cerrado. We compared the number of breeding pairs and their burrows in October and November 2009 at 15 study sites in grasslands managed by fire (firebreaks) and unmanaged grasslands adjacent to and distant from firebreaks. We visited active burrows two-four times and described the burrow entrances and sentinel sites and counted and observed adults and young. A total of 19 burrows were found at firebreaks. One and two burrows were found in grasslands adjacent to and distant from firebreaks, respectively. For all burrows found, one to three young reached the adult size, being able to fly and/or run in early November. The 22 burrows found were in the ground, associated or not with termite and ant nests. Most (86.4%) burrows had only one entrance. Only three burrows had two or three entrances. Structures used as sentinel perches by adults were mounds in front of the burrow entrances, termite nests, shrubs and trees. Most of these sentinel sites were shorter than 2 m high and located less than 10 m from the burrow entrance. At Emas National Park, firebreaks appear to provide more attractive conditions to the nesting of A. cunicularia than unmanaged grasslands, likely because of the short herbaceous stratum due to frequent burning of firebreaks. This study suggests that fire management provides suitable conditions for the successful reproduction of A. cunicularia in firebreaks at Emas National Park.

Age polyethism in Plebeia emerina (Friese) (Hymenoptera: Apidae) colonies related to propolis handling

Stingless bees collect plant resins and make it into propolis, although they have a wider range of use for this material than do honey bees (Apis spp.). Plebeia spp. workers employ propolis mixed with wax (cerumen) for constructing and sealing nest structures, while they use viscous (sticky) propolis for defense by applying it onto their enemies. Isolated viscous propolis deposits are permanently maintained at the interior of their colonies, as also seen in other Meliponini species. Newly-emerged Plebeia emerina (Friese) workers were observed stuck to and unable to escape these viscous propolis stores. We examined the division of labor involved in propolis manipulation, by observing marked bees of known age in four colonies of P. emerina from southern Brazil. Activities on brood combs, the nest involucrum and food pots were observed from the first day of life of the marked bees. However, work on viscous propolis deposits did not begin until the 13th day of age and continued until the 56th day (maximum lifespan in our sample). Although worker bees begin to manipulate cerumen early, they seem to be unable to handle viscous propolis till they become older.

OSL age determinations of Pleistocene fluvial deposits in Central Amazonia

Absolute dating methods have been used in chronological studies of geological processes and sedimentary units of Quaternary age in Central Amazonia, Brazil. Although radiocarbon dating has been very useful in archaeological research and soil studies, the temporal interval of this method is inefficient in evaluating the sedimentation aspects and geological events from the beginning of the Quaternary in the Amazon basin. The use of crystal luminescence dating has been one of the most promising tool for determining the absolute dating of Quaternary deposits in the Amazonian region. Optically stimulated luminescence (OSL) dating, following the MAR and SAR protocols, in a tectonic-sedimentary study of Quaternary fluvial deposits in the confluence area of the Negro and Solimões rivers, indicated ages from 1.3 (Holocene) to about 67.4 kyears (Late Pleistocene) for these sediments. Low radioactive isotope concentrations were found about 2ppm for 235U and 238U; 5ppm for 232Th; and the 40K concentrations were almost zero. A comparison was made between MAR and SAR protocols taking into account the fluvial depositional process.

Família e trabalho: difícil conciliação para mães trabalhadoras de baixa renda

Este artigo é produto da pesquisa Articulação Trabalho e Família: Famílias Urbanas de Baixa Renda e Políticas de Apoio às Trabalhadoras, que teve por objetivo analisar a administração das dificuldades e dos conflitos que surgem na vida cotidiana de mulheres que trabalham fora de casa e têm responsabilidades familiares. Apresenta dados quantitativos e qualitativos: os primeiros foram extraídos da Pesquisa Nacional por Amostragem de Domicílios, de 2002, e os segundos, da realização de quatro grupos focais, com mulheres de 20 a 45 anos, de famílias de baixa renda, com filhos de até 14 anos. A análise foi realizada de forma integrada, estruturada em torno das seguintes questões: o conceito de trabalho doméstico; a divisão sexual do trabalho doméstico; o uso do tempo em afazeres domésticos; a conciliação do trabalho com a família e políticas sociais que contribuem para essa conciliação.

Time trends and predictors of mortality from ill-defined causes in old age: 9 year folllow-up of the Bambuí cohort study (Brazil)

The study objective was to examine differentials in time trends and predictors of deaths assigned to symptoms, signs and ill-defined conditions in comparison with other ill-defined conditions (ill-defined cardiovascular diseases, cancer and injury) in a population-based cohort study. Of 1,606 baseline participants aged 60 years and over, 524 died during 9-year follow-up and were included in this study. Deaths coded to "symptoms" declined by 77% in the period from 1997-1999 to 2003-2005. Deaths coded to other ill-defined conditions remained unchanged. The calendar period 2003-2005 (RR = 0.25; 95%CI: 0.09-0.70) and in-hospital deaths (RR = 0.16; 95%CI: 0.08-0.34) were independently associated with "symptoms", but not with other ill-defined conditions. Baseline socio-demographic characteristics and chronic diseases were not predictors of these outcomes. International and national agencies have focused on the reduction of deaths assigned to "symptoms" to improve the registration of vital statistics, while other ill-defined conditions have received little attention. Our data provide evidence supporting the need to redress this situation.

Ratio of weight to height gain: a useful tool for identifying children at risk of becoming overweight or obese at preschool age

PURPOSE: To analyze the usefulness of the weight gain/height gain ratio from birth to two and three years of age as a predictive risk indicator of excess weight at preschool age. METHODS: The weight and height/length of 409 preschool children at daycare centers were measured according to internationally recommended rules. The weight values and body mass indices of the children were transformed into a z-score per the standard method described by the World Health Organization. The Pearson correlation coefficients (rP) and the linear regressions between the anthropometric parameters and the body mass index z-scores of preschool children were statistically analyzed (alpha = 0.05). RESULTS: The mean age of the study population was 3.2 years (± 0.3 years). The prevalence of excess weight was 28.8%, and the prevalence of overweight and obesity was 8.8%. The correlation coefficients between the body mass index z-scores of the preschool children and the birth weights or body mass indices at birth were low (0.09 and 0.10, respectively). There was a high correlation coefficient (rP = 0.79) between the mean monthly gain of weight and the body mass index z-score of preschool children. A higher coefficient (rP = 0.93) was observed between the ratio of the mean weight gain per height gain (g/cm) and the preschool children body mass index z-score. The coefficients and their differences were statistically significant. CONCLUSION: Regardless of weight or length at birth, the mean ratio between the weight gain per g/cm of height growth from birth presented a strong correlation with the body mass index of preschool children. These results suggest that this ratio may be a good indicator of the risk of excess weight and obesity in preschool-aged children.

Análise morfométrica da transição esôfago-gástrica de eqüinos submetidos a diferentes manejos alimentares e atividade física

O objetivo deste trabalho foi identificar se diferentes tipos de manejo físico e alimentar determinaram mudanças adaptativas na morfometria da região de transição esôfago-gástrica (TEG) em eqüinos. Foram utilizados 15 conjuntos de animais adultos com raça, sexo e idade não identificados, divididos em três grupos de acordo com a dieta e a atividade física: grupo I - composto por cinco conjuntos da TEG de eqüinos em treinamento intensivo e alimentados principalmente à base de concentrado; grupo II - com cinco conjuntos da TEG de eqüinos que não desempenhavam atividade física intensa e eram alimentados principalmente à base de concentrado, e o grupo III - composto por cinco conjuntos da TEG de eqüinos mantidos a pasto e que não desempenhavam atividade física intensa. A região de transição esôfago-gástrica teve a estrutura do seu epitélio avaliada morfometricamente, onde foram feitas mensurações para identificar a espessura do epitélio estratificado pavimentoso queratinizado. A espessura do grupo I teve como média 122,3µm, do grupo II foi de 173,4µm e do grupo III foi de 281,7µm. Os resultados encontrados para a espessura do epitélio estratificado pavimentoso queratinizado dos eqüinos mostraram a existência de diferenças estatisticamente significativas dos eqüinos do grupo I, quando comparados aos eqüinos do grupo III.

Parâmetros genéticos para idade ao primeiro parto estimados por diferentes modelos para rebanhos da raça Nelore

Com objetivo de estimar parâmetros genéticos e estudar a utilização de diferentes efeitos em avaliações genéticas para idade ao primeiro parto (IPP) por diferentes modelos, foram utilizados registros de IPP de animais da raça Nelore, nascidos entre os anos de 1990 e 2005. Foram considerados os seguintes modelos (M): M1, incluindo o efeito fixo de GC1 (constituído pelos animais nascidos na mesma fazenda e ano), além da covariável, peso aos 365 dias de idade (efeito linear e quadrático), totalizando 24.263 registros de IPP; M2, considerando os efeitos fixos de GC1, ano e estação de parição, totalizando 59.792 registros de IPP e M3, incluindo os efeitos fixos de GC2 (agrupando os animais nascidos na mesma fazenda, ano e que conceberam no mesmo manejo reprodutivo), ano e estação de parição, totalizando 59.792 registros de IPP. As estimativas dos componentes de variância e herdabilidade e os valores genéticos (VG) foram obtidos pelo método da máxima verossimilhança restrita, com a inclusão da matriz de parentesco disponível. As diferenças esperadas na progênie (DEPs) foram obtidas dividindo os VG por dois. Após a obtenção desses resultados, foram realizadas correlações entre os VG e o ranqueamento das DEPs dos reprodutores para IPP, utilizando-se o procedimento PROC CORR (SAS, 2003). Ao se considerar o ano e a estação de parto nos modelos de análise (M2 e M3), esses produziram um maior R², indicando que tais modelos conseguiram explicar, em maior grau, as diferenças existentes entre os animais para IPP. As herdabilidades estimadas foram de baixa magnitude (0,14 e 0,15). As correlações entre os VG obtidas por diferentes modelos foram 0,73 (M1 x M2); 0,91 (M2 x M3) e 0,66 (M1 x M3).

Freqüência de anticorpos anti-Neospora caninum em soros de caprinos do estado de São Paulo e sua relação com o manejo dos animais

Com o objetivo de se avaliar a freqüência de caprinos leiteiros soropositivos para Neospora caninum, no estado de São Paulo, e se verificarem possíveis associações com idade, sexo e problemas reprodutivos, nos capris, e, também, presença de cães, nas propriedades, foram obtidos soros de 923 caprinos de ambos os sexos e idade acima de 3 meses. Os animais eram provenientes de 17 propriedades de diferentes municípios. Para o diagnóstico, foi utilizado o teste de aglutinação para Neospora (NATe"25), e, em todos os capris, aplicou-se um inquérito a partir do qual se obtiveram informações epidemiológicas e de esfera reprodutiva. Todos os resultados estatísticos foram discutidos no nível de 5% de significância. Assim, chegou-se à conclusão de que a freqüência percentual de positividade para N. caninum foi de 19,77%, e, em apenas uma propriedade, não houve registro de animal soropositivo, o que revela difusão do agente, no Estado. Não foram verificadas diferenças significativas entre freqüências de positividade quanto ao sexo, idade ou problemas reprodutivos. Porém, ressalta-se que a presença de cães, nos capris, foi associada a uma maior freqüência de caprinos soropositivos a N. caninum. A representação geográfica da distribuição de caprinos soropositivos para o protozoário, em mapa coroplético em hachuras, pode implicar em um ganho considerável para estudos da epidemiologia geográfica, na elaboração de um planejamento de controle da enfermidade.