Prenatal management of monoamniotic twin pregnancies.

OBJECTIVE: To evaluate antenatal surveillance strategies and the optimal timing of delivery for monoamniotic twin pregnancies. METHODS: Obstetric and perinatal outcomes were retrospectively retrieved for 193 monoamniotic twin pregnancies. Fetal and neonatal outcomes were compared between fetuses followed in an inpatient setting and those undergoing intensive outpatient follow-up from 26 to 28 weeks of gestation until planned cesarean delivery between 32 and 35 weeks of gestation. The risk of fetal death was compared with the risk of neonatal complications. RESULTS: Fetal deaths occurred in 18.1% of fetuses (70/386). Two hundred ninety-five neonates from 153 pregnancies were born alive after 23 weeks of gestation. There were 17 neonatal deaths (5.8%), five of whom had major congenital anomalies. The prospective risk of a nonrespiratory neonatal complication was lower than the prospective risk of fetal death after 32 4/7 weeks of gestation (95% confidence interval 32 0/7-33 4/7). The incidence of death or a nonrespiratory neonatal complication was not significantly different between fetuses managed as outpatients (14/106 [13.2%]) or inpatients (15/142 [10.5%]; P=.55). Our statistical power to detect a difference in outcomes between these groups was low. CONCLUSIONS: The in utero risk of a monoamniotic twin fetus exceeds the risk of a postnatal nonrespiratory complication at 32 4/7 weeks of gestation. If close fetal surveillance is instituted after 26-28 weeks of gestation and delivery takes place at approximately 33 weeks of gestation, the risk of fetal or neonatal death is low, no matter the surveillance setting. LEVEL OF EVIDENCE: : II.

Efeito da densidade de plantas e da adubação NPK na produção inicial de palmito de pupunheira

Avaliaram-se os efeitos da densidade de plantas e doses de adubação na produção de palmito de pupunheira, em condições de campo, na Fazenda Yuricam, Rio Preto da Eva (AM). O delineamento experimental foi de blocos casualizados com três repetições, com os tratamentos em arranjo fatorial 3 x 5, sendo avaliados os fatores: densidade de plantas (10.000; 5.000 e 3.333 plantas ha-1) e doses de adubação NPK (0-0-0; 112,5-12,5-90; 337,5-38-270; 225-90-180, 225-25-180 em kg ha-1 de N, P2O5 e K2O, respectivamente). Os resultados do primeiro ano de produção de palmito, em termos de estipes colhidas, para efeito das doses de adubação NPK, foram: 225-90-180 (66 %); 225-25-180 (57 %); 337,5-38-270 (50 %); 112,5-12,5-90 (26 %); 0-0-0 (1 %) - os números entre parênteses indicam os percentuais de plantas coletadas em relação às plantadas - e para efeitos de densidade: 3.333 plantas ha-1 (58 %); 5.000 plantas ha-1 (28 %); 10.000 plantas ha-1 (40 %). O tempo médio para extração de palmito foi menor na densidade de 3.333 plantas ha-1 (18,4 meses) e na dose de adubação NPK de 225-90-180 (18,1 meses). O efeito simples da adubação NPK dentro da densidade de 10.000 plantas ha-1 com a adubação 225-90-180 e 225-25-180 apresentou maior produção de palmito, com 841 e 779 kg ha-1, e de 1.154 e 1.223 kg ha-1 de estipe tenro, respectivamente, nas duas adubações.

Risk of cardiovascular events and blood pressure control in hypertensive HIV-infected patients: Swiss HIV Cohort Study (SHCS).

BACKGROUND: Prevalence of hypertension in HIV infection is high, and information on blood pressure control in HIV-infected individuals is insufficient. We modeled blood pressure over time and the risk of cardiovascular events in hypertensive HIV-infected individuals. METHODS: All patients from the Swiss HIV Cohort Study with confirmed hypertension (systolic or diastolic blood pressure above 139 or 89 mm Hg on 2 consecutive visits and presence of at least 1 additional cardiovascular risk factor) between April 1, 2000 and March 31, 2011 were included. Patients with previous cardiovascular events, already on antihypertensive drugs, and pregnant women were excluded. Change in blood pressure over time was modeled using linear mixed models with repeated measurement. RESULTS: Hypertension was diagnosed in 2595 of 10,361 eligible patients. Of those, 869 initiated antihypertensive treatment. For patients treated for hypertension, we found a mean (95% confidence interval) decrease in systolic and diastolic blood pressure of -0.82 (-1.06 to -0.58) mm Hg and -0.89 (-1.05 to -0.73) mm Hg/yr, respectively. Factors associated with a decline in systolic blood pressure were baseline blood pressure, presence of chronic kidney disease, cardiovascular events, and the typical risk factors for cardiovascular disease. In patients with hypertension, increase in systolic blood pressure [(hazard ratio 1.18 (1.06 to 1.32) per 10 mm Hg increase], total cholesterol, smoking, age, and cumulative exposure to protease inhibitor-based and triple nucleoside regimens were associated with cardiovascular events. CONCLUSIONS: Insufficient control of hypertension was associated with increased risk of cardiovascular events indicating the need for improved management of hypertension in HIV-infected individuals.

Mezirowin itseohjautuvuuskäsityksiä ymmärrettävästi

Artikkelissa arvioidaan Leena Ahteenmäki-Pelkosen väitöskirjatutkimusta "Kriittinen näkemys itseohjautuvuudesta. Systemaattinen analyysi Jack Mezirowin itseohjautuvuuskäsityksistä"