Predição clinica pré-natal de recém-nascidos pequenos para a idade gestacional

Esta tese visa estudar um procedimento obstétrico clínico rotineiro, recomendado por várias sociedades obstétricas no mundo, inclusive a Federação Brasileira das Sociedades de Ginecologia e Obstetrícia e o Ministério da Saúde do Brasil, a medida de altura uterina. A recomendação é medir a distância entre o bordo superior da sínfise púbica e o fundo do útero (com fita inextensível, marcada em centímetros) a cada consulta pré-natal, e cotejar o valor obtido a valores de referência, determinados por uma curva padrão definida por percentis de altura uterina obtidos ao longo da gravidez. O objetivo desse procedimento é detectar anormalidades no crescimento fetal, seja crescimento excessivo ou insuficiente. O crescimento fetal excessivo está associado a aumento na morbidade perinatal, por aumento dos casos de hipóxia e de traumatismo secundários a parto distócico, além de maior risco de obesidade e diabetes tipo 2 na vida adulta. Também eleva a morbidade materna, por aumento no número de cesáreas e partos instrumentados. A importância da detecção de gestações com crescimento fetal insuficiente reside nos índices aumentados de mortalidade e de morbidade nesses recém-nascidos, no período perinatal, neonatal e pós-natal, até à vida adulta. Método de baixos custo e complexidade, não invasivo e aplicável durante a consulta pré-natal usual, a medida da altura uterina ao longo da gestação tem algumas das características desejáveis em um teste de rastreamento. Entretanto, seu desempenho na identificação das anormalidades do crescimento fetal intra-uterino tem achados bastante desiguais na literatura. Assim como grande parte das características fetais, a altura uterina é diretamente dependente do tempo de gestação e, portanto, erros na datação da gestação podem interferir no desempenho do método como indicador de anormalidade de crescimento intra-uterino Esta tese, baseada em dados do Estudo Brasileiro do Diabetes Gestacional (EBDG), avalia o impacto clínico da medição rotineira da altura uterina em gestantes que fazem acompanhamento pré-natal no Sistema Único de Saúde (SUS). No primeiro artigo, descrevemos a distribuição das medidas de altura uterina a cada semana de gestação obtidas no EBDG e a confrontamos com a distribuição descrita no estudo do Centro Latino-Americano de Perinatologia (CLAP). Determinamos também o desempenho diagnóstico das duas distribuições na identificação de recém-nascidos pequenos e grandes para a idade da gestação nas gestantes do estudo brasileiro. No segundo artigo, derivam-se e testam-se regras clínicas para a detecção pré-natal de recém-nascidos pequenos para a idade gestacional, agregando à medida da altura uterina outras características clínicas associadas a esse desfecho da gravidez. Utiliza-se a divisão randômica da população estudada em duas coortes, uma para derivação das regras clínicas de predição e a outra para a testagem e validação dessas regras.

Aplicação da inflação diária para previsão do IPCA

Since 2006, the Getulio Vargas Foundation (FGV) calculates a daily version of the Broad Consumer Price Index (IPCA), the official inflation index, calculated under the responsibility of the IBGE, the federal statistics agency in Brazil. Ardeo et. al. (2013) showed the importance of this indicator and how this daily information can be useful to a country that had high level of inflation. Despite the fact that this measure is a fair antecedent variable for inflation, due to some peculiarities concerning the collection period, the initial daily rating may not anticipate some effects, such as seasonal factors and the increase in prices controlled by the Brazilian Government. Hence, by taking into account the Monitor´s daily time series, this paper intends to forecast the IPCA for the first six days of data collection. The results showed up that the proposal technic improved the IPCA forecast in the beginning of data collection.

Avaliação do retinol em parturientes com diabetes mellitus gestacional no pós parto imediato

Micronutrient deficiencies affect individuals mainly in developing countries, where vitamin A deficiency is a public health problem worldwide more worrying, especially in groups with increased physiological needs such as children and women of reproductive age. Vitamin A is supplied to the body through diet and has an important role in the visual process, cell differentiation, maintenance of epithelial tissue, reproductive and resistance to infection. The literature has demonstrated the relationship between vitamin A and diabetes, including gestational, leading to a risk to both mother and child. Gestational diabetes is any decrease in glucose tolerance of variable magnitude diagnosed each the first time during pregnancy, and may or may not persist after delivery. Insulin resistance during pregnancy is associated with placental hormones, as well as excess fat. Studies have shown that retinol transport protein produced in adipose tissue in high concentrations, this would be associated with resistance by interfering with insulin signaling. Therefore, this study aimed to evaluate the concentration of retinol in serum and colostrum from healthy and diabetic mothers in the immediate postpartum period. One hundred and nine parturient women were recruited, representing seventy-three healthy and thirty-six diabetic. Retinol was extracted and subsequently analyzed by High Performance Liquid Chromatography. Among the results highlights the mothers with gestational diabetes were older than mothers healthy, had more children and a higher prevalence of cases of cesarean section. Fetal macrosomia was present in 1.4% of healthy parturient women and in 22.2% of diabetic mothers. The maternal serum retinol showed an average of 39.7 ± 12.5 mg/dL for healthy parturients 35.12 ± 15 mg/dL for diabetic and showed no statistical difference. It was observed that in the group of diabetic had 17% vitamin A deficiency, whereas in the healthy group, only 4% of the women were deficentes. Colostrum, the concentration of retinol in healthy was 131.3 ± 56.2 mg/dL and 125.3 ± 41.9 mg/dL in diabetic did not differ statistically. This concentration of retinol found in colostrum provides approximately 656.5 mg/day for infants born to healthy mothers and 626.5 mg/day for infants of diabetic mothers, based on a daily consumption of 500 mL of breast milk and need Vitamin A 400 mg/day, thus reaching the requirement of the infant. The diabetic mothers showed significant risk factors and complications related to gestational diabetes. Although no 11 difference was found in serum retinol concentration and colostrum among women with and without gestational diabetes, the individual analysis shows that parturients women with diabetes are 4.9 times more likely to develop vitamin A deficiency than healthy parturients. However, the supply of vitamin A to the newborn was not committed in the presence of gestational diabetes

Concentrações séricas de progesterona, 17 b-estradiol e cortisol durante o final do próestro, estro e diestro gestacional em cadelas

Neste estudo, foram utilizadas 7 cadelas sem raça definida, adultas e hígidas, copuladas com macho hígido, após exame andrológico, para acompanhamento das variações hormonais de progesterona, 17b-estradiol e cortisol a partir do final do próestro, durante o estro e diestro gestacional em fêmeas da espécie canina. As avaliações séricas do cortisol foram iniciadas no período de estro. A citologia vaginal esfoliativa foi utilizada como parâmetro auxiliar para a determinação das fases do ciclo estral, mais especificamente para análise do melhor momento para cópula, através da presença das células superficiais queratinizadas visibilizadas nas lâminas. Os resultados obtidos mostraram concentrações médias de progesterona elevando-se discretamente no final do próestro (de 1,56 para 2,85ng ml-1), concomitante com o início do declínio dos valores de estradiol no mesmo período (de 20,93 para 18,81pg ml-1). Durante a gestação pôde-se observar concentrações elevadas de progesterona (36,90ng ml-1), havendo declínio apenas no terço final (4,10ng ml-1), quando também pôde ser notada, por um momento, ligeira elevação das concentrações médias de 17b-estradiol (2,46pg ml-1). O aumento do cortisol sérico foi notado na última semana da gestação havendo, antes disso, alterações significativas (P<0,05) nas concentrações séricas baseadas nos padrões descritos em literatura. No pós-parto imediato a redução do cortisol sérico (6,52ng ml-1) foi considerada relevante de acordo com as concentrações detectadas na última semana da gestação (22,27ng ml-1). A progesterona esteve mantida em níveis basais no pós-parto imediato (< 1ng ml-1).

Vivência de mulheres em situação de cárcere penitenciário durante o período gestacional

The gradual increase of violence in Brazilian society has being resulting in a growing of the prison population over last years, as well as the proportion of women than men. The participation of women in crime and responsibilities within her family makes this phenomenon a growing social problem. Women prisoners are mostly young, in reproductive age, making pregnancy a recurrent situation while they are serving a sentence. The studies about female criminality are poor and not helpful about its real dimension, especially when targeted to women who experienced pregnancy in this environment. Given these considerations, this research had as its object of study the experience of women in prison during pregnancy: analyze the experience of women in prison during the gestational period. This is a descriptive and qualitative study. The data were sourced through a semi-structured interview with nine incarcerated women, between August and September 2011, who met the inclusion criteria previously established, and organized according to the precepts of content analysis according to Bardin. Through this coding and classification process became a central thematic: the experience of women in prison during pregnancy, resulting in three categories: category 1 interpersonal relationships; category 2 - feelings that permeate the pregnant woman in prison; and category 3 absence of health care to incarcerated pregnant. The data were analyzed according to the available literature and the study revealed that interpersonal relationships, maintained by these women in prison, were marked by distance from family members, primarily due to socioeconomic factors, being a challenge for addressing of pregnancy in prison and reports of abuse of power by employees working in the institution. The women, who experience pregnancy in prison are more likely to experience feelings of worry, doubts, sadness and fear for baby s health due to lack of antenatal care and about the prison environment structure to meet your needs. The health care aimed at these women is poor and often does not occur, endangering the baby s life and his own mother, this is being a troubling reality in public health system. Finally, it is expected that this study can give visibility to an issue rarely discussed in the literature and contribute to the construction of specific public policies for this reality, in order to minimize the effects of incarceration during pregnancy

Estimativa da radiação solar global diária em função do potencial de energia solar na superfície do solo

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

O índice BODE reflete o nível de atividade física na vida diária de pacientes com DPOC?

Objectives: To study the relationship between the level of physical activity in daily life and disease severity assessed by the BODE index in patients with chronic obstructive pulmonary disease (COPD). Methods: Sixty-seven patients with COPD (36 men) with forced expiratory volume in the first second (FEV(1)) of 39 (27-47)% predicted and age of 66 (61-72) years old were evaluated by spirometry, dyspnea levels (measured by the Medical Research Council scale, MRC) and by the 6-minute walking test (6MWT). The BODE index was calculated based on the body mass index (weight/height(2)), FEV(1), MRC and 6MWT, and then the patients were divided in four quartiles according to their scores (Quartile I: 0 to 2 points, n=15; Quartile II: 3 to 4 points, n=20; Quartile III: 5 to 6 points, n=23; Quartile IV: 7 to 10 points, n=9). Two activity monitors (DynaPort (R) and SenseWear (R)) were used to evaluate the level of physical activity in daily life. The Kruskal-Wallis test (Dunns's post-hoc test), the Mann-Whitney test and the Spearman Correlation Coefficient were used for statistical analysis. Results: There were modest correlation between the BODE index and the time spent walking per day, the total daily energy expenditure and the time spent in moderate and vigorous activities per day (-0.32 <= r <=- 0.47; p <= 0.01 for all variables). When comparing the pooled quartiles I+II with III+IV, there were significant difference between the time spent walking per day, the total daily energy expenditure and the time spent in moderate activities per day (p <= 0.05). Conclusion: The level of physical activity in daily life has a modest correlation with the classification of COPD severity assessed by the BODE index, reflecting only differences between patients with classified as mild-moderate and severe-very severe COPD.

Análise da relação entre alterações do padrão do sono e dor lombo-pélvica em mulheres no segundo trimestre gestacional

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Distribuição diária do comportamento da mosca da fruta Anastrepha zenildae Zucchi, (Diptera: Tephritidae) em laboratório.

The knowledge of Anastrepha zenildae behavioral aspects combined with the biology of Tephritidae may contribute to monitoring and control programs of this fruit fly that is considered as economically important to the Rio Grande do Norte state. In order to characterize the daily activity profile of this species, we studied the behaviors of resting, locomotion, feeding, cleaning, courtship, copulation and oviposition of animals submitted to an artificial 12:12h light-dark cycle (750:1lux) with controlled temperature (26±2 °C). The observations were made with groups of 16 males and 16 females during 3 consecutive days each generation from parental to F5. Resting, locomotion, feeding and cleaning data were recorded as frequency and time of occurrence by scanning technique in 15 minutes windows per hour, with a record each minute. Courtship, copulation and oviposition were recorded as frequency, time of occurrence and duration by al occurrences technique. Resting was the most frequent behavior with males resting more than females. Locomotion was more evident in the first half of the ligh phase with higher values in females. Cleaning and feeding behaviors were more frequent in the second half of the light phase for both sexes with females eating more frequently than males. During the courtship, males were grouped in lek formations showing wings vibration and pheromone liberation. Courtship occurred more frequently 4 to 7 h after lights on (81,9%) with copulations being more frequent 6 h after lights on with a mean duration of 58,1±40,4 min. Copulation attempts were observed in males inside and outside the lek with aggressive behavior being observed only between males in the lek. Oviposition behavior was similar to that described for other species of the genus with a peak of this activity 2-3 h after the lights on, mean duration of 43, 7±34, 8 sec and 2 to 5 eggs by event. According to the results, sexual behavior of A. zenildae is temporally different of other sympatric species of the genus, being favorable to the reproductive isolation as well as the use of resources as oviposition substrate.

Ritmo circadiano de atividade motora e distribuição diária dos comportamentos afiliativos ao longo da fase juvenil em saguis (callithrix jacchus)

The temporal allocation of the active phase in relation to light and dark cycle (LD) changes during puberty in humans, degus, rats and rhesus. In marmosets, the animal model used in several biomedical researches, there is evidence of a delay at the beginning of the active phase and an increase in total daily activity after onset of puberty. However, as this aspect was evaluated in animals maintained in natural environmental conditions, it was not possible to distinguish between the effects of puberty and of seasonality. Furthermore, as motor activity is the result of different behaviors in this species, it is also important to characterize the diurnal distribution of other behaviors in juvenile stage. With the aim of characterizing the circadian rhythm of motor activity and the diurnal profile of affiliative behavior in marmosets, the motor activity of 5 dyads juveniles between 4 and 12 months of age and their parents was recorded continuously for actímetro. The families were maintained under artificial LD 12:12 h, constant temperature and humidity. The duration of grooming behavior, proximity and social play among juveniles was recorded 2 times a week in sessions of 15 minutes each hour of the active phase. Afetr onset of puberty in juvenile, it was observed that there was no change in the parameters of circadian motor activity rhythm which were common to most animals. Despite the absence of pubertal modulation, it was observed that the circadian activity profiles have stronger synchrony between individuals of the same family than that of different families, which may indicate that the circadian activity rhythm was modulated by the dynamics of social interactions. In relation to age, the total daily activity and the ratio between evening and morning activity (EA/MA) were higher in juveniles than in adults, which may be associated with differences in the circadian timing system between age groups. Furthermore, the onset of the 10 consecutive hours of higher activity (M10) occurred earlier in adult males than in other members of the group, probably as a way to avoid competition for resources in one of the first activities of the day that is foraging. During the juvenile stage, there was an increase in total daily activity that may be associated with increased motor ability of juveniles. In addition to the circadian activity rhythm, the daytime profile of proximity and social play behaviors was similar between the 5th and 12th month of life of juveniles, in which the interval between 7- 10 h in the morning showed the highest values of proximity and lower values of play social. Moreover, the duration of the grooming showed a similar distribution to adults from the 8th month, wherein the higher values occurring at the interval between 11 14 h of day. Considering the results, the parameters of the circadian activity rhythm had a greater influence of social factors than puberty. In relation to age, there were no changes related to the allocation of the active phase in relation to the LD cycle, but total daily activity, the ratio AV/AM and the start of the M10 is possible to observe differences between juveniles and adults

Distribuição diária das atividades comportamentais dos camarões marinhos Farfantepenaeus subtilis (Pérez Farfante, 1967) e Litopenaeus schmitti (Burkenroad, 1938) em condições laboratoriais

Marine aquaculture has developed in the last decades all over the world, especially related to shrimp management. In Brazil, the introduction of the species Litopenaeus vannamei has contributed to the success of the activity, even if there are problems associated with the management of a exotic species, such as new diseases and ecological pressure on native species. It has been emphasized the need of research for developing new methodology that will allow native species management, being the most important Farfantepenaeus subtilis and Litopenaeus schmitti. Most knowledge obtained from research with those species has generally used a technical approach and mainly focused feeding process. There are no specific behavioral data on their activity pattern which should be of great importance for the use of native species on commercial culture farms. So, it was our objective to study and compare the daily distribution of behavioral activities of the marine shrimp species Litopenaeus schmitti and Farfantepenaeus subtilis. Forty animals of each species, 5 individuals per aquarium, were maintained in aquaria containing 200L of sea water under continuous aeration and filtration. They were marked individually and were observed by the instantaneous focal time sampling, along 10 continuous days, in 6 daily 15 min observation windows, every two hour. In each window, behaviors and location position of the animals in the aquarium were registered at 1 min intervals. Food was offered 3 times a day, representing 10% of each aquarium biomass. Aquaria were maintained in artificial photoperiod, 12hour light/l2 hour dark, 4 aquaria in light cycle equivalent to the environmental one (light from 06:00 to 17:59 h and dark from 18:00 to 05:59 h) and the other 4 in the reverse light cycle (light from 18:00 to 05:59 h and dark from 06:00 to 17:59 h) to allow sequential behavioral observation in both phases of the 24 hour cycle. There was a clear distinction between the distribution of behavioral activities of F. subtilis and L. schmitti in the two phases. The activity pattern of Farfantepenaeus subtilis demonstrates that species has prominently night habits and a burying pattern during the light cycle. Exploration, inactivity and swimming were the most common activities. The behavioral pattern of Litopenaeus schmitti indicates that species is active along both phases of the light cycle, and the most evident behaviors were exploration, inactivity and swimming

Variação diária e anual de freqüência e atividade do Boto Cinza Sotalia guianensis em Pipa, Nordeste do Brasil

The aim of this study was to investigate the daily and annual variation in frequency and in activity of an estuarine dolphin population, Sotalia guianensis, in Brazilian northeastern. Thus we estimated the daily variation and seasonality in frequency of adult and immature and in behavior of socialization, aerial activity, foraging of a boto equatorial population in the Curral inlet (6º13 00 S; 35º3 36 W). We detect some variation. Thus we associate the daily variation with daily period, tide fluctuation and annual season. And the seasonality variation we associate with the fotoperíodo and precipitation variation. From October 1999 to September 2003, through collect four times at month, we made instantaneous record at each five minute in six hours of survey. The surveys hours were ranged into light time of 24 hours, that is, between 06:00 and 17:00 o clock. These observations were developed simultaneous for two observers in a land-based survey at coastline cliff top of which observer have a fully visualization of whole inlet. We found that animals were more active and frequent during the morning. They were more active during low tide than high tide. However they did not show association with tide. We found yet that in a period from June to November (winter-spring) there was the highest socialization, aerial activity and foraging frequency. However adult and immature individual number did not have significance variation along the year. The larger concentration of this behaviors were not associate with photoperiod neither precipitation in the region. These results showed the existence of behavioral daily variation and seasonality in a species that live in equatorial region

A curva de regressão da gonadotrofina coriônica humana é útil no diagnóstico precoce da neoplasia trofoblástica gestacional pós-molar?

OBJETIVO: avaliar a utilidade da curva de regressão normal da gonadotrofina coriônica humana (hCG) no diagnóstico precoce de neoplasia trofoblástica gestacional pós-molar (NTG). MÉTODOS: estudo longitudinal, incluindo 105 pacientes com mola hidatiforme completa (MHC) acompanhadas no Centro de Doenças Trofoblásticas de Botucatu, entre 1998 e 2005. Os títulos da hCG sérica foram mensurados quinzenalmente em todas as pacientes. Curvas individuais de regressão da hCG das 105 pacientes foram estabelecidas. A comparação entre a curva de regressão normal estabelecida em nosso serviço com as curvas individuais da hCG foi usada no rastreamento e diagnóstico (platô/ascensão) de NTG. O número de semanas pós-esvaziamento quando a hCG excedeu o limite normal foi comparado com o número semanas em que a hCG apresentou platô/ascensão. RESULTADOS: das 105 pacientes com MHC, 80 apresentaram remissão espontânea (RE) e 25 desenvolveram NTG. Das 80 pacientes com RE, 7 (8,7%) apresentaram, inicialmente, dosagem da hCG acima do normal, mas, no devido tempo, alcançaram a remissão. Todas as 25 pacientes com NTG apresentaram desvio da curva normal da hCG em 3,8±2,5 semanas e mostraram platô ou ascensão em 8,4±2,9 semanas (p<0,001). CONCLUSÕES: a curva de regressão normal da hCG pós-molar pode ser útil para diagnóstico de NTG.

Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil

CONTEXTO E OBJETIVO: Gestações complicadas pelo diabetes estão associadas com aumento de complicações maternas e neonatais. Os custos hospitalares aumentam de acordo com a assistência prestada. O objetivo foi calcular o custo-benefício e a taxa de rentabilidade social da hospitalização comparada ao atendimento ambulatorial em gestantes com diabetes ou com hiperglicemia leve. DESENHO do ESTUDO: Estudo prospectivo, observacional, quantitativo, realizado em hospital universitário, sendo incluídas todas as gestantes com diabetes pregestacional e gestacional ou com hiperglicemia leve que não desenvolveram intercorrências clínicas na gestação e que tiveram parto no Hospital das Clínicas, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (HC-FMB-Unesp). MÉTODOS: Trinta gestantes tratadas com dieta foram acompanhadas em ambulatório e 20 tratadas com dieta e insulina foram abordadas com hospitalizações curtas e frequentes. Foram obtidos custos diretos (pessoal, material e exames) e indiretos (despesas gerais) a partir de dados contidos no prontuário e no sistema de custo por absorção do hospital e posteriormente calculado o custo-benefício. RESULTADOS: O sucesso do tratamento das gestantes diabéticas evitou o gasto de US$ 1.517,97 e US$ 1.127,43 para pacientes hospitalizadas e ambulatoriais, respectivamente. O custo-benefício da atenção hospitalizada foi US$ 143.719,16 e ambulatorial, US$ 253.267,22, com rentabilidade social 1,87 e 5,35 respectivamente. CONCLUSÃO: A análise árvore de decisão confirma que o sucesso dos tratamentos elimina custos no hospital. A relação custo-benefício indicou que o tratamento ambulatorial é economicamente mais vantajoso do que a hospitalização. A rentabilidade social de ambos os tratamentos foi maior que 1, indicando que ambos os tipos de atendimento à gestante diabética têm benefício positivo.