GESTAÇÃO DE RISCO: PERCEPÇÃO E SENTIMENTOS DAS GESTANTES COM AMNIORREXE PREMATURA

Premature amniorrhexis, risky pregnancy, became a global concern because of the harm to the mother and fetus. Aim to identify the knowledge of women of premature amniorrhexis and get to know their perceptions and their feelings about this pathology. Descriptive study with a qualitative approach, developed in a public maternity ward. 11 women participated while hospitalized with a diagnosis of premature amniorrhexis, in the months of September and October 2007. The collection of semi-structured data was used, from which emerged the categories: Women's knowledge in relation to premature amniorrhexis, requiring information, and their feelings experienced, and reaction before their water broke. The results showed that women know little of the disease, or fear for the life of their children, and do not know what to do before that. Additionally health care professionals should regard women as human beings that need support and understanding.Amniorrexe prematuro, embarazo de riesgo, se convirtió en preocupación mundial debido a los agravios en la gestante y en el feto. Objetivamos identificar el conocimiento de las gestantes sobre amniorrexe prematura y conocer sus percepciones y sus sentimientos ante esta patología. Estudio descriptivo con un enfoque cualitativo, desarrollado en una maternidad pública. Participaron 11 gestantes hospitalizadas con diagnóstico de amniorrexe prematura, en los meses de septiembre y octubre de 2007. Se utilizó en la recogida de datos entrevista semi-estructurada a partir de la cual surgieron las categorías: conocimiento de las gestantes en relación con amniorrexe prematura, que requieren la información, los sentimientos experimentados, la reacción ante la ruptura de la bolsa de aguas. Los resultados mostraron que las mujeres saben poco de la enfermedad, el temor por la vida de sus hijos y no saben qué hacer ante esta situación. De ahí la necesidad de los profesionales de la salud de mirar a las gestantes como seres que necesitan de apoyo y comprensión.Amniorrexe prematura, gestação de risco, tornou-se preocupação mundial devido os agravos na gestante e no feto. Objetivamos identificar o conhecimento de gestantes sobre amniorrexe prematura e conhecer suas percepções e seus sentimentos diante desta patologia. Estudo descritivo com abordagem qualitativa, desenvolvido em uma maternidade pública. Participaram 11 gestantes internadas com o diagnóstico de amniorrexe prematura, nos meses de setembro e outubro de 2007. Utilizou-se na coleta de dados entrevista semi-estruturada de onde emergiram as categorias: conhecimento das gestantes em relação à amniorrexe prematura, necessitando de informações, sentimentos vivenciados, reação diante do rompimento da bolsa das águas. Os resultados revelaram que as gestantes pouco conhecem da patologia, temem pela vida dos filhos e não sabem o que fazer diante dessa situação. Consideramos então a necessidade dos profissionais de saúde olhar para as gestantes como seres que necessitam de apoio e compreensão

Association of Trypanosoma vivax in extracellular sites with central nervous system lesions and changes in cerebrospinal fluid in experimentally infected goats

Changes in cerebrospinal fluid (CSF) and anatomical and histopathological central nervous system (CNS) lesions were evaluated, and the presence of Trypanosoma vivax in CNS tissues was investigated through PCR. Twelve adult male goats were divided into three groups (G): G1, infected with T. vivax and evaluated during the acute phase; G2, infected goats evaluated during the chronic phase; and G3, consisting of non-infected goats. Each goat from G1 and G2 was infected with 1.25 × 105 trypomastigotes. Cerebrospinal fluid (CSF) analysis and investigation of T. vivax was performed at the 15th day post-infection (dpi) in G1 goats and on the fifth day after the manifestation of nervous system infection signs in G2 goats. All goats were necropsied, and CNS fragments from G1 and G2 goats were evaluated by PCR for the determination of T. vivax. Hyperthermia, anemia and parasitemia were observed from the fifth dpi for G1 and G2, with the highest parasitemia peak between the seventh and 21st dpi. Nervous system infection signs were observed in three G2 goats between the 30th and 35th dpi. CSF analysis revealed the presence of T. vivax for G2. Meningitis and meningoencephalitis were diagnosed in G2. PCR were positive for T. vivax in all the samples tested. In conclusion, T. vivax may reach the nervous tissue resulting in immune response from the host, which is the cause of progressive clinical and pathological manifestations of the CNS in experimentally infected goats

A NEW POSSIBILITY FOR SURVEILLANCE: DO WE IDENTIFY ALL CASES OF LEPTOSPIROSIS?

SUMMARY Leptospirosis is a febrile disease with a typically underestimated global incidence, especially in regions where dengue is endemic. Therefore, it is difficult to accurately determine the number of leptospirosis cases in these areas, which contributes to significant under-reporting this disease. In this study, we estimated the number of possible leptospirosis cases among dengue-like cases that were reported during 2008, 2010, and 2012 in the city of Fortaleza, northeast Brazil. Patients were evaluated for dengue and leptospirosis using immunoenzymatic tests for IgM antibodies that were specific to each pathogen. Among the suspected cases of dengue that resulted as negative in laboratory tests, 10.8% (2008), 19.2% (2010), and 30.8% (2012) were confirmed to be leptospirosis. Considering the cases reported by the surveillance authority as dengue that were subsequently discarded based on the laboratory test results, we estimate that the number of actual leptospirosis cases may be 26 to 49 times higher than those diagnosed and reported by the Health Services. Furthermore, we believe that approximately 20% of dengue-like cases may be leptospirosis cases in areas where the two diseases are endemic

Maternal and neonatal factors related to prematurity

ABSTRACT OBJECTIVE To identify maternal and neonatal factors associated with prematurity in the municipality of Porto Alegre. METHOD This was a population-based case-control study. The cases were newborns under 37 weeks of gestation and the controls were newborns over 37 weeks. The data came from the records of 19,457 births in the city of Porto Alegre in the year 2012 from the Information System on Live Births of the Municipal Health Department. The analysis was carried outand adjusted by a Logistic Regression according to a hierarchical model. The variables studied were allocated into three hierarchy levels: sociodemographic variables; reproductive history; and gestational and birth factors. RESULTS There were 767 cases allocated and 1,534 controls in a design of a case for two controls (1:2) by simple randomization. In the final model, a statistically significant association was found for prematurity for the following variables: mother's age under 19 years old (OR=1.32; CI 95%: 1.02-1.71) or over 34 years old (OR=1.39; CI 95%: 1.12-1.72); inadequate maternal schooling for age (OR=2.11; CI 95%: 1.22-3.65); multiple pregnancies (OR=1.14; CI 95%: 1.01-1.29); C-section (OR=1.15; CI 95%: 1.03-1.29); birth weights under 2,500g (OR=4.04; CI 95%: 3.64-4.49); Apgar score at five minutes between zero and three (OR=1.47; CI 95%: 1.12-1.91); and inadequate prenatal care (OR=1.18; CI 95%: 1.02-1.36). CONCLUSION The present study showed the most immediate consequence of prematurity for newborns by evidencing its association with worse Apgar scores and low birth weight. The following factors were also shown as possible more distal determinants of prematurity: mother's age; inadequate maternal education; multiple gestation; inadequate prenatal care; and C-section

Fatores de risco para câncer de colo do útero segundo resultados de IVA, citologia e cervicografia

Este estudo objetivou avaliar a associação entre fatores de risco para câncer de colo do útero e lesões cervicais por HPV comparando-se os resultados da inspeção visual com o ácido acético (IVA), a citologia e a cervicografia. Realizou-se pesquisa de prevalência com 157 mulheres de um centro de saúde de Fortaleza, no período de junho a setembro de 2006. Utilizou-se o SPSS para codificar os dados. Realizaram-se inferências por meio de testes estatísticos (χ2= quiquadrado e RV= razão de verossimilhança). IVA, cervicografia e citologia obtiveram 43,3%, 10,19% e 3,2% de resultados alterados, respectivamente. As variáveis com importante associação às lesões cervicais na IVA foram: idade menor de 20 anos (p= 0,0001); um ou mais parceiros nos últimos três meses (p= 0,015); uso de contraceptivos (p= 0,0008); presença de corrimento vaginal (p= 0,0001); e processo inflamatório moderado ou acentuado (p= 0,0001). Na citologia: baixa escolaridade (p= 0,0001) e elevado pH (p= 0,001). Não se encontrou associação significante na cervicografia.Este estudio objetivó evaluar la asociación entre factores de riesgo para cáncer de cuello de útero y lesiones cervicales por HPV, según comparación entre los resultados de la inspección visual con ácido acético (IVA), citología y cervicografía. Se realizó investigación de prevalencia, con 157 mujeres en un centro de salud de Fortaleza-CE-Brasil, en el período de junio a setiembre de 2006. Se utilizó el SPSS para codificar los datos. Se realizaron inferencias a través de tests estadísticos (χ2 = Qui-cuadrado y RV= razón de verosimilitud). La IVA, cervicografía y citología obtuvieron 43,3%, 10,19% y 3,2% de resultados alterados. Las variables con importante asociación a lesiones cervicales en la IVA fueron: edad menor a 20 años (p=0,0001), uno o más parejas en los últimos tres meses (p=0,015), uso de anti-conceptivos (p=0,0008), presencia de vaginitis (p=0,0001) y pH elevado (p=0,001). No se encontró asociación significativa en la cervicografía.This study aimed to evaluate the association between risk factors for uterine cervical neoplasms and cervical lesions by HPV by comparison of the visual inspection with acetic acid (VIA), cytology and cervicography results. A prevalence research was made with 157 women in a health center of Fortaleza in the period of June to September 2006. The SPSS program was used to codify the data. Inferences were made through statistical tests (χ2= chi square and LR= likelihood ratio). The VIA, cervicography and cytology obtained 43.3%, 10.19% and 3.2% of altered results. The variables with important association to cervical lesions in the VIA were: aged less than 20 years old (p= 0.0001); one or more partners in the last three months (p= 0.015); use of contraceptives (p = 0.0008); presence of vaginal discharge (p= 0.0001) and moderate or accentuated inflammatory process (p= 0.0001). In the cytology: low instructional level (p= 0.0001) and high pH (p= 0.001). It wasn't found any significant association in the cervicography

Lack of Guanylate Cyclase C results in increased mortality in mice following liver injury

<p>Abstract</p> <p>Background</p> <p>Guanylate Cyclase C (GC-C) expression in the intestine plays a role in the regulation of fluid and ion transport, as well as epithelial cell apoptosis and proliferation. In the adult rat liver, GC-C expression is increased in response to injury. We hypothesized that GC-C is required for repair/recovery from liver injury.</p> <p>Methods</p> <p>We subjected wild type (WT) and GC-C deficient mice to acute liver injury with a single injection of the hepatotoxin carbon tetrachloride. Changes in the level of expression of GC-C and its ligands uroguanylin and guanylin were quantified by real-time PCR. Liver morphology, and hepatocyte necrosis, apoptosis and proliferation, were examined at 1-3 days post-injury in mice on a mixed genetic background. Survival was followed for 14 days after carbon tetrachloride injection in wild type and GC-C deficient mice on both a mixed genetic background and on an inbred C57BL6/J background.</p> <p>Results</p> <p>GC-C deficient mice on the mixed genetic background nearly all died (median survival of 5 days) following carbon tetrachloride injection while WT littermates experienced only 35% mortality. Elevated levels of TUNEL-positive hepatocyte death on post-injury day 1, increased apoptosis on day 2, and increased areas of centrilobular necrosis on days 2 and 3, were evident in livers from GC-C null mice compared to WT. Collectively these data suggest increased hepatocyte death in the GC-C null mice in the early time period after injury. This corresponds temporally with increased expression of GC-C and its ligands guanylin and uroguanylin in post-injury WT mouse liver. The hepatocyte proliferative response to injury was the same in both genotypes. In contrast, there was no difference in survival between GC-C null and WT mice on the inbred C57BL/6 J background in response to acute liver injury.</p> <p>Conclusions</p> <p>Signalling via GC-C promotes hepatocyte survival <it>in vivo </it>and is required for effective recovery from acute toxic injury to the liver in a strain-specific manner.</p