Epidemiological analysis of maternal mortality in the state of Parana: the impact of the COVID-19 pandemic

Introduction: Maternal mortality is a significant indicator in Brazilian public policies concerning women's health care. The Rede Mãe Paranaense program works to decrease these indicators, but the impacts of the pandemic on maternal-fetal mortality are not yet understood. Objectives: To analyze Maternal Mortality in the years 2015-2019 and compare it to the year 2020 in Paraná. Methods: Retrospective documentary study, through data collection from the DATASUS/SIM program. Results: An increase in indirect maternal deaths was observed, specifically in the ICD-10 category O98 (Maternal infectious and parasitic diseases [...]), which included deaths caused by COVID-19 (p < 0.0001). Puerperal deaths predominated, especially in the white population, with infectious and parasitic diseases being the main indirect causes. A relative comparison of the periods demonstrated that indirect deaths in 2020 exceeded the average of the previous 5 years, indicating the impact of COVID-19 on maternal mortality. Discussion: In both studied periods, deaths occurred predominantly in a hospital setting. However, in 2020, the proportion of deaths in hospitals increased from 76% to 91%, reflecting a consequence of the elevated maternal mortality due to the COVID-19 pandemic and higher rates of complications in the pregnancies of these patients. Conclusion: The pattern disruption of indirect maternal mortality demonstrated the significant impact of the COVID-19 pandemic on maternal health. Further studies should analyze and compare additional variables, due to the nature of the study and the sample taken from a specific state in Brazil limit the generalization of findings to other locations and populations. Additionally, epidemiological data collection research can serve as a planning tool to formulate intervention and prevention strategies for comorbidities that directly and indirectly influence pregnancies.Introdução: A mortalidade materna é relevante indicador nas políticas públicas Brasileiras de assistência à saúde da mulher. A Rede Mãe Paranaense trabalha para reduzir esses indicadores, mas ainda são desconhecidos os impactos da pandemia no óbito materno-fetal. Objetivo:  Analisar a Mortalidade Materna nos anos de 2015-2019 e comparar ao ano de 2020 no Paraná. Métodos: Estudo documental retrospectivo, através de coleta de dados do programa DATASUS/SIM. Resultados: Foi observado aumento das mortes maternas indiretas, especificamente na categoria CID10-O98 (Doenças infecciosas e parasitárias maternas [...]), onde foram incluídos os óbitos causados pela COVID-19 (p < 0,0001). Predominaram as mortes puerperais e na população de cor/raça branca, sendo as doenças infecciosas e parasitárias as principais causas indiretas. Uma comparação relativa dos períodos demonstrou que os óbitos indiretos em 2020 superaram a média dos 5 anos anteriores, indicando o impacto da COVID-19 na mortalidade materna. Discussão: Em ambos os períodos estudados, as mortes ocorreram, predominantemente, em ambiente hospitalar. Contudo, em 2020, a proporção de mortes em hospitais aumentou de 76% para 91%, expressando um reflexo do aumento da mortalidade materna devido à pandemia da COVID-19 e de maiores taxas de complicações nas gestações dessas pacientes. Conclusão: A quebra de padrão de mortalidade materna indireta demonstrou o impacto significativo da pandemia de COVID-19 na saúde materna. Novos estudos devem analisar e comparar outras variáveis, pois a natureza do estudo e a amostra extraída de um estado específico do Brasil, limitam a generalização dos achados para outros locais e populações. Ademais, pesquisas de levantamento de dados epidemiológicos podem ser úteis como ferramenta de planejamento no âmbito de elaborar estratégias de intervenção e prevenção de comorbidades que influenciem direta e indiretamente as gestações

Qualidade de Vida de Crianças e Adolescentes Portadores de Diabetes Mellitus Tipo I.

INTRODUCTION: Diabetes Mellitus (DM) is a metabolic syndrome of multiple etiologies, which results from the lack of insulin or its inability to perform its function properly, characterized by chronic hyperglycemia, with the presence of metabolic disorders in proteins, carbohydrates and lipids. OBJECTIVE: To present, according to the scientific literature, the quality of life of children and adolescents with Type I Diabetes Mellitus. METHODOLOGY: This is a qualitative study, referring to an integrative literature review, presenting a synthesis of the studies analyzed in full, organizing them for the elaboration of the results regarding the established theme, being carried out in the month of August 2023. RESULTS: After the diagnosis of DM1, the child and the adolescent ends up going through several phases due to the changes that end up happening in your life. These changes end up bringing about a profound transformation in her world, modifying her routine and making her have to live with some limitations. FINAL CONSIDERATIONS: These consequences are directly linked to psychological factors and the difficulty in accepting the disease. Thus, it is important that these users have follow-up and further clarification on the subject, in order to encourage their autonomy and self-confidence in the face of DM1 treatment.INTRODUÇÃO: A Diabetes Mellitus (DM) é uma síndrome metabólica de etiologia múltipla, que decorre da carência de insulina ou da incapacidade da mesma exercer sua função adequadamente, caracterizando-se por uma hiperglicemia crônica, com presença de distúrbios metabólicos nas proteínas, carboidratos e lipídios. OBJETIVO: Apresentar, de acordo com a literatura científica, a qualidade de vida de crianças e adolescentes portadores da Diabetes Mellitus Tipo I. METODOLOGIA: Trata-se de um estudo qualitativo, refere-se a uma revisão integrativa da literatura, apresentando uma síntese dos estudos analisados na íntegra, organizando-os para a elaboração dos resultados a respeito da temática estabelecida, sendo realizada no mês de agosto de 2023. RESULTADOS: Após o diagnóstico da DM1, a criança é o adolescente acaba passando por várias fases devido às mudanças que acabam acontecendo em sua vida. Essas mudanças acabam trazendo uma transformação profunda em seu mundo, modificando sua rotina e fazendo com que ela precise conviver com algumas limitações. CONSIDERAÇÕES FINAIS: Essas consequências estão diretamente ligadas a fatores psicológicos e a dificuldade na aceitação da doença. Assim, torna-se importante que esses usuários tenham acompanhamento e mais esclarecimentos a respeito do assunto, de forma a incentivar sua autonomia e autoconfiança diante do tratamento da DM1

Hard-Object Feeding in Sooty Mangabeys (Cercocebus atys) and Interpretation of Early Hominin Feeding Ecology

Morphology of the dentofacial complex of early hominins has figured prominently in the inference of their dietary adaptations. Recent theoretical analysis of craniofacial morphology of Australopithecus africanus proposes that skull form in this taxon represents adaptation to feeding on large, hard objects. A modern analog for this specific dietary specialization is provided by the West African sooty mangabey, Cercocebus atys. This species habitually feeds on the large, exceptionally hard nuts of Sacoglottis gabonensis, stereotypically crushing the seed casings using their premolars and molars. This type of behavior has been inferred for A. africanus based on mathematical stress analysis and aspects of dental wear and morphology. While postcanine megadontia, premolar enlargement and thick molar enamel characterize both A. africanus and C. atys, these features are not universally associated with durophagy among living anthropoids. Occlusal microwear analysis reveals complex microwear textures in C. atys unlike those observed in A. africanus, but more closely resembling textures observed in Paranthropus robustus. Since sooty mangabeys process hard objects in a manner similar to that proposed for A. africanus, yet do so without the craniofacial buttressing characteristic of this hominin, it follows that derived features of the australopith skull are sufficient but not necessary for the consumption of large, hard objects. The adaptive significance of australopith craniofacial morphology may instead be related to the toughness, rather than the hardness, of ingested foods

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Multiple copy number variation in a patient with Kleefstra syndrome

ABSTRACT Objective: To report a rare case of a patient with a molecular diagnosis of Kleefstra syndrome (KS) who has four other chromosomal alterations involving pathogenic variants. Case description: Male patient, two years old, with global delay, including in neuropsychomotor development, ocular hypertelorism, broad forehead, brachycephaly, hypotonia, ligament laxity, unilateral single palmar crease and arachnoid cyst. The microarray-based comparative genomic hybridization (a-CGH) identified copy number variations (CNVs) in five regions: 9q34.3, 6p22.1, Yq11.223, Yp11.23, and 2q24.1. The heterozygous microdeletion in 9q34.3 involving the EHMT1 gene confirms the diagnosis of KS. Comments: The presence of pathogenic CNVs and/or those of uncertain significance, located on chromosomes 2, 6 and Y, may be contributing to a variability in the patient's clinical condition (arachnoid cyst, single palmar fold and ligament laxity), compared to other individuals with only KS genetic alteration, making the dignosis of the disease harder