Perfil clínico de gestantes portadoras de lúpus eritematoso sistêmico do Hospital de Clínicas da Universidade Federal do Paraná

Modelo do estudo: estudo descritivo, observacional, transversal e parte retrospectivo. Objetivo: Avaliar o perfil clínico e desfecho materno-fetal das gestantes com lúpus eritematoso sistêmico (LES) em acompanhamento no Hospital de Clínicas da Universidade Federal do Paraná (UFPR). Metodologia: O estudo descreveu o histórico clínico e obstétrico preconcepção, aspectos clínicos durante a gestação e o desfecho materno-fetal de 30 gestantes com LES, atendidas no ambulatório de Pré-natal do Hospital de Clínicas da UFPR, entre março de 2012 a novembro de 2015. Resultados: Verificou-se que 46,7% das gestantes apresentavam manifestação renal do LES, 50% tinham histórico de complicação obstétrica prévia e 13,3% apresentavam atividade de doença antes da gravidez. Na gestação, 26,7% apresentaram atividade de doença e 46,7% evoluíram com complicações materno-fetais (hipertensão gestacional, pré-eclâmpsia, perdas gestacionais, restrição do crescimento intrauterino, prematuridade, baixo peso ao nascer ou óbito neonatal). Houve relevância estatística entre atividade de doença durante a gestação e atividade de doença preconcepção, assim como entre prematuridade e presença de anticorpos antifosfolípides e síndrome antifosfolípide e também do conjunto de complicações materno-fetais com atividade preconcepção e uso de doses de prednisona >10mg/dia. Conclusão: Neste estudo encontramos uma frequência elevada (46,7%) de complicações maternas e/ou fetais em gestações de pacientes lúpicas, portanto, gestantes com LES são consideradas de alto risco. Recomenda-se que a gravidez destas pacientes seja planejada e acompanhada por profissionais com conhecimento no manejo da doença de base.Model study: descriptive, observational, cross-sectional and partially retrospective study. Objective: The aim of this study was to evaluate the clinical profile and maternal-fetal outcomes of pregnant women with systemic lupus erythematosus (SLE) followed at Hospital de Clínicas of the UFPR. Methodology: The study described the clinical and preconception obstetric history, clinical and laboratory aspects during pregnancy and maternal-fetal outcomes of 30 pregnant women with SLE assisted at Prenatal Clinic of the Hospital de Clínicas of the UFPR, between March 2012 and November 2015. Results: It was found that 46,7% of the pregnant women presented renal manifestation of the SLE, history of maternal or fetal complications was observed in 50% of them and 13,3% of the patients had preconception active disease. During pregnancy, 26,7% had disease activity and 46,7% developed maternal or fetal complications (gestational hypertension, preeclampsia, pregnancy loss, delayed intrauterine growth, prematurity birth, low birth weight or neonatal death). There was statistical significance between disease activity during pregnancy and preconception active disease, as well between prematurity and the presence of antiphospholipid antibodies and antiphospholipid syndrome and also between the maternal and fetal complications as a whole and preconception activity and the use of prednisone >10mg/day. Conclusions: In this study we found a high frequency (46.7%) of maternal and/or fetal complications in pregnancies of lupus patients, therefore, pregnant women with SLE are considered to be at high risk. It is recommended that pregnancy in SLE patients should be planned and monitored by professionals who are experts in the disease management

Variabilidade da vazão na Bacia Hidrográfica do Rio Araguaia influenciada pela precipitação em anos extremos e desmatamento

Os extremos climáticos e a dinâmica de uso e cobertura do solo podem acarretar alterações na vazão dos rios. O objetivo deste trabalho foi analisar a vazão do rio Araguaia sob os efeitos de anos extremos associada à dinâmica do uso do solo na bacia hidrográfica do rio Araguaia no período de 1981 a 2019. O produto do uso e cobertura do solo foi baseado na classificação do Projeto MapBiomas, importado da plataforma Google Earth Engine. Os dados de precipitação e vazão medidas foram obtidos da Agência Nacional de Águas, enquanto a precipitação estimada se baseou nos dados Climate Hazards Group InfraRed Precipitation with Station data. A climatologia da precipitação apresentou os menores valores (1.464,9–1.720,4 mm) no setor centro-sul, e os maiores (1.720,4–2.014,6 mm) montantes pluviais foram vistos ao norte. Contudo, identificou-se nos cinco postos pluviométricos alta variabilidade de precipitação, com destaque para os anos extremos. Tais anos chuvosos e secos foram marcados por grande diferença na disponibilidade hídrica. Houve intensa redução dos biomas amazônico e cerrado em 31.641,8 e 42.618,9 km², respectivamente, principalmente em decorrência da expansão de 18.936,1 km² das atividades de agricultura e 47.494 km² de pasto. A variabilidade fluviométrica apresentou tendência de diminuição, principalmente nos últimos 15 anos. Ações públicas como intensificação de políticas ambientais, monitoramento com enfoque nas áreas mais comprometidas e estratégicas, como a cabeceira do rio Araguaia, podem minimizar os impactos causados por extremos climáticos e desmatamento.The climatic extremes and the dynamics of land use and cover can cause changes in river flow. The objective of this work was to analyze the flow of the Araguaia River under the effects of extreme years associated with the dynamics of land use in the Araguaia Watershed (AW) from 1981 to 2019. The land use and land cover product were based on the MapBiomas Project classification, imported from the Google Earth Engine. The measured rainfall and flow data were obtained from the National Water Agency. In contrast, the estimated rainfall was based on the data Climate Hazards Group InfraRed Precipitation with Stations. The precipitation climatology showed the lowest values (1,464.9–1,720.4 mm) in the south-central sector, and the highest (1,720.4–2,014.6 mm) rainfall amounts were observed in the north sector. However, it was identified in the five pluviometric stations with a high variability of precipitation, with an emphasis on the extreme years. Such wet and dry years were marked by a large difference in water availability. There was an intense reduction of the Amazon and Cerrado biomes by 31,641.8 and 42,618.9 km², respectively, mainly due to the expansion of 18,936.1 km² of agricultural activities and 47,494 km² of pasture. The fluviometric variability showed a decreasing trend, mainly in the past 15 years. Public actions, such as the intensification of environmental policies, monitoring focusing on the most compromised and strategic areas such as the headwaters of the Araguaia River, can minimize the impacts caused by climate extremes and deforestation

Measurement properties of the questionnaire "Mosaic of opinions on induced abortion" : a multicenter study in seven Brazilian hospitals

In Brasil, abortion is legal in cases of rape, when there is a risk of maternal death, and in cases of fetal anencephaly. However, the literature reports that some doctors refuse to care for women with such demands or come to perform it in a discriminatory manner. OBJECTIVE: Pretest, test and evaluate the measurement properties of the “Mosaic of Opinions on Induced Abortion,” a questionnaire developed to investigate the perspectives of Brazilian healthcare professionals about the morality of abortion. METHODS: Firstly, the questionnaire was pretested in an intentional sample of specialists. Secondly, it was tested in a randomized sample of 32 healthcare professionals. Finally, we conducted a multi-center study in seven university hospitals to evaluate the measurement properties of the questionnaire. RESULTS: Combined samples of the three phases totalized 430 individuals. In pretest and test, all the evaluated aspects obtained satisfactory results. In the multicenter phase, confirmatory factorial analysis led to an important reduction of the questionnaire, which also obtained good indicators of reliability, beyond the validation of construct and criteria. CONCLUSION: Questionnaire has been validated and is suitable for use in other surveys in Brasil

Antiarrhythmogenic effects of a neurotoxin from the spider Phoneutria nigriventer.

In this study, we evaluated the effects of PhKv, a 4584 Da peptide isolated from the spider Phoneutria nigriventer venom, in the isolated rat heart and in isolated ventricular myocytes. Ventricular arrhythmias were induced by occlusion of the left anterior descending coronary artery for 15 min followed by 30 min of reperfusion. Administration of native PhKv (240 nM) 1 min before or after reperfusion markedly reduced the duration of arrhythmias. This effect was blocked by atropine, thereby indicating the participation of muscarinic receptors in the antiarrhythmogenic effect of PhKv. Notably, recombinant PhKv (240 nM) was also efficient to attenuate the arrhythmias (3.8 0.9 vs. 8.0 1.2 arbitrary units in control group). Furthermore, PhKv induced a significant reduction in heart rate. This bradycardia was partially blunted by atropine and potentiated by pyridostigmine. To further evaluate the participation of acetylcholine on the PhKv effects, we examined the release of this neurotransmitter from neuromuscular junctions. It was found that Phkv (200 nM) significantly increased the release of acetylcholine in this preparation. Moreover, PhKv (250 nM) did not cause any significant change in action potential or Ca2þ transient parameters in isolated cardiomyocytes. Altogether, these findings show an important acetylcholine-mediated antiarrhythmogenic effect of the spider PhKv toxin in isolated hearts

Applying the maternal near miss approach for the evaluation of quality of obstetric care : a worked example from a multicenter surveillance study

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase inmaternalmortality ratio, themain factors associated with nonadequate performance were geographic difficulty in accessing health services ( < 0.001), delays related to quality of medical care ( = 0.012), absence of blood derivatives ( = 0.013), difficulties of communication between health services ( = 0.004), and any delay during thewhole process ( = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care

Applying the maternal near miss approach for the evaluation of quality of obstetric care : a worked example from a multicenter surveillance study

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase inmaternalmortality ratio, themain factors associated with nonadequate performance were geographic difficulty in accessing health services ( < 0.001), delays related to quality of medical care ( = 0.012), absence of blood derivatives ( = 0.013), difficulties of communication between health services ( = 0.004), and any delay during thewhole process ( = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care