Mode of delivery and labour analgesia: a study of preference in portuguese pregnant women

Background: Portugal has had one of the highest cesarean rates in Europe, possibly influenced by patient preferences. A reduction in the prevalence of these rates due to safety, quality, and concern with costs is one of the current goals of obstetric care. Fear of pain, often associated with vaginal delivery, is one of the reasons why pregnant women might prefer a cesarean section. Objective: The aim of this study was to identify the type of delivery and anaesthesia/analgesia preferred, as well as the reasons and factors associated with this preference, in a representative sample in order to identify possible modifiable factors possibly involved in increased rates. Methods: A descriptive cross-sectional study was carried out by an anonymous questionnaire to 245 pregnant women from February to April 2018. Respondents were also asked about their preference for peripartum anaesthesia/analgesia and on the sources of information that helped decide their preferences. Results: 22% of respondents would prefer an elective cesarean section. This preference was higher in women with a previous cesarean section. The preference for vaginal delivery was higher in women with more advanced pregnancies. The main reasons that led participants to prefer a vaginal delivery were the quicker postpartum recovery and not wanting to miss the first hours of their child's life. Regarding the preference for an elective cesarean section, the main reasons were fear and convenience. Most pregnant women preferred epidural analgesia. Respondents who selected their doctor (most common source) were more likely to prefer vaginal delivery. Conclusion: A minority of women showed a preference for cesarean delivery. A majority would prefer to have epidural anaesthesia. Despite the high cesarean rates, maternal desire for cesarean section is low, suggesting that this number is due to factors other than the preference of pregnant women.info:eu-repo/semantics/publishedVersio

Machine learning models based on clinical indices and cardiotocographic features for discriminating asphyxia fetuses—Porto retrospective intrapartum study

IntroductionPerinatal asphyxia is one of the most frequent causes of neonatal mortality, affecting approximately four million newborns worldwide each year and causing the death of one million individuals. One of the main reasons for these high incidences is the lack of consensual methods of early diagnosis for this pathology. Estimating risk-appropriate health care for mother and baby is essential for increasing the quality of the health care system. Thus, it is necessary to investigate models that improve the prediction of perinatal asphyxia. Access to the cardiotocographic signals (CTGs) in conjunction with various clinical parameters can be crucial for the development of a successful model.ObjectivesThis exploratory work aims to develop predictive models of perinatal asphyxia based on clinical parameters and fetal heart rate (fHR) indices.MethodsSingle gestations data from a retrospective unicentric study from Centro Hospitalar e Universitário do Porto de São João (CHUSJ) between 2010 and 2018 was probed. The CTGs were acquired and analyzed by Omniview-SisPorto, estimating several fHR features. The clinical variables were obtained from the electronic clinical records stored by ObsCare. Entropy and compression characterized the complexity of the fHR time series. These variables' contribution to the prediction of asphyxia perinatal was probed by binary logistic regression (BLR) and Naive-Bayes (NB) models.ResultsThe data consisted of 517 cases, with 15 pathological cases. The asphyxia prediction models showed promising results, with an area under the receiver operator characteristic curve (AUC) >70%. In NB approaches, the best models combined clinical and SisPorto features. The best model was the univariate BLR with the variable compression ratio scale 2 (CR2) and an AUC of 94.93% [94.55; 95.31%].ConclusionBoth BLR and Bayesian models have advantages and disadvantages. The model with the best performance predicting perinatal asphyxia was the univariate BLR with the CR2 variable, demonstrating the importance of non-linear indices in perinatal asphyxia detection. Future studies should explore decision support systems to detect sepsis, including clinical and CTGs features (linear and non-linear)

Right ventricular lead in cardiac resynchronization therapy : what is the most electrically favorable stimulation site?

© The European Society of Cardiology 2018. All rights reserved.Introduction: The most recent studies in cardiac resynchronization therapy (CRT) have been focused on attempts to improve response rate, such as the determination of the optimal placement of the left ventricular (LV) lead. The position of the LV lead guided by the site of latest electrical delay (ED), seems to be a promising strategy. The same strategy may be useful in assessing the ideal positioning of right ventricular (RV) lead in CRT. Purpose: To determine the most favorable position of the RV lead (septal versus apical) in CRT, by measuring the ED of the LV poles during septal or apical RV pacing in patients with triple-site CRT (TRIV). Methods: A single-center prospective study of consecutive patients (Oct. 2014 to Oct. 2017) submited to CRT device implantation (Quadra Allure MPTM, which allows post-implantation ED measurement) in TRIV mode - with a quadripolar lead in the LV, a RV lead positioned at the septum and a RV lead at the apex. In the follow-up, the lead position was confirmed and determined by fluoroscopic evaluation (anterior, lateral and postero-lateral in the short axis and basal, mid and apical on the long axis). The ED was measured at the 4-pole LV lead, during apical and septal RV pacing and the relation between the ED and lead position was evaluated. Results: Twenty two patients were included: 82% male, median age 78 years; 50% implanted CRT with defibrillator; 27% had ischemic heart disease and 73% non-ischemic etiology; all patients had permanent atrial fibrillation and the QRS duration was of 176±29ms. The position of the LE lead poles was classified as lateral in 44% and postero-lateral in 56%, basal in 28%, medial in 39% and apical in 34%. We evaluated 160 ED. The mean ED between the apical RV lead and the LV poles was significantly higher than the delay between septal RV lead and the LV poles [161±33ms vs 75±45ms (p<0.001)]. This difference remained significant in LV poles located in a lateral position (76±62 vs. 166±36ms; p<0.001) or in a postero-lateral position (74±30 vs. 157±31ms; p<0.001); the same ocurred for LV poles in a basal (99±62 vs. 179±24ms, p<0.001), mid (72±38 vs. 167±31ms, p<0.001) and apical location (57±24 vs. 140±32ms, p<0.001). Conclusion: The LV lead position is an important determinant of the success of CRT, but is conditioned by anatomical and technical characteristics. The optimization of CRT may then depend on the positioning of RV lead. This study demonstrated that the apical (vs. septal) RV lead positioning presents higher ED in relation to LV lead, regardless of the latter position.info:eu-repo/semantics/publishedVersio

The polar lipidome of cultured Emiliania huxleyi: a source of bioactive lipids with relevance for biotechnological applications

Polar lipids from microalgae have aroused greater interest as a natural source of omega-3 (n-3) polyunsaturated fatty acids (PUFA), an alternative to fish, but also as bioactive compounds with multiple applications. The present study aims to characterize the polar lipid profile of cultured microalga Emiliania huxleyi using hydrophilic interaction liquid chromatography coupled with high-resolution mass spectrometry (HILIC-MS) and fatty acids (FA) analysis by gas chromatography (GC-MS). The lipidome of E. huxleyi revealed the presence of distinct n-3 PUFA (40% of total FA), namely docosahexaenoic acid (22:6n-3) and stearidonic acid (18:4n-3), which give this microalga an increased commercial value as a source of n-3 PUFA present in the form of polar lipids. A total of 134 species of polar lipids were identified and some of these species, particularly glycolipids, have already been reported for their bioactive properties. Among betaine lipids, the diacylglyceryl carboxyhydroxymethylcholine (DGCC) class is the least reported in microalgae. For the first time, monomethylphosphatidylethanolamine (MMPE) has been found in the lipidome of E. huxleyi. Overall, this study highlights the potential of E. huxleyi as a sustainable source of high-value polar lipids that can be exploited for different applications, namely human and animal nutrition, cosmetics, and pharmaceuticals.FCT/ FCT/MCTES (Portugal) for the financial support to CICECO (UIDB/50011/2020 and 50011/2020), QOPNA (UID/QUI/00062/2019), LAQV-REQUIMTE (UIDB/50006/2020), CESAM (UIDB/50017/2020 and UIDP/50017/2020), RNEM (LISBOA-01-0145-FEDER-402-022125) and CCMAR: (UIDB/04326/2020).info:eu-repo/semantics/publishedVersio

Block Room: a chave para a eficiência

Introdução: A utilização crescente de anestesia locorregional (ALR) e de um block room (BR) pode ter impacto na eficiência do bloco operatório (BO). O objetivo deste estudo consiste na validação de inquéritos-piloto que avaliem o conhecimento de ortopedistas e de enfermeiros do BO sobre os benefícios da ALR e da utilização de um BR. Metodologia: Elaboraram-se 2 tipos de inquéritos-piloto e aplicaramse em 3 instituições hospitalares independentes. Realizou-se a análise descritiva das variáveis e da consistência interna, nomeadamente pelo cálculo do coeficiente α de Cronbach e análise fatorial, com restruturação consequente do inquérito. Resultados: Foram preenchidos 80 inquéritos: 42 pelos enfermeiros do BO e 38 pelos ortopedistas, com 20-24 anos e 10-14 anos de serviço, em média, respetivamente. Verifica-se que os enfermeiros recomendam frequentemente técnicas anestésicas aos seus doentes (em particular ALR: 76,2%). Já os ortopedistas recomendam ocasionalmente, sendo que quando recomendam 47,4% particulariza a ALR. Ambos os grupos consideram que, em comparação com a anestesia geral (AG), a ALR é mais segura (85,7%/76,3%), está associada a menor sedação (81,0%/73,7%), melhor controlo da dor pós-operatória (90,5%/84,2%) e menos efeitos laterais (76,2%/50%). Quanto à satisfação do doente, o grupo de enfermeiros concorda que é superior com a ALR (73,8%); já para os ortopedistas esta questão é indiferente (47,4%). Ambos os grupos escolheriam a ALR para si (97,6%/75,7%), assim como a recomendariam a um familiar (100%/83,3%). Relativamente à realização de ALR na sala de indução, 44.7% dos ortopedistas concordam que está associado a menor tempo de preparação anestésica, a uma maior produtividade (52,6%) e a maior eficácia (76,4%). Os inquéritos-piloto apresentam um α de Cronbach de 0,533 no grupo dos ortopedistas e 0,417 nos enfermeiros. A análise fatorial confirma a existência de 4 fatores, que explicam 74% da variância dos resultados. Na interpretação da tabela da matriz fatorial, todos os itens têm um valor>0.5, pelo que há uma associação clara a um fator. Discussão: Ambos os inquéritos-piloto apresentam consistência interna inadmissível. Múltiplos fatores podem estar envolvidos, tais como desconhecimento científico, interpretação incorreta ou disparidade de opinião. De modo a aumentar a consistência interna, foi retirada a questão relativamente à ansiedade dos doentes (AG vs. ALR) em ambos os grupos e à avaliação neurológica pós-operatória (AG vs. ALR) no grupo dos ortopedistas (consistência interna final 0,753). Pela análise fatorial, a questão relativamente à alta hospitalar precoce (AG vs. ALR) foi removida no grupo dos enfermeiros (consistência interna final 0,539). Apesar das suas limitações, os inquéritos-piloto encontram-se validados para a população portuguesa. Uma proporção considerável de ortopedistas considera que BR proporciona ganhos de eficiência no BO. O suporte genuíno de toda a equipa do BO poderá ter um papel crítico na mudançainfo:eu-repo/semantics/publishedVersio

Blueberry consumption challenges hepatic mitochondrial bioenergetics and elicits transcriptomics reprogramming in healthy wistar rats

An emergent trend of blueberries’ (BB) “prophylactic” consumption, due to their phytochemicals’ richness and well-known health-promoting claims, is widely scaled-up. However, the benefits arising from BB indiscriminate intake remains puzzling based on incongruent preclinical and human data. To provide a more in-depth elucidation and support towards a healthier and safer consumption, we conducted a translation-minded experimental study in healthy Wistar rats that consumed BB in a juice form (25 g/kg body weight (BW)/day; 14 weeks’ protocol). Particular attention was paid to the physiological adaptations succeeding in the gut and liver tissues regarding the acknowledged BB-induced metabolic benefits. Systemically, BB boosted serum antioxidant activity and repressed the circulating levels of 3-hydroxybutyrate (3-HB) ketone bodies and 3-HB/acetoacetate ratio. Moreover, BB elicited increased fecal succinic acid levels without major changes on gut microbiota (GM) composition and gut ultra-structural organization. Remarkably, an accentuated hepatic mitochondrial bioenergetic challenge, ensuing metabolic transcriptomic reprogramming along with a concerted anti-inflammatory pre-conditioning, was clearly detected upon long-term consumption of BB phytochemicals. Altogether, the results disclosed herein portray a quiescent mitochondrial-related metabolomics and hint for a unified adaptive response to this nutritional challenge. The beneficial or noxious consequences arising from this dietary trend should be carefully interpreted and necessarily claims future research.info:eu-repo/semantics/publishedVersio