Desigualdades sociodemográficas e na assistência à maternidade entre puérperas no Sudeste do Brasil segundo cor da pele: dados do inquérito nacional Nascer no Brasil (2011-2012)

Historically, in Brazil, the health indicators of mothers and babies by skin color show an unfavorable picture to black and brown-skinned women. In the last decade, the reduction of disparities in income and education, as well as the universalization of health care, may have altered this situation to some extent. The objective of this study was to analyze the changes in socio-demographic inequalities and maternity care in Southeastern Brazil, by race/color, in the last decade. We used data from the national survey Born in Brazil (2011-2012). Descriptive statistical analysis was performed in order to define socio-demographic characteristics, access to antenatal care, clinical and obstetric history, and characteristics of birth assistance. We found differences unfavorable to black and brown-skinned women in education, income, and paid work; white women had more private health insurance plans, and increased age. Black and brown women had fewer medical appointments, fewer ultrasounds, more antenatal care considered inadequate, higher parity, and more hypertensive disorders. In childbirth, they had fewer companions and more vaginal deliveries, although the cesarean rate has grown twice as high among black women. More often they went into labor and had children born full term. There was no statistically significant difference in marital status, pregnancy complications, diabetes mellitus, anemia, syphilis, HIV, pilgrimage to delivery, neonatal or maternal near miss, and most of the interventions in vaginal delivery. Although major disparities persist, there was some reduction in sociodemographic differences as well as increased access to both appropriate and unnecessary and potentially harmful interventions.Historicamente, no Brasil, os indicadores de saúde de mães e bebês segundo cor da pele mostram quadro desfavorável às negras (pretas e pardas). Na última década, a redução das disparidades de renda e escolaridade, assim como a universalização da assistência à saúde, podem ter alterado esse quadro, em alguma medida. O objetivo deste artigo foi analisar as mudanças nas desigualdades sociodemográficas e na assistência à maternidade no Sudeste do Brasil, segundo raça/cor, na última década. Utilizamos dados do inquérito nacional Nascer no Brasil (2011-2012). Análise estatística descritiva foi realizada para a caracterização sociodemográfica, do acesso à assistência pré-natal, antecedentes clínicos e obstétricos, e características da assistência ao parto. Encontramos diferenças desfavoráveis às pretas e pardas quanto à escolaridade, renda e ao trabalho remunerado; as brancas tinham mais planos de saúde privados e maior idade. As pretas e pardas tiveram menor número de consultas, menos ultrassonografias, mais cuidado pré-natal considerado inadequado, maior paridade e mais síndromes hipertensivas. No parto, tiveram menos acompanhantes, mais partos vaginais, embora a cesárea tenha dobrado entre as negras, que com mais frequência entraram em trabalho de parto e tiveram filhos nascidos de termo pleno. Não houve diferença estatisticamente significativa quanto à situação conjugal, intercorrências da gestação, diabetes mellitus, anemias, sífilis, HIV, peregrinação para o parto, near miss materno ou neonatal e na maioria das intervenções no parto vaginal. Ainda que importantes disparidades persistam, houve alguma redução das diferenças sociodemográficas e um aumento do acesso, tanto a intervenções adequadas quanto às desnecessárias e potencialmente danosas

Influence of cooling methods on the residual mechanical behavior of fire-exposed concrete : an experimental study.

This work reports the main conclusions of a study on the mechanical behavior of concrete under ISO 834 fire with different cooling methods. The aim of this research was to provide reliable data for the analysis of structures damaged by fire. The experimental program used cylindrical concrete test specimens subjected to ISO 834 heating in a furnace up to maximum gas temperatures of 400, 500, 600, 700, and 800 ?C. The compressive strength was measured in three situations: (a) at the different temperature levels reached in the furnace; (b) after a natural cooling process; and (c) after aspersion with water at ambient temperature. The results indicate that the concrete residual compressive strength is fairly dependent on the maximum temperature reached in the furnace and revealed that concrete of a lower strength preserved relatively higher levels of strength. The cooling method significantly influenced the strength, albeit at a lower intensity. In all cases, the residual strength remained in the range of 38% to 67% of the strength at ambient temperature. The statistical analysis showed that the data obtained by the experimental program are significant and confirmed the influence of the conditions imposed on the residual strength

Antibody reactivity against potato apyrase, a protein that shares epitopes with Schistosoma mansoni ATP diphosphohydrolase isoforms, in acute and chronically infected mice, after chemotherapy and reinfection

Schistosoma mansoni ATP diphosphohydrolase isoforms and potato apyrase share conserved epitopes. By enzyme-linked immunosorbent assays, elevated levels of IgM, IgG2a and IgG1 antibody reactivity against potato apyrase were observed in S. mansoni-infected BALB/c mice during the acute phase of infection, while only IgM and IgG1 antibody reactivity levels maintained elevated during the chronic phase of infection. Antibody reactivity against potato apyrase was monitored over an 11-month period in chronically-infected mice treated with oxamniquine. Eleven months later, the level of seropositive IgM decreased significantly (~30%) compared to the level found in untreated, infected mice. The level of seropositive IgG1 decreased significantly four months after treatment (MAT) (61%) and remained at this level even after 11 months. The IgG2a reactivity against potato apyrase, although unchanged during chronic phase to 11 MAT, appeared elevated again in re-infected mice suggesting a response similar to that found during the acute phase. BALB/c mouse polyclonal anti-potato apyrase IgG reacted with soluble egg antigens probably due to the recognition of parasite ATP diphosphohydrolase. This study, for the first time, showed that the IgG2a antibody from S. mansoni-infected BALB mice cross-reacts with potato apyrase and the level of IgG2a in infected mice differentiates disease phases. The results also suggest that different conserved-epitopes contribute to the immune response in schistosomiasis

An emerging clone, KPC-2-producing Klebsiella pneumoniae ST16, associated with high mortality rates in a CC258 endemic setting

Background Carbapenemase-producing K. pneumoniae have become a global priority, not least in low-middle income countries. Here, we report the emergence and clinical impact of a novel KPC-K. pneumoniae ST16 clone in a Clonal Complex (CC)258 endemic setting. Methods In a teaching Brazilian hospital, a retrospective cohort of adult KPC-KP bloodstream infections (BSI) cases (January 2014 to December 2016) was established to study the molecular epidemiology and its impact on outcome (30-day all-cause mortality). KPC-KP isolates were MLST-typed. Survival analysis between ST/CC groups and risk factors for fatal outcome (logistic regression) were evaluated. Representative isolates underwent whole genome sequencing (WGS), and had their virulence tested in a Galleria larvae model. Results One hundred sixty-five unique KPC-KP BSI cases were identified. CC258 was predominant (66%), followed by ST16 (12%). The overall 30-day mortality rate was 60%; in contrast, 95% of ST16 cases were fatal. Patient’s severity scores were high and baseline clinical variables were not statistically different across ST’s. In multivariate analysis, ST16 (OR 21.4; CI95% 2.3-202.8; p=0,008) and septic shock (OR 11.9; CI95% 4.2-34.1; p<0,001) were independent risk factors for fatal outcome. ST16 clone carried up to 14 resistance genes, including blaKPC-2 in an IncFIBpQIL plasmid, KL51 capsule and Yersiniabactin virulence determinants. ST16 clone was highly pathogenic in the larvae model. Conclusions Mortality rates were high in this KPC-KP BSI cohort, where CC258 is endemic. An emerging ST16 clone was associated with high mortality. Our results suggest that even in endemic settings, highly virulent clones can rapidly emerge demanding constant monitoring

Nanotechnology for the treatment of deep endometriosis: uptake of lipid core nanoparticles by LDL receptors in endometriotic foci

OBJECTIVE: Rapidly dividing cells in multiple types of cancer and inflammatory diseases undergo high low density lipoprotein (LDL) uptake for membrane synthesis, and coupling an LDL-like nanoemulsion, containing lipid nanoparticles (LDE) to a chemotherapeutic agent efficiently targets these cells without significant systemic effects. This was a prospective exploratory study that evaluated the uptake of a radioactively labeled LDE emulsion by receptors of endometriotic foci and the capacity of the LDE for cellular internalization. METHODS: The lipid profile of each patient was determined before surgery, and labeled LDE were injected into fourteen patients with intestinal or nonintestinal endometriosis. The radioactivity of each tissue sample (intestinal endometriosis, nonintestinal endometriosis, healthy peritoneum, or topical endometrium) was measured. RESULTS: The group with intestinal endometriosis presented higher levels of plasma LDL but lower LDE uptake by foci than the nonintestinal group, suggesting less cell division and more fibrosis. The uptake of LDE was highest in the topical endometrium, followed by the healthy peritoneum, and lowest in the endometriotic lesion. Since the endometriotic foci showed significant LDE uptake, there was likely increased consumption of LDL by these cells, similar to cells in cancers and inflammatory diseases. Plasma cholesterol levels had no influence on LDE uptake, which showed that the direct delivery of the nanoemulsion to target tissues was independent of serum lipoproteins. There were no significant differences in the parameters (p40.01) because of the small sample size, but the findings were similar to those of previous studies. CONCLUSION: Nanotechnology is a promising therapeutic option for surgery and hormonal blockage for deep endometriosis, with a lower complication rate and no systemic side effects

The growth dynamics in Brachiaria species according to nitrogen dose and shade

It was studied the effects of shading (0, 36 and 54%) and of four nitrogen doses (0, 50, 100 and 150 mg N/dm³ of soil) on the morphogenetic traits and on the tillering of grasses of Brachiaria genus (B. decumbens, B. ruziziensis and B. brizantha cv. Marandu and cv. Xaraes), cultivated in pots with 5 kg substrate. It was used a complete random design, in a 3 × 4 × 4 factorial scheme with three replications. Nitrogen promoted increase in leaf appearance rate and in average leaf blade length, whereas shading increased stem elongation rate. Leaf elongation rate and tillering varied with the interaction among shading percentages and nitrogen doses. Shading increased response efficiency of leaf elongation rate to nitrogen doses, but reduced for tillering, evidencing priority existing tillering growth in detriment to appearance of new tillers when there is light restriction for the plants. Phenotypic adjustments, in response to light reduction, indicate that the studied grasses present tolerance to moderate shading.Estudaram-se os efeitos do sombreamento (0, 36 e 54%) e de doses de nitrogênio (0, 50, 100 e 150 mg/dm³ de solo) nas características morfogênicas e no perfilhamento de gramíneas do gênero Brachiaria (B. decumbens, B. ruziziensis e B. brizantha cvs. Marandu e Xaraes) cultivadas em vasos com capacidade para 5 kg de substrato. Adotou-se o delineamento inteiramente casualizado, em esquema fatorial 3 × 4 × 4 com três repetições. O nitrogênio promoveu aumento na taxa de aparecimento de folhas e no comprimento médio das lâminas foliares, enquanto o sombreamento aumentou a taxa de alongamento do colmo. A taxa de alongamento de folhas e o perfilhamento variaram com a interação entre as percentagens de sombra e as doses de nitrogênio. O sombreamento aumentou a eficiência de resposta da taxa de alongamento de folhas às doses de nitrogênio, mas reduziu para o perfilhamento, evidenciando prioridade no crescimento de perfilhos existentes em detrimento do surgimento de novos perfilhos quando há restrição de luminosidade para as plantas. Os ajustes fenotípicos, em resposta à diminuição de luz, indicam que as forrageiras estudadas apresentam tolerância ao sombreamento moderado