Prevalência e conduta terapêutica de lesões pré-malignas de colo uterino em gestantes atendidas em hospital público do Rio Grande do Sul

Cervical cancer is closely linked with the presence of human papillomavirus (HPV), which is responsible for the onset of premalignant cervical lesions. This study aimed to estimate the prevalence of premalignant lesions in pregnant women who underwent prenatal follow-up at the Hospital Universitário de Santa Maria (HUSM), to analyze the profile of the patients and to evaluate the treatment performed by analyzing their medical records, stored in the hospital archive after approval by the Ethics Committee. With the data collection, it was verified that of the 645 patients who underwent the cytopathological examination, 1.08% presented premalignant lesions, of which 0.62% were cases of low-grade squamous intraepithelial lesion (LSIL) and 0.46% % of high-grade squamous intraepithelial lesion (HSIL). In the majority of cases, patients with LSIL and HSIL had adequate follow-up, where the therapeutic management was satisfactory. O câncer de colo do útero está intimamente ligado com a presença do papilomavírus humano (HPV), o qual é responsável pelo surgimento de lesões pré-malignas de colo uterino. Este estudo objetivou estimar a prevalência de lesões pré-malignas em gestantes que realizaram o acompanhamento pré-natal no Hospital Universitário de Santa Maria (HUSM), analisar o perfil das pacientes e avaliar o tratamento realizado por meio de análise dos prontuários impressos das pacientes armazenados no setor de arquivo do hospital, após a aprovação do Comitê de Ética. Com a coleta de dados, verificou-se que de 645 pacientes que realizaram o exame citopatológico, 1,08% apresentaram lesões pré-malignas, sendo 0,62 % casos de lesão escamosa intra-epitelial de baixo grau (LSIL) e 0,46 % de lesão escamosa intra-epitelial de alto grau (HSIL). Em sua grande maioria, as pacientes com LSIL e HSIL tiveram um acompanhamento adequado, onde a conduta terapêutica tomada foi satisfatória

Delta-aminolevulinate dehydratase activity and oxidative profile in pregnant women with pre-gestational type 2 diabetes and gestational diabetes

The aim of this study was to perform a comparative evaluation between pregnant women: healthy, with pre-gestational type 2 diabetes (T2DM) and gestational diabetes mellitus (GDM), to determine if diabetes mellitus developed at different times interferes with the oxidative impact on the pregnant woman maternal body. A total of 90 pregnant women were recruited in the third trimester of pregnancy, subdivided into the three groups, and evaluated through their clinical characteristics, oxidative stress markers and delta-aminolevulinate dehydratase (δ-ALA- D) activity. Pregnant women with diabetes mellitus (DM) showed an increase in: age, pre-gestational and gestational body mass index (BMI), blood pressure, blood glucose and platelet count; those with T2DM had higher pre-gestational BMI and glycated hemoglobin A1c (HbA1c). The levels of thiobarbituric acid reactive substances were higher and the levels of non-protein thiols and catalase activity were lower in the DM groups compared to the control. Vitamin C was decreased in the T2DM group. The δ-ALA-D activity was decreased in pregnant women with GDM and the rate of enzymatic reactivation was higher in the DM groups. DM presented in gestation, regardless of the moment of its development, generates increase of the oxidative stress and decrease of the antioxidant defences, representing the largest difference with the control group. It is suggested that the insulin used in the treatment of T2DM acts in a beneficial way in the δ-ALA-D activity

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Vaginal delivery is associated with lower levels of thiol groups, vitamin C and ferric reducing ability in colostrum compared with caesarean section

This study aimed to investigate the effects of delivery type (normal or caesarean) on the antioxidant and oxidative capacity of colostrum collected shortly after delivery. A total of 61 parturients were included in the study and divided into two groups: those who underwent vaginal delivery (n = 36) and those who underwent elective caesarean section (n = 25). Colostrum samples were collected by manual milking up to 48 h post parturition and analysed for thiol groups (–SH), vitamin C, ferric reducing ability (FRAP), nitrate/nitrite oxides (NOx), and advanced oxidation protein products (AOPP). Colostrum levels of –SH (p = 0.0042), vitamin C (p = 0.0455), and FRAP (p = 0.0374) were significantly lower in the vaginal delivery group. The results suggest that vaginal delivery, compared to caesarean section, is associated with lower levels of antioxidants in colostrum and the mode of delivery plays an important role in the composition of antioxidants in maternal colostrum that help protect newborns from oxidative damage.IMPACT STATEMENT What is already known on this subject? Colostrum is the first biological fluid produced by the mother after delivery and is responsible for a child’s growth, cognitive development and health. It is known that childbirth can cause oxidative imbalance, and its effects have already been evaluated in maternal and foetal blood, however, there are few studies evaluating the effects of childbirth on colostrum composition. What do the results of this study add? Previously, a study showed that caesarean section caused greater oxidation of colostrum compared to vaginal delivery. Thus, we sought to evaluate other markers (thiol groups, vitamin C, ferric reducing ability, nitrate/nitrite oxides, and advanced oxidation protein products), in a short period of time after delivery, in order to elucidate this still little discussed issue. Unlike the previous one, our study suggests that vaginal delivery, compared to caesarean section, is associated with lower levels of antioxidants in colostrum, which may make it difficult to protect newborns from oxidative damage. What are the implications of these findings for clinical practice and/or further research? Our study suggests that normal delivery can influence the antioxidant composition of maternal colostrum, and it is debateable for future clinical practice to improve eating habits during pregnancy and lactation, in order to strengthen the antioxidant capacity of colostrum and reduce oxidative damage to newborns

Longitudinal Study of Delta-Aminolevulinate Dehydratase Activity and Oxidative Profile in Healthy Pregnant Women

Pregnancy is characterized by changes in various organs, triggering changes in the use of energy substrates and increased oxygen consumption. In addition, gestation is an oxidative event that can be assessed by the relationship between free radicals and antioxidants produced by the body. Excessive production of free radicals has detrimental effects such as damage to enzymes, carbohydrates, and DNA. Thus, the objective of this study was to evaluate the oxidative status and antioxidant responses throughout pregnancy through a longitudinal study. Reactive oxygen species were analyzed by means of thiobarbituric acid reactive substances and nitric oxide, the antioxidant system through vitamin C, sulfhydryl groups, total antioxidant capacity, and ferric reducing ability of plasma as well as enzymes such as catalase and delta-aminolevulinate-dehydratase in pregnant women in the three gestational trimesters (n = 30). According to the results, the markers of oxidative damage showed significant differences in the different gestational trimesters where they were increased in the second trimester when compared to the first trimester. The antioxidant defenses responded differently in each gestational trimester, suggesting a response pattern to try to combat the damage caused by free radicals, in order to stabilize the increase of oxidative stress caused in the second gestational trimester

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt