Postpartum depression epidemiology in a Brazilian sample

INTRODUCTION: Psychiatric symptoms are frequent in the postpartum period, a moment marked by hormonal alterations and changes in social character, family organization and women's identity. The Edinburgh Postnatal Depression Scale (EPDS) is a self-reporting instrument to track depression after pregnancy, unfortunately not always properly supported by health care professionals. This study aimed at verifying the prevalence of postpartum depression in women receiving care at basic health units. METHODS: Cross-sectional study including 292 women in the postpartum period (from day 31 to 180) who answered the EPDS questionnaire. Cut-off point < 12 for EPDS depression was used. RESULTS: A total of 115 women (39.4%) had scores < 12 in EPDS, classified as depressive; 177 (60.6%) had scores < 12 and were not considered depressive. Women with lower education, higher number of pregnancies, higher parity, higher number of live children and shortest relationship time had more depression. CONCLUSION: High frequency of postpartum depression is associated with social factors, which shows the importance of health care professionals in early detection of depression, with the aid of instruments such as EPDS, due to its efficacy and practicability.INTRODUÇÃO: Sintomas psiquiátricos são freqüentes após o parto, momento marcado por alterações hormonais e mudanças no caráter social, na organização familiar e na identidade feminina. A Escala de Depressão Pós-Parto de Edimburgo (EPDS) é instrumento de auto-avaliação para rastrear depressão após a gestação, nem sempre adequadamente reconhecida pelos profissionais de saúde. O objetivo deste estudo foi avaliar prevalência de depressão pós-parto em mulheres atendidas em unidades básicas de saúde. MÉTODOS: Estudo transversal com aplicação da EPDS em 292 mulheres que se encontravam entre 31 e 180 dias após o parto. Adotamos o ponto de corte < 12 na EPDS como depressão. RESULTADOS: Do total, 115 (39,4%) apresentaram escores < 12, na EPDS, foram consideradas deprimidas; 177 (60,6%), com escores < 12, foram consideradas não-deprimidas. Mulheres com menor escolaridade, maior número de gestações, maior paridade, maior número de filhos vivos e menor tempo de relacionamento apresentaram mais depressão. CONCLUSÃO: A elevada freqüência de depressão pós-parto está relacionada com fatores sociais, demonstrando a importância dos profissionais de atenção básica na detecção precoce da depressão, tendo como auxílio instrumentos como a EPDS, pela sua eficácia e praticidade.Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)Santa Casa de Misericórdia do Espírito Santo Escola de Ciências Superiores Departamento de Ginecologia e ObstetríciaUniversidade Federal do Espírito Santo Departamento de EstatísticaUNIFESP, EPMSciEL

Pregnancy follow-up and outcome in a patient with Takayasu's arteritis

We describe here the pregnancy follow-up and outcome in a patient with Takayasu's arteritis, with a detailed account of the complications during gestation and delivery and the impact of the disease on the newborn's health.No presente relato, que descreve a gestação de paciente portadora de arterite de Takayasu, serão avaliadas a interação dessa afecção com a gravidez e as intercorrências materno-fetais, do parto e do recém-nascido.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Impact of clinical characteristics on human chorionic gonadotropin regression after molar pregnancy

OBJECTIVES: This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a molar pregnancy. METHODS: This was a retrospective cohort study of 277 patients with molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. RESULTS: There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2&nbsp;versus.&nbsp;3.7 days,&nbsp;p=0.02 and 3.4&nbsp;versus.&nbsp;4.0 days,&nbsp;p=0.002, respectively). CONCLUSION: Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia

Violência sexual e associação com a percepção individual de saúde entre mulheres gestantes

OBJECTIVE: To estimate the prevalence of sexual violence history among pregnant women and its association with the self-perception of health status. METHODS: Cross-sectional study including a total of 179 pregnant women older than 14 years old at gestation week 14 to 28 attending public health services in the city of São Paulo, Southeastern Brazil, between 2006 and 2007. Data collection instruments included: questionnaire on sexual violence; questionnaire on sociodemographic data; and an assessment of health-related quality of life using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12®). Age, skin color, education, occupational and marital status, and self-perception of physical and mental health were compared between women with and without a lifetime history of sexual violence. Sexual violence was categorized as penetrative and non-penetrative sex. RESULTS: Among all women interviewed, the prevalence of sexual violence was 39.1%, of which 20% were of penetrative type by known perpetrators. In 57% of cases, the first episode of violence was before the age of 14. There were no sociodemographic differences between women with and without history of sexual violence. Mean scores of self-perception of physical health among women with history of sexual violence were lower (42.2; SD= 8.3) compared to those without history of sexual violence (51.0; SD= 7.5) (pOBJETIVO: Estimar la prevalencia de histórico de violencia sexual entre mujeres gestantes y su asociación con la percepción de salud. MÉTODOS: Estudio transversal, con 179 mujeres mayores de 14 años y embarazadas de 14 a 28 semanas, entrevistadas en servicios públicos de salud en Sao Paulo, Sureste de Brasil, entre los años de 2006 y 2007. Los instrumentos utilizados fueron: inventario de violencia sexual, inventario de datos sociodemográficos y cuestionario de calidad de vida relacionada con la salud: "Medical Outcomes 12-Item Short-Form Health Survey" (SF-12 ®). Mujeres con y sin historia de violencia sexual fueron comparadas con respecto a la edad, escolaridad, ocupación, estado civil, color de la piel y autopercepción de salud física y mental. La violencia sexual fue caracterizada en penetrativa o no penetrativa. RESULTADOS: Hubo prevalencia de 39,1% de violencia sexual entre las entrevistadas, siendo 20% del tipo penetrativo, cometida sobretodo por agresores conocidos. En 57% de las mujeres la primera agresión ocurrió antes de los 14 años. No hubo diferencias sociodemográficas entre mujeres que sufrieron y las que no sufrieron violencia sexual. Escores promedios de percepción de salud física entre las entrevistadas con antecedente de violencia sexual fueron menores (42,2; DP=8,3) con relación a las mujeres sin este antecedente (51,0; DP=7,5) (pOBJETIVO: Estimar a prevalência de histórico de violência sexual entre mulheres gestantes e sua associação com a percepção de saúde. MÉTODOS: Estudo transversal, com 179 mulheres maiores de 14 anos e grávidas de 14 a 28 semanas, entrevistadas em serviços públicos de saúde em São Paulo, SP, entre os anos de 2006 e 2007. Os instrumentos utilizados foram: inventário de violência sexual, inventário de dados sociodemográficos e questionário de qualidade de vida relacionada à saúde: "Medical Outcomes 12-Item Short-Form Health Survey" (SF-12®). Mulheres com e sem história de violência sexual foram comparadas quanto à idade, escolaridade, ocupação, estado civil, cor da pele e autopercepção de saúde física e mental. A violência sexual foi caracterizada em penetrativa ou não penetrativa. RESULTADOS: Houve prevalência de 39,1% de violência sexual entre as entrevistadas, sendo 20% do tipo penetrativo, cometida sobretudo por agressores conhecidos. Em 57% das mulheres a primeira agressão ocorreu antes dos 14 anos. Não houve diferenças sociodemográficas entre mulheres que sofreram e as que não sofreram violência sexual. Escores médios de percepção de saúde física entre as entrevistadas com antecedente de violência sexual foram menores (42,2; DP=8,3) do que das mulheres sem este antecedente (51,0; DP=7,5) (

PHC9 COST-EFFECTIVENESS OF RIVAROXABANVERSUS ENOXAPARIN FORTHROMBOPROPHYLAXIS AFTER TOTAL HIP REPLACEMENT IN THE UK

Vitis vinifera cell cultures respond to pathogens and elicitors by synthesizing and extracellularly accumulating stilbenoid phytoalexins. Large amounts of trans-resveratrol (t-R) are produced when a cell culture is elicited with methylated cyclodextrins (MBCD), either alone or combined with methyl jasmonate (MeJA). t-R transport to the extracellular medium, which represents the apoplastic space, would place this antifungal defense right in the battlefield to efficiently fight against pathogen attack. Yet despite their physiological relevance, these transport pathways are mostly unknown. A broad hypothesis-free DIGE-based proteomic experiment of a temporal series of elicited grapevine cell cultures was performed to explore the expression profiles of t-R biosynthetic proteins and other co-expressing proteins potentially involved in such a cell response. A correlation between two tau class glutathione-S-transferases (GSTs) with several stilbene synthase and phenylalanine ammonia-lyase isoforms, and with the t-R metabolite itself, was found and further assessed by a qRT-PCR gene expression analysis. The best candidate, GSTU-2, was cloned from the cDNA of the MBCD + MeJA-elicited grapevine cells and used for Agrobacterium-mediated grapevine cell transformation. The non-elicited lines that overexpressed GSTU-2 displayed an extracellular t-R accumulating phenotype, but stabilization of t-R required the addition to culture medium of adsorbent compounds, e.g., PVP or β-cyclodextrin. The wild-type cell cultures accumulated no t-R, not even in the presence of adsorbents. The transient expression of the GSTU-2-GFP fusion proteins in grapevine cells showed localisation in the plasma membrane, and the immunoprecipitation of HA-tagged GSTU-2 revealed its interaction with HIR, a plasma membrane-bound protein. These findings are consistent with a functional role in transport. This is the first report providing several pieces of experimental evidence for the involvement of a specific tau class GST in t-R transport to the extracellular medium

Prevalence of Hepatitis E Virus in Swine Fed on Kitchen Residue

The aim of this study was to investigate the prevalence of swine hepatitis E virus (HEV) in pigs fed different feedstuffs (kitchen residue or mixed feeds) and genetic identification of HEV isolated in Hebei province, China. Serum and fecal samples were collected from adult swine. Anti-HEV antibody was evaluated by double sandwich antigen enzyme immunoassay. HEV RNA was extracted from fecal samples and amplified by nested RT-PCR. The reaction products were sequenced, and the sequence analyzed. Virus-like particles were distinguishable by negative staining in the electron microscope. Histopathological observation and immunohistochemical localization were used in the animal models. Overall, the anti-HEV positive percentage of serum samples from pigs fed on kitchen residue was 87.10% (27/31), and 53.06% (130/245) from pigs fed on complete feed. The HEV RNA positivity rate of fecal samples from pigs fed on kitchen residue was 61.54% (8/13), but zero for pigs fed on complete feed. Sequence analysis of these eight samples and comparison with the published sequence showed that there were eight groups that belonged to genotype 4 d and the nucleotide identity was 95.6–99.3%. swHE11 is most closely related to strain CCC220, and the other seven HEV isolates were most closely related to strains swGX40, SwCH189 and V0008ORF3, which are isolates from human and pigs. Histopathological observation showed that there was liver damage in the experimental group, and immunohistochemistry indicated that the HEV antigens were strongly positive at 7 days after infection. The results demonstrated that the prevalence of HEV in pigs fed on kitchen residue was higher than in those fed on complete feed (P<0.05)

Inactivation of infectious hepatitis E virus present in commercial pig livers sold in local grocery stores in the United States

Hepatitis E virus (HEV) is a zoonotic pathogen and pigs are a known reservoir. Recently we showed that approximately 11% of commercial pig livers sold in local U.S. grocery stores for food consumptions are contaminated by infectious HEV. In this study, a swine bioassay was used to determine if the infectious HEV in contaminated commercial pig livers could be inactivated by traditional cooking methods. Group 1 pigs (n=5) were each inoculated intravenously (I.V.) with a HEV-negative liver homogenate as negative controls, group 2 pigs (n=5) were each inoculated I.V. with a pool of two HEV-positive pig liver homogenates as positive controls, groups 3, 4 and 5 pigs (n=5, each group) were each inoculated I.V. with a pool of homogenates of two HEV-positive livers incubated at 56°C for 1 hr, stir-fried at 191°C for 5 min or boiled in water for 5 min, respectively. As expected, the group 2 positive control pigs all became infected whereas the group 1 negative control pigs remained negative. Four of the five pigs inoculated with HEV-positive liver homogenates incubated at 56°C for 1 hr also became infected. However, pigs in groups 4 and 5 did not become infected. The results indicated that HEV in contaminated commercial pig livers can be effectively inactivated if cooked properly, although incubation at 56°C for 1 hr cannot inactivate the virus. Thus, to reduce the risk of food-borne HEV transmission, pig livers must be thoroughly cooked

Zoonotic hepatitis E: animal reservoirs and emerging risks

Hepatitis E virus (HEV) is responsible for enterically-transmitted acute hepatitis in humans with two distinct epidemiological patterns. In endemic regions, large waterborne epidemics with thousands of people affected have been observed, and, in contrast, in non-endemic regions, sporadic cases have been described. Although contaminated water has been well documented as the source of infection in endemic regions, the modes of transmission in non-endemic regions are much less known. HEV is a single-strand, positive-sense RNA virus which is classified in the Hepeviridae family with at least four known main genotypes (1–4) of mammalian HEV and one avian HEV. HEV is unique among the known hepatitis viruses, in which it has an animal reservoir. In contrast to humans, swine and other mammalian animal species infected by HEV generally remain asymptomatic, whereas chickens infected by avian HEV may develop a disease known as Hepatitis-Splenomegaly syndrome. HEV genotypes 1 and 2 are found exclusively in humans while genotypes 3 and 4 are found both in humans and other mammals. Several lines of evidence indicate that, in some cases involving HEV genotypes 3 and 4, animal to human transmissions occur. Furthermore, individuals with direct contact with animals are at higher risk of HEV infection. Cross-species infections with HEV genotypes 3 and 4 have been demonstrated experimentally. However, not all sources of human infections have been identified thus far and in many cases, the origin of HEV infection in humans remains unknown