Contracepção Em Adolescentes Antes E Depois Do Parto: Escolhas E Desafios Para O Futuro

To determine methods of contraception used by adolescents before and after pregnancy. Methods A cross-sectional study was performed, and data were collected from medical records of all teens in puerperal consultation at the Hospital da Mulher - José Aristodemo Pinotti (Caism), Universidade Estadual de Campinas (CAISM), São Paulo, Brazil, between July 2011 and September 2013. The inclusion criterionwas being 10 to 19 years old, and the exclusion criterion was having a first consultation 90 days after childbirth. Statistical analyseswere performed with averages, standard deviations, percentages, correlations and Fisher's exact tests using the SAS program, version 9.4. Results A total of 196 adolescents in postpartum consultation were included (44 days after childbirth on average). The majority was older than 14 years (89%), with an average age of 16.2 years, and the most were exclusively breast-feeding (70%). Before pregnancy, the use of any contraceptive methods was mentioned by 74% adolescents; the most frequent use was combined oral contraceptive followed by condom. The main reason for abandoning the use of contraception was the occurrence of an unintended pregnancy (41%), followed by reports of side effects (22%), behavior issues (18%) and desire for pregnancy (16%). A positive correlation was found between the age of the adolescent at the moment of childbirth, the age of menarche (r = 0.3), and the first sexual intercourse (r = 0.419). Vaginal delivery occurred in 76% of the cases. After birth, depot medroxyprogesterone acetate (DMPA) was the contraception method most frequently used (71%), followed by oral contraceptives (11.8%) and intrauterine devices (IUDs, 11.2%). Conclusions The most prescribed contraceptive method before pregnancy in adolescents who had childbirth was combined oral contraceptives. Many of the study participants had an unintended pregnancy. After childbirth, the most used contraceptive method was DMPA. To improve contraception and reduce the chance of unintended pregnancies among adolescents, we should promote the use of long-acting reversible contraceptives (LARCS).38154555

PERCEPÇÃO AMBIENTAL DE USUÁRIOS DE PRAIA NO LITORAL SETENTRIONAL POTIGUAR-RN: EMBATES E PERSPECTIVAS FRENTE A OCUPAÇÃO DA ORLA MARÍTIMA

A presente pesquisa tem como objetivo principal verificar a percepção dos frequentadores das praias sobre o modelo de uso e ocupação do espaço da orla marítima de Tibau e Grossos. Os procedimentos metodológicos utilizaram-se da abordagem mista por meio da aplicação de 99 questionários em 4 pontos da orla de ambos os municípios. Para tabulação dos dados foi utilizada a análise nominal, por meio da porcentagem com o auxílio do programa Excel 2013. Os resultados demonstraram que os usuários da praia, entendem sobre a importância da conservação destes ambientes e os serviços que estes fornecem a sociedade, nesse contexto ressalta-se o ordenamento referente à proximidade das casas de veraneio em relação à praia, em todas as orlas os entrevistados alegaram que acham as casas muito próximas a praia, sendo que na orla B – Tibau mostrou o maior percentual com 87%, em seguida a orla C com 68% e por último a orla B – Grossos com 56% dos entrevistados. Já os que não consideram as casas de veraneio muito próxima à praia, o maior percentual ficou na orla B – Grossos com 44% dos entrevistados. Portanto, a área de estudo necessita de um plano de ordenamento territorial e principalmente planos municipais de turismo para melhor efetividade do setor de ambos os municípios, de modo que forneça tantos aos turistas, como aos moradores locais frequentadores das praias de ambos os municípios melhorias em dias de lazer

Immune-Mediated Hemolytic Anemia in a Bitch Triggered by Drugs

Background: Immune-mediated hemolytic anemia (IMHA) is characterized by an autoimmune response with production of auto-antibodies and destruction of erythrocytes resulting in anemia. Primary IMHA is referred to a condition when the cause is unknown (idiopathic), whereas secondary IMHA involves changes in red blood cells caused by the action of drugs, neoplasms, or infectious diseases. The diagnosis can be made through changes in the blood count, usually of a regenerative character, Coombs test, and autoagglutination test. The present study aimed to report a case of drug-induced hemolytic anemia, with emphasis on the clinical signs, diagnostic methods, and treatment, in a female dog.Case: A 9-year-old mixed-breed bitch weighing 29.6 kg was referred to the Veterinary Medical Teaching Hospital (HCV-UFRGS) with a previous diagnosis of gallbladder mucocele that was unresponsive to clinical treatment. After laboratory tests, cholecystectomy was performed, and the procedure required conversion from laparoscopic to open cholecystectomy. Therapy included administration of amoxicillin, dipyrone, tramadol hydrochloride, and meloxicam. Three days after surgery, the dog presented with apathy, lethargy, hyporexia, and a pale and subicteric mucosa. The patient developed hypochromic macrocytic anemia with reticulocytosis, spherocytosis, anisocytosis, and leukocytosis with neutrophilia. The result of the autoagglutination test was positive, confirming the diagnosis. All medications were suspended, and immunosuppressive treatment with dexamethasone was included, with a subsequent switch to prednisolone. After 10 days of treatment, the patient experienced significant improvement, and therapy was discontinued.Discussion: Based on the patient's history, the cause of the IMHA was secondary to drug administration, and it is not possible to distinguish if it was due to one or a combination of drugs, as they were all started and stopped simultaneously. The patient had hypothyroidism, which may have contributed to the production of antibodies against TSH receptors, blocking the hormone's action, thereby causing tissue damage due to T cell-mediated cytotoxicity and the effect of cytokines. The pale and subicteric mucosa, apathy, weakness, lethargy, exercise intolerance, and dyspnea resulted from extravascular hemolysis and bilirubin released from erythrocyte rupture with a subsequent decrease in the number of red blood cells, leading to oxygen transport deficiency. The diagnosis is based on the blood count and results of autoagglutination supported by the response to immunosuppressive therapy. Anemia results in increased production and release of precursor cells from the bone marrow, accompanied by reticulocytosis and increased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). The treatment of IMHA consists of supportive care and immunosuppressive therapy with corticosteroids to ensure suppression of the immune system, preventing response against erythrocytes. Initially, tramadol hydrochloride, dipyrone, and amoxicillin with potassium clavulanate were suspended to interrupt the cause of IMHA, and administration of dexamethasone in an immunosuppressive dose was started. Therefore, it is important to include drug-induced IMHA in the differential diagnosis of patients who present with anemia after using medications. Early diagnosis, initiation of therapy, and adequate care were important factors for the recovery of the animal.Título: Anemia hemolítica imunomediada medicamentosa em uma cadelaKeywords: dog, hypochromic macrocytic anemia, erythrocyte, hemoglobin, spherocyte.Descritores: cão, anemia macrocítica hipocrômica, eritrócito, hemoglobina, esferócito.

Nefrectomia total unilateral em cachorro-do-mato (Cerdocyon thous)

Background: The loss of natural habitats associated with the development of humanity resulted in the need for longer trips and greater interaction with highways by some animal species. Vehicle collision with animals is one of the main factors of pressure over wild animal populations in Brazil; veterinary surgery can play an important role for the recovery of these patients. The lesions commonly seen in animals hit by vehicles may comprise skin lesions, central nervous system injuries, intrathoracic and intra-abdominal complications, among which renal lesions are included. The aim of this work is to report the use of a total nephrectomy technique in a crab-eating fox.Case: A female, adult, 5-kg crab-eating fox (Cerdocyon thous Linnaeus, 1766) was received for emergency care at the Veterinary Hospital of Universidade Federal do Paraná at Palotina. The patient had been struck by a vehicle at a local highway, was unconscious, and exhibited signs of blood loss such as hypothermia, hypotension, and pale mucous membranes. As the clinical evaluation was performed, the patient was stabilized with pain management, correction of hypovolemia and hypothermia, and oxygen therapy. Blood samples were taken in case of the need for preoperative tests. Subsequently, the animal was submitted to the diagnostic imaging section to investigate possible injuries. No chemical restraint was necessary for the procedures. Radiography examination revealed loss of intra-abdominal contrast, which was confirmed to be free fluid on ultrasound examination. Immediately after imaging examination, the animal was taken to the surgical room for exploratory laparotomy. The surgical incision, which was performed over the linea alba, extended from the xiphoid process to the pubis. During surgery, free fluid was confirmed to be diffuse bloody fluid, which was observed in the abdomen; there was absence of lesions in all organs except the right kidney, which revealed clots and lacerations to the capsule, cortex, and medulla, resulting in poor viability of the organ. The condition required removal of the organ, which was performed with the conventional technique described for domestic animals. During the nephrectomy surgical procedure, the patient exhibited severe hypotension with the need of compensatory measures such as intravenous administration of crystalloid and colloid solutions, and vasoactive drugs, which were maintained during the period of surgery. Postoperative care included administration of analgesics and anti-inflammatory drugs for three days, and antibiotics for seven days. Hematological and renal profiles as well as ultrasound examinations were used for monitoring of clinical evolution. The patient was kept in isolation to avoid behavioral stress during hospital stay.Discussion: In this case, the importance of ultrasound diagnosis and viability of the nephrectomy technique were established for the specimen, which was returned to its natural habitat eighteen days after the vehicle collision, after authorization from the local environmental agency. Immediate care of a wild animal that suffers trauma is an important factor to increase success rate for recovery of fauna threatened by vehicle collisions. Early diagnosis associated with the employment of surgical techniques commonly used for domestic animals allow wild-animal clinicians and surgeons to improve viability of threatened populations

Gastrointestinal Syndrome in a Rabbit (Oryctolagus cuniculus)

Background: The term “rabbit gastrointestinal syndrome” (RGIS) refers to a decrease in peristaltic movements, which in some cases can progress to absolute inactivity of the digestive apparatus. This condition is mostly secondary to others that promote changes in gastrointestinal motility, such as dehydration, fiber deficiency, excess carbohydrates in diets, stress, and acute or chronic painful processes. Clinical manifestations are mostly nonspecific. Thus, a case of RGIS resulting from environmental change in a domestic rabbit (Oryctolagus cuniculus) is reported.Case: A 4-month-old male domestic rabbit weighing 0.962 kg was referred to a university veterinary hospital. The patient had a history of absence of defecation and anorexia for the past two days. The owner reported that the patient was apathetic but became aggressive when manipulated. The changes started after a move of residence. On physical evaluation, an increase in abdominal volume and a painful response to touch on the abdomen were observed. Complementary examinations were performed, such as a blood count and an ultrasound study. The blood tests showed no alterations, but the ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic structure associated with acoustic shading in the small intestine, all findings suggestive of obstruction. Given the failure of clinical management, the patient was referred for an exploratory laparotomy procedure followed by enterotomy. The obstruction point was located near the ileocecal junction. After surgery, analgesics, antibiotics, fluid therapy, anti-inflammatory drugs, intestinal motility inducers, and probiotics were prescribed. One week after the surgical procedure, the patient showed improvement in the clinical condition, with normal appetite, defecation, and docility.Discussion: RGIS is diagnosed based on the clinical history, clinical manifestations, and complementary examinations. In the reported case, the patient presented apathy, anorexia, absence of defecation, and aggressiveness on manipulation, which were associated with abdominal pain. In cases of RGIS, hematological changes may or may not be present, which matches the findings in this report. Imaging exams provide important information, such as the patient’s condition and evolution. Ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic, immobile acoustic shading structure in the small intestine. Ultrasound findings were compatible with those found in cases of foreign-body obstructions, a common complication in RGIS. Initially, a clinical approach was taken, but in view of the unfavorable evolution of the case, with worsening motility and alterations in the imaging examination, a surgical approach was instituted. Intestinal obstructions in rabbits are usually found either in the proximal duodenum or near the ileocecal junction. In the presently reported patient, an obstruction was identified in the ileocecal junction region and the content found was composed of hair and dehydrated food. There are several conditions that can alter intestinal peristalsis in rabbits; in the present case, it was considered that the distress caused by moving to a new household led to a condition of RGIS. Despite the reserved prognosis associated with surgical interventions in the gastrointestinal system of rabbits, as described in the literature, in the present case this approach made it possible to preserve the patient’s life, which returned to its normal activities and behavior

Conventional method for the diagnosis of mycoses : a comparative study

Introdução: O método clássico para o diagnóstico de micoses é realizado pelo Exame Micológico Direto (EMD) e cultural, que possibilita a visualização de estruturas fúngicas vegetativas e estruturas reprodutivas, respectivamente. Essa combinação é fundamental para reduzir possíveis erros analíticos e aumentar a precisão do diagnóstico. Métodos: Com a finalidade de verificar a frequência do EMD e cultural, e comparar seus parâmetros de sensibilidade e especificidade, realizamos uma análise retrospectiva entre janeiro de 2018 e maio de 2020, de 1603 laudos micológicos oriundos de um laboratório de análises clínicas, localizado em Porto Alegre. Resultados: Após a análise dos laudos observamos que a maioria dos casos apresentaram o EMD negativo com cultura positiva (36,24%). Na sequência, 30,87% dos casos foram de amostras negativas e 25,57% dos laudos foram positivos para ambos os exames. A minoria dos casos (7,29%) apresentou o EMD positivo com cultura negativa. Conclusão: Esta análise revelou que o exame cultural é mais sensível e específico, demonstrando uma maior confiabilidade no diagnóstico. Entretanto, vale ressaltar que a realização dos exames em conjunto, além de reduzir possíveis erros analíticos, proporciona um diagnóstico melhor fundamentado.Introduction: The classic method for the diagnosis of mycoses is performed by both direct mycological examination (DME) and culture, which allow the visualization of vegetative and reproductive fungal structures, respectively. This combination is essential to reduce possible analytical errors and increase the accuracy of the diagnosis. Methods: To assess the frequency of DME and culture, and compare their parameters of sensitivity and specificity, we performed a retrospective analysis of 1603 mycological reports produced between January 2018 and May 2020 in a clinical analysis laboratory in Porto Alegre, southern Brazil. Results: After analyzing the reports, we observed that most cases presented a negative DME and a positive culture (36.24%). Subsequently, 30.87% of the cases were negative for both tests, and 25.57% were positive for both tests. The minority of cases (7.29%) presented a positive DME and a negative culture. Conclusion: Our analysis revealed that cultural examination is more sensitive and specific, showing greater reliability in the diagnosis. However, it is noteworthy that performing the tests together, in addition to reducing possible analytical errors, provides a more consistent diagnosis

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千葉医学雑誌57-