Cirurgia Com Tela Para Correção De Prolapso De Parede Anterior: Metanálise

Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6–8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: ‘anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)’ in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score ( > 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07–1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72–82,25]), longer surgery time (MD = 15,08 [0,48–29,67]), but less prolapse recurrence (OR = 0,22 [01,3–0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.38735636

Cirurgia com tela para correção de prolapso de parede anterior: metanálise

Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6–8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: ‘anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)’ in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score ( > 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07–1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72–82,25]), longer surgery time (MD = 15,08 [0,48–29,67]), but less prolapse recurrence (OR = 0,22 [01,3–0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.387356364Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comum o anterior. Para tratamento são utilizadas cirurgias, com ou sem telas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos: Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): “Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)”. Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados: Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p ≤ 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões: Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Tipos e doses de adubação orgânica no crescimento, no rendimento e na composição química do óleo essencial de elixir paregórico Sources and doses of organic fertilization in Ocimum selloi growth, essential oil yield and chemical composition

A prática da adubação orgânica, além de fornecer nutrientes para as plantas, proporciona a melhoria da estrutura física do solo, aumenta a retenção de água, diminui as perdas por erosão e favorece o controle biológico. O elixir paregórico (Ocimum selloi Benth.) é uma espécie medicinal nativa das regiões Sul e Sudeste do Brasil onde é utilizada popularmente como antidiarréico, antiespasmódico e antiinflamatório. Este trabalho teve como objetivo verificar o efeito de diferentes doses de dois adubos orgânicos no crescimento, no rendimento e na composição do óleo essencial de elixir paregórico. Os experimentos foram conduzidos em Lavras, MG, em estufa plástica com os seguintes tratamentos de adubação: ensaio A - esterco bovino: 1) sem adubação (controle); 2) solo + 3kg m-2 de esterco; 3) solo+ 6kg m-2 de esterco; 4) solo+ 9kg m-2 de esterco; 5) solo + 12kg m-2 de esterco; ensaio B - Esterco avícola: 1) sem adubação (controle); 2) solo + 1,5kg m-2 de esterco; 3) solo + 3kg m-2 de esterco; 4) solo + 4,5kg m-2 de esterco e 5) solo + 6kg m-2 de esterco. Foi verificada a influência das doses de adubação com esterco bovino e galinha sobre o crescimento da planta em altura e diâmetro do caule, acúmulo de biomassa seca, AF, AFE, RPF, teor de clorofilas, espessura do limbo foliar, rendimento e composição química do óleo essencial.<br>The organic fertilization provides nutrients for the plants, improves the soil physical structure, increases the water retention, reduces the erosion losses and favors the biological control. Ocimum selloi is a native medicinal plant of south and southeast of Brazil where is used popularly as antidiarrhetic, antispasmodic and anti-inflammatory. This research aimed to verify the effect of different doses of two organic fertilizers souces in O. selloi growth, essential oil yield and chemical composition. The experiments were carried out in Lavras, MG, with pots in polyethylene greenhouse with two manuring treatments: Test A - Cattle manure: 1) Soil without manuring (control); 2) Soil + 3kg m-2 cattle manure; 3) Soil + 6kg m-2 cattle manure; 4) Soil + 9kg m-2 cattle manure; 5) Soil + 12kg m-2 cattle manure; Test B - Chicken manure: 1) Soil without manuring (control); 2) Soil + 1.5kg m-2 chicken manure; 3) Soil + 3 kg m-2 chicken manure; 4) Soil + 4.5kg m-2 chicken manure and 5) Soil + 6kg m-2 chicken manure. The influence of cattle and chicken manuring doses was verified on plant height, stem diameter, dry biomass weight, TLA, SLA, LWR, chlorophylls content, leaf thickness, essential oil yield and composition

Adubação nitrogenada no consórcio de milho com duas espécies de braquiária em sistema plantio direto

O objetivo deste trabalho foi avaliar a produtividade de grãos e de forragem do consórcio entre milho e espécies de braquiária (safras de 2008/2009 e 2009/2010), submetidos a doses de nitrogênio em cobertura, em sistema plantio direto. Utilizou-se o delineamento experimental inteiramente casualizado, com quatro repetições, em arranjo fatorial 2x5, com duas espécies de braquiária (Urochloa brizantha 'Xaraés' e U. ruziziensis) e cinco doses de N aplicadas em cobertura: 0, 50, 100, 150 e 200 kg ha‑1. Foram avaliados: leituras indiretas do teor foliar de clorofila (índice de clorofila Falker, ICF), teores de macronutrientes foliares, componentes da produção e produtividade de grãos do milho, e produtividade de matéria seca das forrageiras após o consórcio. Constatou-se que a espécie U. ruziziensis foi a mais competitiva com o milho em consórcio, o que proporcionou menores teores nutricionais e ICF nas duas safras analisadas. O crescimento vegetativo, os componentes da produção e a produtividade de grãos do milho não foram influenciados pelos consórcios. A adubação nitrogenada em cobertura aumenta linearmente o ICF, os teores de N, P e S, bem como os componentes da produção e a produtividade de grãos

Germinação e vigor de sementes de Bauhinia divaricata L. Germination and vigor of the Bauhinia divaricata L. seeds

A pata-de-vaca (Bauhinia divaricata) é uma espécie arbórea, amplamente distribuída no Brasil, de alto valor ornamental e econômico. Sua propagação ocorre por meio de sementes, cuja germinação tem sido pouco investigada. Dessa forma, o presente trabalho teve como objetivo definir o tipo de substrato e a temperatura mais adequados para avaliar a germinação e o vigor de sementes de Bauhinia divaricata. O experimento foi realizado no Laboratório de Análise de Sementes do CCA-UFPB, em Areia-PB, em delineamento inteiramente casualizado com os tratamentos distribuídos em esquema fatorial 3 x 5, com os fatores temperaturas constantes de 25 e 30&deg;C e alternada 20-30&deg;C e substratos entre papel, sobre papel, rolo de papel, entre areia e entre vermiculita, em quatro repetições de 25 sementes, em câmaras tipo BOD, com fotoperíodo de oito horas. Foram analisadas as seguintes variáveis: porcentagem de germinação, primeira contagem e índice de velocidade de germinação e massa seca de plântulas. Concluiu-se que a temperatura de 25&deg;C, juntamente com os substratos entre papel, sobre papel e rolo de papel, é adequada para condução de testes de germinação e vigor com sementes de Bauhinia divaricata. O substrato areia nas três temperaturas (20-30, 25 e 30&deg;C) foi responsável pelas menores porcentagens de germinação e níveis de vigor das sementes.<br>The Bauhinia divaricata is an arboreal species with high ornamental and economical value and distributed throughout Brazil. It is propagated by seeds, from which germination needs more investigation. So, this study was carried out at the Seed Analysis Laboratory pertaining to CCA-UFPB - Areia, in BOD-type chambers with 8h photoperiod in order to determine the most adequate substratum and temperature for evaluating the germination and vigor of the Bauhinia divaricata seeds. The entirely randomized experimental design in the factorial scheme 3 x 5 was used. The factors were constituted by constant temperatures of 25 and 30&deg;C and alternate 20-30&deg;C, as well as substrata between paper, on paper, paper roll, among sand and among vermiculite, in four replicates of 25 seeds. The following variables were analyzed: percent germination, first counting, germination index and dry matter of the plantlets. The 25&deg;C temperature and the substrata between paper, on paper and paper roll showed to be adequate to the test for germination and vigor of the Bauhinia divaricata seeds. The lowest germination percentages and the seed vigor levels occurred in the sand substratum at three temperatures (20-30, 25 and 30&deg;C)

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions. © Copyright