Precocious and late pregnancy in adolescents: is there a difference comparing the obstetric risks?

PURPOSE: to describe the obstetric outcomes in pregnant adolescents at a tertiary hospital and to compare the maternal and labor outcomes between precocious and late adolescents. METHODS: in a transversal analytical study, 2058 cases were evaluated, considering 322 (15.65%) from the precocious group and 1736 (84.35%) from the late group that delivered at the Maternidade Escola Assis Chateaubriand/UFC from January 1, 2000 to December 31, 2000. The clinical complications in the prenatal period, kind of delivery, indications for cesarean section, birth gestational age at birth, birth weight, comparison of birth weight and gestational age, Apgar score at the first and fifth minute, presence of malformations, and neonatal death were analyzed. The exact Fisher and the chi2 tests were used to compare both groups. The prevalence ratio was calculated. RESULTS: from of total of deliveries, 25.95% belonged to adolescents. The average age was 17.19 years. Prenatal visits were made by 88% of the patients, but 60% had an insufficient number of visits. The most frequent clinical situations were preeclampsia (14.72%), anemia (12.97%) and urinary tract infections (6.37%), with no statistical difference between the groups. Thirty-one and three percent of the births were by cesarean section, preeclampsia being the main indication in the two age groups (25 and 23%, respectively). The frequency of an Apgar score less than 7 at the first minute was 19,9% in the precocious adolescent group and 14,2% in the late adolescent group (x²=6,96, p=0.008). There was no statistical difference regarding prematurity rate (20.2 vs 16.1%), low-birth weight infants (12.4 vs 10.4%), low Apgar score at the fifth minute (5.3 vs 3.3%), congenital malformations (3.1 vs 2.7%), and neonatal death (5.3 vs 3.3%). CONCLUSIONS: the precocious and late pregnant adolescents presented similar pregnancy evolution and obstetric outcomes, except for the differences of the first minute Apgar scores.OBJETIVOS: descrever aspectos da assistência e resultados obstétricos da gravidez em adolescentes atendidas em um centro de atendimento terciário do Ceará e comparar os resultados maternos e perinatais entre adolescentes precoces e tardias. MÉTODOS: em estudo transversal, analítico, avaliaram-se 2.058 casos, sendo 322 (15,6%) de adolescentes precoces e 1.736 (84,4%) tardias, atendidas no ano de 2000. Foram analisados as intercorrências clínicas no pré-natal, tipo de parto, indicações de cesárea, idade gestacional no parto, peso do recém-nascido ao nascimento, adequação do peso à idade gestacional, índices de Apgar no primeiro e quinto minuto de vida, presença de malformações e óbito neonatal. Utilizaram-se o teste exato de Fisher e o chi2 na comparação entre os dois grupos. Calculou-se também a razão de prevalência. RESULTADOS: do total de partos ocorridos no período, 25,9% eram de adolescentes e a média de idade destas foi de 17,2 anos. Constatou-se que 88% freqüentaram o pré-natal, sendo 60% com número insuficiente de consultas. As intercorrências clínicas mais freqüentes foram a pré-eclâmpsia (14,7%), a anemia (12,9%) e a infecção do trato urinário (6,4%), sem diferença de freqüência entre os grupos. Ocorreram 31,3% de nascimentos por cesárea, sendo a pré-eclâmpsia a principal indicação nas duas faixas etárias (25 e 23%, respectivamente). A freqüência de Apgar menor que 7 no primeiro minuto foi de 19,9% no grupo das adolescentes precoces e 14,2% entre as tardias (x²=6,96, p=0,008). Não houve diferença quanto à freqüência de prematuridade (20,2 vs 16,1%), recém-nascido pequeno para idade gestacional (12,4 vs 10,4%), baixos escores de Apgar de quinto minuto (5,3 vs 3,3%), malformações congênitas (3,1 vs 2,7%) e morte neonatal (1,6 vs 3,1%). CONCLUSÕES: as gestantes adolescentes precoces e tardias apresentaram evolução da gestação e desempenho obstétrico semelhantes, exceto pela diferença nos escores de Apgar no primeiro minuto.Universidade Federal do Ceará Maternidade-Escola Assis ChateaubriandUniversidade Federal do CearáUniversidade Federal do Ceará Departamento de Matemática e EstatísticaUniversidade Federal do Ceará Departamento de Saúde Materno-InfantilUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de ObstetríciaUNIFESP, EPM, Depto. de ObstetríciaSciEL

BLOQUEIO DO PLANO TRANSVERSO DO ABDÔMEN GUIADO POR ULTRASSOM EM FELINOSUBMETIDO A MASTECTOMIA REGIONAL

Locoregional blocks have been increasingly used in veterinary medicine. Blocking the transverse plane of the abdomen (TAP Block) is a technique of locoregional anesthesia, it is part of the multimodal analgesia strategy, capable of promoting anesthesia and analgesia in regions of skin, musculature and parietal peritoneum. The aim of this study is to report the transverse plane block in a two-year-old male cat undergoing regional mastectomy. Two ultrasound-guided TAP space block points were made on each side of the abdomen: one in the caudal part of the middle abodminal region, cranial to the iliac crest, and the other point, caudal to the last rib, with 0.5mg/kg of 0.25% bupivacaine at each point, standardizing an injected volume of 0.6mL. Acepromazine (0.05mg/kg), pethidine (3mg/kg), ketamine (2mg/kg) and midazolam (0.3mg/kg) were used as pre-anesthetic medication, induction with propofol (3mg/kg) and maintenance by inhalation anesthesia with isoflurane. It is concluded that the TAP block was effective for regional abdominal mastectomy, with a high safety index and easy to perform with adequate training, even with less frequent transducers.Os bloqueios locorregionais vêm sendo cada vez mais utilizados na medicina veterinária. O bloqueio do plano transverso do abdômen (TAP Block) é uma técnica de anestesia locorregional, faz parte da estratégia de analgesia multimodal, capaz de promover anestesia e analgesia em regiões de pele, musculatura e peritônio parietal. O objetivo deste trabalho é relatar o bloqueio do plano transverso em um felino macho de dois anos de idade submetido a mastectomia regional. Foram feitos dois pontos de bloqueio do espaço TAP guiado por ultrassom, em cada lado do abdômen: um na parte caudal da região abdominal média, cranial a crista ilíaca, e o outro ponto, caudal a última costela, com 0,5mg/kg de bupivacaína a 0,25% em cada ponto, padronizando um volume injetado de 0,6mL. Foi utilizado acepromazina (0,05mg/kg), petidina (3mg/kg), cetamina (2mg/kg) e midazolam (0,3mg/kg) como medicação pré-anestésica, indução com propofol (3mg/kg) e manutenção por anestesia inalatória com isoflurano. Conclui-se que o TAP block foi eficaz para mastectomia regional abdominal, com alto índice de segurança e de fácil execução com treinamento adequado, mesmo com transdutores de baixafrequência

A garantia da equidade à população trans na atenção primária à saúde / Guaranteeing equity to the trans population in primary health care

A população trans é um grupo de pessoas que ao longo dos anos vem sido vítima da discriminação, estigmatizada e marginalizada pela sociedade, e isso vem sido percebido no âmbito da saúde. Neste sentindo, este artigo trata-se de uma revisão de literatura que tem por objetivo analisar as evidências disponíveis na literatura sobre equidade no atendimento a pessoas transgênero atendidas na atenção primária à saúde, discorrendo sobre a importância da prestação de um atendimento de qualidade a esta população colocando em foco a garantia da equidade, que é um dos princípios fundamentais do sistema único de saúde

PROTOCOLO ANESTÉSICO EM GUAXINIM SUBMETIDO À COLOCEFALECTOMIA

In raccoons, the presence of osteoarthritis affecting the hip joint is commonly observed. In domestic carnivores, the treatment can be conservative or surgical and, among the surgical techniques, colocephalectomy is mentioned. Since it is a procedure that causes moderate to severe pain, a balanced anesthesia protocol is necessary, which can be associated with locoregional block techniques such as the epidural. Protocols described for the species are limited, being commonly used for chemical restraints, physical assessments, and imaging exams. Therefore, this work aims to report the anesthetic protocol performed on a raccoon (Procyon cancrivorus) submitted to colocephalectomy. Dexmedetomidine (5µg/kg), ketamine (5mg/kg), and diazepam (0.3mg/kg) were used intramuscularly as pre-anesthetic medication, in addition to induction with propofol, and the maintenance by inhalational anesthesia with isoflurane. For epidural anesthesia, an approach was performed in the lumbosacral region, with the administration of bupivacaine (1mg/kg) and morphine (0.1mg/kg). There were no complications and the physiological parameters remained stable. The need for analgesic rescue was ruled out and the anesthetic recovery was fast. Thus, it is concluded that the proposed anesthetic management promoted hemodynamic stability and a satisfactory recovery for the species.Em guaxinins, comumente se observa a presença de osteoartrites acometendo a articulação coxofemoral. Em carnívoros domésticos, o tratamento pode ser conservativo ou cirúrgico e, dentre as técnicas cirúrgicas, cita-se a colocefalectomia. Por ser um procedimento que provoca dor moderada a severa, um protocolo de anestesia balanceada se faz necessário, podendo associar a técnicas de bloqueio locorregional, como a epidural. Protocolos descritos para a espécie são limitados, porém comumente empregados para contenções químicas, avaliações físicas e exames de imagem. Portanto, o objetivo deste trabalho é relatar a o protocolo anestésico realizado em guaxinim (Procyon cancrivorus) submetido à colocefalectomia. Foram utilizados dexmedetomidina (5µg/kg), cetamina (5mg/kg) e diazepam (0,3mg/kg) por via intramuscular como medicação pré-anestésica, indução com propofol e manutenção por anestesia inalatória com isoflurano. Para execução da anestesia epidural, realizou-se uma abordagem na região lombossacral, sendo administrados bupivacaína (1mg/kg) e morfina (0,1mg/kg). Não houve intercorrências e os parâmetros fisiológicos mantiveram-se estáveis. Descartou-se a necessidade de resgate analgésico e a recuperação anestésica foi rápida. Dessa forma, conclui-se que o manejo anestésico proposto promoveu estabilidade hemodinâmica e recuperação satisfatórias para a espécie

BLOQUEIO DO PLANO TRANSVERSO DO ABDÔMEN EM COELHA SUBMETIDA À MASTECTOMIA E OVARIOHISTERECTOMIA

The locoregional blocks have been increasingly studied in veterinary medicine, especially in non-conventional pets and wild animals. The transverse abdominis plane block (TAP block) is a locoregional anesthesia technique capable of promoting anesthesia and analgesia in the skin, muscle, and parietal peritoneum regions, which are is part of the multimodal analgesia strategy. This study aims to report the transverse plane block in a four-year-old domestic rabbit submitted to regional mastectomy and ovariohysterectomy. Two ultrasound-guided TAP space blocks were performed bilaterally with 2mg/kg of bupivacaine 0.25%, standardizing a total injected volume of 2.4mL. Dexmedetomidine (5ɥg/kg) and midazolam (0.5mg/kg) were used intramuscularly as pre-anesthetic medication, induction with isoflurane in a 100% oxygen mask, and maintenance by inhalation anesthesia with isoflurane. Physiological parameters remained stable, with no need for analgesic rescue, rapid extubation, and peaceful awakening. Thus, it is concluded that the TAP block was effective in analgesia for regional mastectomy and ovariohysterectomy as a multimodal protocol, increasing the safety index. Moreover, it is easy to perform even with low-frequency transducers.Os bloqueios locorregionais vêm sendo cada vez mais estudados na medicina veterinária, principalmente em pets não-convencionais e animais silvestres. O bloqueio do plano transverso do abdômen (TAP block) é uma técnica de anestesia locorregional capaz de promover anestesia e analgesia em regiões da pele, musculatura e peritônio parietal, as quais fazem parte da estratégia de analgesia multimodal. O objetivo deste trabalho é relatar o bloqueio do plano transverso em um coelho doméstico de quatro anos de idade submetido à mastectomia regional e ovariohisterectomia. Foram realizados dois pontos bilateralmente de bloqueio do espaço TAP guiado por ultrassom com 2mg/kg de bupivacaína a 0,25%, pa dronizando um volume total injetado de 2,4mL. Foram utilizados dexmedetomidina (5ɥg/kg) e midazolam (0,5mg/kg) por via intramuscular como medicação pré-anestésica, indução com isoflurano na máscara de oxigênio 100% e manutenção por anestesia inalatória com isoflurano. Os parâmetros fisiológicos mantiveram-se estáveis, sem necessidade de resgate analgésico, com extubação rápida e despertar tranquilo. Desta forma, conclui-se que o TAP block foi eficaz na analgesia para mastectomia regional e ovariohisterectomia como protocolo multimodal, aumentando o índice de segurança, além de ser de fácil execução mesmo com transdutores de baixa frequência

Spider mite web mediates anti-predator behaviour

Herbivores suffer significant mortality from predation and are therefore subject to natural selection on traits promoting predator avoidance and resistance. They can employ an array of strategies to reduce predation, for example through changes in behaviour, morphology and life history. So far, the anti-predator response studied most intensively in spider mites has been the avoidance of patches with high predation risk. Less attention has been given to the dense web produced by spider mites, which is a complex structure of silken threads that is thought to hinder predators. Here, we investigate the effects of the web produced by the red spider mite, Tetranychus evansi Baker & Pritchard, on its interactions with the predatory mite, Phytoseiulus longipes Evans. We tested whether female spider mites recognize predator cues and whether these can induce the spider mites to produce denser web. We found that the prey did not produce denser web in response to such cues, but laid more eggs suspended in the web, away from the leaf surface. These suspended eggs suffered less from predation by P. longipes than eggs that were laid on the leaf surface under the web. Thus, by altering their oviposition behaviour in response to predator cues, females of T. evansi protect their offspring

microRNA expression and telome length analysis in monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia

Leucemia Linfóide Crônica (LLC) é a leucemia mais comum em países ocidentais, tem apresentação clínica e evolução heterogênea. Especula-se que todos os casos sejam precedidos por Linfocitose B Monoclonal (LBM). Não são bem conhecidos os mecanismos moleculares responsáveis por esta evolução. Alterações na expressão de miRNAs e em comprimento telomérico podem contribuir para desencadear esta neoplasia. O objetivo deste estudo foi identificar diferenças em comprimento telomérico e expressão de miRNAs entre pacientes com LLC, portadores de LBM clínica e populacional e controles saudáveis. Estudamos 21 pacientes com LLC, 11 portadores de LBM clínica, 6 de LBM populacional e 10 voluntários saudáveis. Para o controle de comprimento telomérico, utilizamos dados de estudo anterior do nosso serviço com grupo de 261 voluntários saudáveis de 0 a 86 anos. Realizamos separação de células CD19+CD5+ por citometria de fluxo nos grupos de estudo e de linfócitos B no grupo controle. Analisamos expressão dos miRNAs 15a, 16-1, 29b, 34a, 155, 181a e 181b por RT-qPCR e comprimento telomérico por qPCR. O miR- 155 foi o único que demonstrou expressão diferente entre os grupos LLC e LBM, sendo maior nos pacientes com LLC. Este miRNA e o miR-34a têm aumento de expressão nas células com fenótipo anormal, apesar desta diferença não ter tido significância estatística quando considerada a expressão do miR-155 na LBM. Os miRNAs 15a, 16-1, 181a e 181b são hipoexpressos nas células com fenótipo anormal. O miR-29b teve expressão semelhante nos grupos estudados. O comprimento telomérico foi semelhante nos 3 grupos de estudo e menor quando comparados ao grupo controle. O miR-155 tem diferente expressão em LBM e LLC, podendo ser um dos responsáveis por esta evolução. Alterações nos miRNAs 34a, 15a, 16-1, 181a e 181b contribuem para expansão clonal de linfócitos B CD5+. O papel do miR-29b na fisiopatogênese e evolução da LLC ainda não está bem definido. O comprimento telomérico diminuído em LLC e LBM pode fazer parte dos eventos iniciais da fisiopatogênese desta leucemia.Chronic Lymphocytic Leukemia (CLL) is the most common leukemia on Western countries, it has an heterogeneous clinical presentation and outcome. Monoclonal BCell Lymphocytosis (MBL) may precede all CLL cases. The molecular mechanisms responsible for this evolution are not known. Aberrant miRNA expression and telomere shortening may contribute for the pathophysiology of this disease. The objective of this study was to identify differences on telomere length and miRNA expression between CLL patients, subjects with clinical and population-screening MBL and healthy volunteers. 21 CLL patients, 11 subjects with clinical MBL, 6 with population-screening MBL and 10 healthy volunteers were enrolled on this study. As control for telomere length, we used a group of 261 healthy volunteers aged 0 to 86 years old that had been enrolled on a previous study from our group. After diagnosis confirmation, it has been done a flow citometry CD19+CD5+ cell sorting for the study groups and CD19+ cell sorting for the control group. The expression of the miRNAs 15a, 16-1, 29b, 34a, 155, 181a and 181b was determined by RT-qPCR. The telomere length was determined by qPCR. miR-155 was the only one with different expression between the CLL and MBL groups, presenting higher expression on the CLL group. This miRNA and the miR-34a are overexpressed on the study groups when compared to the control group, although this difference did not reach statistical significance when the miR-155 expression in MBL is considered. miRNAs 15a, 16-1, 181a and 181b are underexpressed on the study groups. The miR-29b was the only one with similar expression on all groups. The telomere length was similar on the 3 study groups and shorter on these groups when compared to normal subjects. The expression of miR-155 is different in CLL and MBL, it may contribute for this evolution. Aberrant expression of miR 34a, 15a, 16-1, 181a and 181b may contribute for the clonal expansion of CD5+ B lymphocytes. The role of miR-29b on the CLL pathogenesis and evolution is still not understood. The reduced telomere length on CLL and MBL may be part of the initial events of this leukemia pathogenesis

Monoclonal B-cell lymphocytosis in individuals from sporadic (non-familial) chronic lymphocytic leukemia families persists over time, but does not progress to chronic B-cell lymphoproliferative diseases

BACKGROUND: Monoclonal B-cell lymphocytosis is classified as 'high-count or clinical' monoclonal B-cell lymphocytosis and 'low-count or population' monoclonal B-cell lymphocytosis. Previously, 167 first-degree relatives pertaining to sporadic (non-familial) chronic lymphocytic leukemia families were studied and the presence of seven monoclonal B-cell lymphocytosis individuals was reported.OBJECTIVE: The aim of this report is to describe the outcomes of five of the original monoclonal B-cell lymphocytosis individuals.METHODS: Flow cytometry analysis was performed on mononuclear cells previously isolated from peripheral blood samples. A strategy of sequential gating designed to identify the population of CD19+/CD5+ B-lymphocytes was used and, subsequently, the monoclonal B-cell lymphocytosis cells were characterized by the CD20weak/CD79bweak/negative phenotype.RESULTS: The monoclonal B-cell lymphocytosis clone showed consistent stability over time with little variations in size. After a median follow-up of 7.6 years, none of the five monoclonal B-cell lymphocytosis individuals progressed to chronic lymphocytic leukemia or other B-cell lymphoproliferative disease.CONCLUSIONS: The data of this study suggest that chronic lymphocytic leukemia-like monoclonal B-cell lymphocytosis detected in the context of sporadic chronic lymphocytic leukemia families is not prone to clinical evolution and could be just a sign of immune senescence

Comparison of microRNA expression in high-count monoclonal B-cell lymphocytosis and Binet A chronic lymphocytic leukemia

Abstract Background Evidence suggests that monoclonal B-cell lymphocytosis precedes all chronic lymphocytic leukemia cases, although the molecular mechanisms responsible for disease progression are not understood. Aberrant miRNA expression may contribute to the pathogenesis of chronic lymphocytic leukemia. The objective of this study was to compare miRNA expression profiles of patients with Binet A chronic lymphocytic leukemia with those of subjects with high-count monoclonal B-cell lymphocytosis and healthy volunteers (controls). Methods Twenty-one chronic lymphocytic leukemia patients, 12 subjects with monoclonal B-cell lymphocytosis and ten healthy volunteers were enrolled in this study. Flow cytometry CD19+CD5+-based cell sorting was performed for the chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis groups and CD19+ cells were sorted to analyze the control group. The expressions of miRNAs (miR-15a, miR-16-1, miR-29b, miR-34a, miR-181a, miR-181b and miR-155) were determined by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Results Significant differences between the expressions in the chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis groups were restricted to the expression of miR-155, which was higher in the former group. A comparison between healthy controls and monoclonal B-cell lymphocytosis/chronic lymphocytic leukemia patients revealed higher miR-155 and miR-34a levels and lower miR-15a, miR-16-1, miR-181a and miR-181b in the latter group. Conclusions Our results show a progressive increase of miR-155 expression from controls to monoclonal B-cell lymphocytosis to chronic lymphocytic leukemia. The role of miR-155 in the development of overt chronic lymphocytic leukemia in individuals with monoclonal B-cell lymphocytosis must be further analyzed