Caesarean sections profile of a university hospital

Introdução: A proporção de partos cesarianos no Brasil está muito além da preconizada pela Organização Mundial da Saúde (OMS), o mesmo ocorrendo em um Hospital Universitário de Porto Alegre, sul do Brasil. A taxa de cesáreas é considerada um indicador poderoso na avaliação da qualidade da assistência perinatal. Nosso objetivo foi analisar o padrão dos partos cesarianos e normais em um hospital universitário no período de 2004 a 2012 quanto à média de permanência, faixa etária da parturiente, taxa de infecção relacionada ao parto, tipo de pagador e idade gestacional. Métodos: Estudo de coorte retrospectivo, observacional, com dados coletados no Sistema de Indicadores de Gestão (IG) de um Hospital Universitário, abrangendo o período de 2004 a 2012. Resultados: A taxa de cesárea no hospital universitário nos anos analisados foi em média 33,21%. Em relação às cesarianas realizadas nesta instituição durante o período em estudo, observou-se que: há uma maior prevalência de cesáreas em mulheres acima de 40 anos, ocorreu um crescimento de partos cesarianos pré‑termo, a média de permanência e taxa de infecção foram superiores em relação às mulheres submetidas ao parto vaginal, e houve predomínio de cesarianas na saúde suplementar quando comparada ao Sistema Único de Saúde. Conclusão: As elevadas taxas de cesárea no hospital universitário, embora acima do recomendado pela OMS, são justificadas por se tratar de um hospital terciário e estão em conformidade com o padrão observado no país.Introduction: Cesarean delivery rates in Brazil are beyond that advised by the World Health Organization (WHO), the same occurring in a university hospital of Porto Alegre, southern Brazil. The rate is considered a powerful indicator in evaluation the perinatal quality of care. Our goal was to analyze the pattern of vaginal birth and cesarean delivery rates at a university hospital in the period of 2004-2012 in terms of the average length of stay, mother age, birth-related infection rate, payer type, and gestational age. Methods: Observational retrospective cohort study with data collected on the Management Indicators System (GI) of a university hospital of Porto Alegre, from 2004 to 2012. Results: The caesarean rate in our university hospital in the analyzed years averaged 33.21%. Analysis of cesareans performed in this institution during the study period showed that: there is a higher prevalence of cesarean births in women over 40 years, there was an increase in the number of preterm cesarean sections, length of stay and infection rates in women undergoing cesarean birth were higher than those of women undergoing vaginal birth, and cesarean deliveries predominated in the private health insurance system compared to the Brazilian Unified Health System. Conclusions: The high rates of cesarean section in our university hospital, although above those recommended by the WHO, are in accordance with the pattern observed in the country and may be explained by the fact that the institution is a tertiary hospital

Effect of 3'UTR RET variants on RET mRNA secondary structure and disease presentation in medullary thyroid carcinoma

The RET S836S variant has been associated with early onset and increased risk for metastatic disease in medullary thyroid carcinoma (MTC). However, the mechanism by which this variant modulates MTC pathogenesis is still open to discuss. Of interest, strong linkage disequilibrium (LD) between RET S836S and 3'UTR variants has been reported in Hirschsprung's disease patients. Objective To evaluate the frequency of the RET 3’UTR variants (rs76759170 and rs3026785) in MTC patients and to determine whether these variants are in LD with S836S polymorphism. Methods Our sample comprised 152 patients with sporadic MTC. The RET S836S and 3’UTR (rs76759170 and rs3026785) variants were genotyped using Custom TaqMan Genotyping Assays. Haplotypes were inferred using the phase 2.1 program. RET mRNA structure was assessed by Vienna Package. Results The mean age of MTC diagnosis was 48.5±15.5 years and 57.9%were women. The minor allele frequencies of RET polymorphisms were as follows: S836S, 5.6%; rs76759170, 5.6%; rs3026785, 6.2%. We observed a strong LD among S836S and 3’UTR variants (|D’| = -1, r2 = 1 and |D’| = -1, r2 = 0,967). Patients harboring the S836S/3’UTR variants presented a higher percentage of lymph node and distant metastasis (P = 0.013 and P<0.001, respectively). Accordingly, RNA folding analyses demonstrated different RNA secondarystructure predictions for WT(TCCGT), S836S(TTCGT) or 3’UTR(GTCAC) haplotypes. The S836S/3’UTR haplotype presented a greater number of double helices sections and lower levels of minimal free energy when compared to the wild-type haplotype, suggesting that these variants provides the most thermodynamically stable mRNA structure, which may have functional consequences on the rate of mRNA degradation. Conclusion The RET S836S polymorphism is in LD with 3’UTR variants. In silico analysis indicate that the 3’UTR variants may affect the secondary structure of RET mRNA, suggesting that these variants might play a role in posttranscriptional control of the RET transcripts

Perfil do Estudante de Medicina da UFRGS – Ênfase em Ansiedade

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Perfil do Estudante de Medicina da UFRGS – Ênfase em Ansiedade

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