An analysis was performed of 2,168 consecutive stroke patients who were examined by computed tomography and entered into a hospital-based stroke registry in Akita Prefecture, Japan. The occurrence of cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage was 30, 55, and 14%, respectively. Age-specific rates of subarachnoid hemorrhage were higher in women than men; other types of stroke showed a preponderance in men. Total strokes increased in the winter; this seasonal difference was confined to cerebral hemorrhage. Putaminal hemorrhages predominated in the younger age groups; thalamic hemorrhage and cerebellar hemorrhage were predominant in the older age groups. The increased accuracy of the diagnosis of stroke subtypes by the use of computed tomography in this study is in contrast to other community-based epldemiologic studies that have relied solely on clinical diagnosis. This increased accuracy is seen to be the reason that new ratios of stroke subtype incidence have been identified. (Stroke 1987;18:402-406) T HE World Health Organization coordinated a collaborative study of stroke incidence in 17 centers from developing and developed countries between 1971 and 1974.' The Japanese centers participating were found to have the highest age-adjusted stroke incidence rates of the 17 centers in the study. Among all these centers, Akita, Japan showed the highest incidence rate for stroke. In epidemiologic studies, diagnosis of stroke is usually based on clinical judgment. The accuracy of clinical diagnoses is known to be rather high, 23 but misdiagnosis can reach 20-30% 4 in pathologic subtypes of stroke (i.e., cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, SAH). Because misdiagnosis of subtypes distorts the results in epidemiologic studies of stroke and because computed tomography (CT) provides highly accurate diagnoses, 5 the Akita medical community has confirmed most stroke patients in recent years by CT, and since 1983 has set up a hospitalbased stroke registry of patients confirmed by CT. This paper analyzes the diagnoses in the stroke registry in Akita and compares them with the results of previous community-based epidemiologic studies of the subtypes of stroke. Subjects and MethodsAll strokes diagnosed by CT from November 1, 1983 to May 31, 1985 were included in the present study. Twenty-four hospitals, encompassing all instiFrom the doctors group of clinico-epidemiological study for stroke, Akita.Address for reprints: Kazuo Suzuki, MD, Department of Epidemiology, Research Institute of Brain and Blood Vessels-Akita, 6-10, Senshu-Kubota-Machi, Akita 010, Japan.Received May 15, 1986; accepted November 5, 1986. tutes using CT in Akita Prefecture, participated. Stroke was defined as the onset of rapidly developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than a vascular origin. Recurring attacks were included. All cases were examined using CT within 3 weeks of the onset...

A Rede Cegonha (RC), lançada em 2011 pelo Ministério da Saúde (MS), é uma estratégia instituída no Sistema Único de Saúde, com objetivo de reduzir a morbimortalidade materna no Brasil. Os objetivos deste estudo são analisar as ações de saúde materna e infantil implementadas no Brasil após a publicação da portaria 1.459 de 2011, que institui a RC, e identificar possíveis avanços decorrentes desta. Estudo descritivo de revisão da literatura especializada, por meio de busca on line entre abril e julho de 2015, nas bases Medline, Lilacs, Scielo, Google Acadêmico e Periódicos Capes e em documentos oficiais produzidos pelo MS. As publicações deveriam atender aos critérios de terem sido publicadas em português, no período compreendido entre 2011 e 2015. Foram encontrados oito artigos e dez documentos do MS relacionados ao tema. Na revisão, foram identificadas ações implementadas pela Rede Cegonha, que tem como bases organizacionais regionalização e integralidade. Uma das ações implantadas em todas as Unidades Básicas de Saúde é o Teste Rápido de Gravidez, criado para detecção precoce da gestação, com acolhimento da equipe de Atenção Básica e orientações baseadas nas necessidades de cada usuária. A RC ampliou o Plano de Qualificação das Maternidades (PQM) em extensão territorial. No quadro atual de atenção obstétrica, é imprescindível que a gestante seja informada sobre seus direitos. A RC mostrou avanço na proteção integral aos processos de gestação, parto, nascimento, puerpério e início da vida, mas, por envolver políticas de educação em saúde, seus efeitos serão mais tocantes apenas em longo prazo.

Selenium (Se) role in obesity is not clear. In addition, information on Se’s role in male physiology, specifically in obesity, is scarce. We conducted this study to evaluate the efficacy of Se supplementation, specifically during puberty until young adulthood, against obesity-induced deregulation of metabolic, cellular, and epigenetic parameters in epididymal fat and/or sperm cells in a rat model. High-fat-diet consumption by male rats during puberty and young adulthood significantly increased body weight, adipocyte size, oxidative stress, deregulated expression of genes associated with inflammation (Adiponectin, IL-6, TNF-α), adipogenesis (CEBPα), estrogen biosynthesis (CYP19) and epigenetic processes in epididymal adipose tissue (Dnmt3a), as well as altered microRNA expression vital for spermatogenesis in sperm cells (miR-15b and miR-497). On the other hand, Se supplementation significantly decreased oxidative stress and mitigated these molecular/epigenetic alterations in epididymal adipose tissue or sperm cells. Our results indicate that selenium supplementation during puberty/young adulthood could improve male physiology in the context of obesity. In addition, it suggests that Se could potentially positively affect offspring health.

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Bismuth type 3 was the commonest ( 14) type of injury/ stricture followed by type 2 (3) and type 1 (2). There was 1 mortality following surgery due to bile leak followed by severe sepsis. Remaining 18 patients had excellent postoperative outcome without significant morbid.

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