ObjectiveTo analyze maternal complications associated to type of delivery, comparing cesarean (c-) section with vaginal delivery. METHODSRetrospective study of 1,748 deliveries carried out at a university hospital in the city of São Paulo, Southeastern Brazil, in which the newborn weighed more than 500 g. Maternal complications occurred during delivery as well as those diagnosed during puerperium that required further hospital admission were analyzed. Statistical analyses included Student's t test and Fisher's Exact test. Significance level was set at 0.05. RESULTS Rev Saúde Pública 2004; 38(1)Maternal complications and type of delivery www.fsp.usp.br/rsp Nomura RMY et al C-sections were performed on 988 patients (56.5%). Hemorrhagic complications occurred in 1.2% of c-sections and in 0.8% of normal deliveries, with no statistically significant difference between both groups. Endometritis was observed in 0.4% of c-sections and in 0.1% of vaginal deliveries, without statistically significant difference. Two cases of puerperal infection evolved to hysterectomies, in the c-section group. There were no maternal deaths related to c-section. CONCLUSIONSNo associations were found between maternal complications and type of delivery in the period analyzed.
Although angiogenic imbalance is clearly related to preeclampsia, it seems to play a more modest role in superimposed preeclampsia, in which other mechanisms should also be investigated.
ContentsOptimal conditions for in vitro culture of feline ovarian follicles have not yet been defined. Follicular development is regulated by intraovarian growth factors, as insulin-like growth factor (IGF-1), and during the different stages of the oestrous cycle, follicles are exposed to specific hormonal environments. The aim of this study was to investigate the effect of IGF-1 on in vitro growth and granulosa cell (GC) viability of preantral follicles collected from domestic cats at follicular and luteal phases of the oestrous cycle. Oestrus and ovulation were induced in 12 cats. A total of 39 and 32 follicles collected at the follicular and luteal phases, respectively, were individually cultured in vitro for 6 days in minimum essential medium media supplemented with or without IGF-1 (100 ng/ ml). Follicles collected during the follicular phase and cultured without IGF-1 displayed a significant increase in size and higher GC viability (46.5 ± 22.1 lm, 66.7%, respectively) than that of follicles collected at the luteal phase and cultured without IGF-1 (26.7 ± 14.4 lm, 50%, respectively; p < 0.05). In contrast, when IGF-1 was added to the culture medium, no differences were observed in size or GC viability between follicles collected at the two phases of the cycle. Nonetheless, follicles collected at the luteal phase and cultured with IGF-1 had a significant increase in their diameter and GC viability (31.9 ± 15.9 lm, 63.6%, respectively) than that cultured without IGF-1 (26.7 ± 14.4 lm, 50%, respectively; p < 0.05). These data suggest that in vitro growth and GC survival of feline preantral follicles are affected by the oestrous cycle phase, and the IGF-1 exerts a positive effect on follicles collected at the luteal phase.
30 semanas), diagnóstico materno de síndrome hipertensiva na gestação índice, antecedente de cicatriz uterina prévia não relacionada à operação cesariana, diagnóstico de rotura prematura de membranas ou diagnóstico de polidrâmnio. A análise univariada das variáveis contínuas foi realizada utilizando-se o teste t de Student e as variáveis categóricas foram avaliadas por meio de teste exato de Fisher ou teste de chi2, com níveis descritivos (p) menores que 0,05 considerados significantes. RESULTADOS: 34 casos de pacientes com diagnóstico de DPP preencheram os critérios de inclusão (incidência de 0,52%). Para o grupo controle foram selecionadas 170 pacientes que obedeceram aos critérios de pareamento propostos. No grupo de pacientes com DPP, 26,5% apresentavam antecedente de parto cesárea (9 casos), ao passo que, no grupo controle, esse antecedente foi observado em 21,2% das pacientes (36 casos). Não houve diferença estatisticamente significativa na incidência de cesárea prévia entre os dois grupos estudados (p=0,65, OR=1,34, IC 95%=0,53-3,34). CONCLUSÃO: o aspecto abordado neste estudo, isto é, a associação do DPP em pacientes com cicatriz uterina de cesárea, não pôde ser confirmado com a presente casuística.]]>
Qualificação científica e, em GCP (Good Clinical Practices), disponibilidade de pacientes e de tempo, recursos adequados, equipe treinada, boa comunicação com o CEP (Comitê de Ética em Pesquisa) e adequado seguimento do protocolo são alguns dos pré-requisitos para a participação em grandes estudos clínicos multicêntricos. Mesmo com todos estes requisitos preenchidos, muitas vezes o baixo recrutamento de pacientes acaba sendo uma barreira significante, evitando que se alcance a eficiência desejada no desenvolvimento clínico de um novo medicamento. Via de regra, a previsão de inclusão de pacientes é mais otimista do que mostra, posteriormente, a realidade.Uma das possíveis soluções para esse problema é o estabelecimento de boas práticas de recrutamento de pacientes (GRP -Good Recruitment Practice), isto é, um conjunto de princípios e procedimentos que complementam as regras de GCP, uma vez que estas não abrangem em profundidade as questões relativas à seleção e recrutamento de pacientes 1,2 .Esta análise passa pela avaliação dos fatores determinantes do baixo volume de pacientes incluídos em estudos clínicos. A falta de conhecimento sobre o tema ainda é um empecilho importante, pois não está claro para a população em geral que a realização de estudos clínicos adequadamente conduzidos é absolutamente essencial para a introdução de novos medicamentos, mais eficazes e/ou menos tóxicos que os já disponíveis.É neste sentido que os princípios de GRP podem ajudar, sendo que o seu objetivo final é o benefício dos pacientes, tanto aqueles que participam das pesquisas como os demais que, posteriormente, receberão um tratamento mais adequado, através da descoberta de novas terapêuticas. Estes princípios têm seu foco na informação e comunicação ao paciente, que deve ser clara, balanceada e não-coerciva. O termo de consentimento livre e esclarecido (TCLE) deve ser escrito em linguagem adequada e, tão importante quanto isto, o processo de submissão do consentimento ao potencial paciente deve ser muito claro e transparente. O próprio desenho do estudo deve passar por uma avaliação de factibilidade, questionando-se se os pacientes que preencherão os critérios de inclusão e exclusão do protocolo de fato existem. Além disso, a relação médico-paciente deve ser, como em todo exercício da medicina, inquestionavelmente ética, na qual o investigador deve se sentir totalmente confortável com a intervenção proposta. Incentivos podem, eventualmente, ser oferecidos aos pacientes, tais como valerefeição ou vale-transporte, desde que previamente aprovados pelo respectivo CEP e obviamente dentro de critérios razoáveis, isto é, não-coercivos e balanceados versus as exigências do protocolo. O mesmo vale para anúncios, que também devem ser previamente aprovados pelo CEP local. Uma sugestão final seria "sempre ter como objetivo pessoal incluir mais pacientes do que o compromissado". Pode ser um bom conselho.
Preeclampsia (PE) is a hypertensive disease of pregnancy-associated with placental cell death and endoplasmic reticulum (ER) stress. It is unknown whether systemic factors aggravate placental dysfunction. We investigated whether serum factors in pregnant women with PE activate ER stress and unfolded protein responses (UPRs) in placental explants and trophoblast cells lineage. We cultured placental explants from third-trimester term placentas from control non-preeclamptic (NPE) pregnant women with serum from women with PE or controls (NPE). In PE-treated explants, there was a significant increase in gene expression of GADD34, CHOP, and SDF2. At the protein level, GRP78, SDF2, p-eIF2α, and p-eIF2α/eIF2α ratio were also augmented in treated explants. Assays were also performed in HTR8/SV-neo trophoblast cell line to characterize the putative participation of trophoblast cells. In PE serum-treated protein levels of p-eIF2a and the ratio p-elF2 α/elF2α increased after 12 h of treatment, while the gene expression of GADD34, ATF4, and CHOP was greater than control. Increased expression of SDF2 was also detected after 24 h-cultured HTR8/SV-neo cells. PE serum increased sFLT1 gene expression and decreased PlGF gene expression in placental explants. Morphologically, PE serum increased the number of syncytial knots and reduced placental cell metabolism and viability. Analysis of the serum of pregnant women with PE through Raman spectroscopy showed changes in amino acids, carotenoids, lipids, and DNA/RNA, which may be associated with the induction of ER stress found in chorionic villi treated with this serum. In conclusion, this study provides evidence that the serum of pregnant women with PE may impact placental villi changing its morphology, viability, and secreted functional factors while triggers ER stress and an UPR. The differences between PE and control sera include molecules acting as inducing factors in these processes. In summary, the results obtained in our assays suggest that after the development of PE, the serum profile of pregnant women may be an additional factor that feeds a continuous imbalance of placental homeostasis. In addition, this study may expand the possibilities for understanding the pathogenesis of this disorder.
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