BACKGROUND: The prevalence of congenital abnormalities in general populations is approximately 3-5%. One of the most important applications of obstetric ultrasound is in detection of fetal structural defects. OBJECTIVE: To assess fetal structural anomalies diagnosed using ultrasound in the three trimesters of pregnancy. DESIGN AND SETTING: Retrospective cohort study at the Mário Palmério University Hospital of the University of Uberaba (Universidade de Uberaba, UNIUBE), from March 2014 to December 2016. METHODS: Ultrasound data at gestational weeks 11-13 + 6, 20-24 and 32-36 were recorded to identify fetal anomalies in each trimester and in the postnatal period. The primary outcome measurements were sensitivity, specificity, positive predictive value and negative predictive value for detection of fetal anomalies and their prevalence. RESULTS: The prevalence of anomalies detected using ultrasound was 2.95% in the prenatal period and 7.24% in the postnatal period. The fetal anomalies most frequently diagnosed using ultrasound in the three trimesters were genitourinary tract anomalies, with a prevalence of 27.8%. Cardiac anomalies were diagnosed more often in the postnatal period, accounting for 51.0% of all cases. High specificity, negative predictive value and accuracy of ultrasound were observed in all three trimesters of pregnancy. CONCLUSION: Ultrasound is safe and has utility for detecting fetal anomalies that are associated with high rates of morbidity and mortality. However, the low sensitivity of ultrasound for detecting fetal anomalies in unselected populations limits its utility for providing reassurance to examiners and to pregnant women with normal results.

The present study was designed to determine the effects of metformin on the forearm glucose uptake and blood flow after an oral glucose challenge. Eleven normal subjects, and ten non-obese type 2 diabetes patients without medication of anti-hyperglycemic drug and with medication of metformin for four weeks, were studied after an overnight fast (12-14 h) and 3 hours after ingestion of 75 g of glucose. Peripheral glucose metabolism was analyzed by the forearm technique combined with indirect calorimetry. The forearm glucose uptake increased in diabetes patients taking metformin (63.5+/-9.1 VS. 39.1+/-5.3 mg/100 ml FA. 3 h). The increase of forearm glucose uptake was due to increase of blood flow. The glucose oxidation was greater in the group treated with metformin, compared to the same group without anti-hyperglycemic drug (19.3+/-2.6 VS. 7.7+/-2.6 mg/100 ml FA. 3 hrs). The free fatty acids were higher in diabetes patients, which normalized after taking metformin. In conclusion, it was found that in these participants metformin acts in insulin resistance; it increases glucose muscle uptake and blood flow. The enhancement of blood flow and lower free fatty acids, not described yet, could be direct effects of the drug or due to reduced glucose toxicity. These positive effects must be responsible for the improvement in vascular function.

Keywords► labor induction ► misoprostol ► oxytocin ► cesarean sections AbstractPurpose To assess cases of labor induction with vaginal 25-µg tablets of misoprostol and maternal outcomes in a tertiary hospital in southeastern Brazil. Methods This was a retrospective cohort study of 412 pregnant women with indication for labor induction. Labor induction was performed with vaginal 25-µg tablets of misoprostol in pregnant women with Bishop scores < 6. Stepwise regression analysis was used to identify the factors present at the beginning of induction that could be used as predictors of successful labor induction. Results A total of 69% of the pregnant women who underwent labor induction progressed to vaginal delivery, and 31% of the women progressed to cesarean section. One or two misoprostol tablets were used in 244 patients (59.2%). Of the 412 patients, 197 (47.8%) required oxytocin later on in the labor process, after induction with misoprostol. The stepwise regression analysis showed that only Bishop scores of 4 and 5 and previous vaginal delivery were independent factors with statistical significance in the prediction of successful vaginal labor induction (β ¼ 0.23, p < 0.001, for a Bishop score of 4 and 5, and β ¼ 0.22, p < 0.001, for previous vaginal delivery). Conclusion Higher Bishop scores and previous vaginal delivery were the best predictors of successful labor induction with vaginal 25-µg tablets of misoprostol. ResumoObjetivo Avaliar os casos de indução do trabalho de parto com misoprostol 25 mcg por via vaginal e seus desfechos maternos em um hospital terciário do Sudeste do Brasil.

Introduction: The Plathymenia reticulata benth is a herbal medicine that has properties of pancreatic islet hyperplasia and glycemic control in diabetic rats. Neem (Azadirachta indica A. Juss, Meliaceae) is a tree native to India that has several medicinal effects. Goal: To verify the effect of glycated hemoglobin levels in rats with type 1 and non-diabetic diabetes mellitus, in treatment with Plathymenia Reticulata Benth, Neem and the association between them. compared to insulin. Methodology: Diabetes was induced by intraperitoneal streptozotocin (65mg/kg) administration after a 24-hour fast. The diagnosis was made using a blood glucose value above 200mg/dl. The study was conducted in 60 male adult Wistar rats, weighing between 180 and 220 grams, divided into 9 groups, between diabetics (DM) and non-diabetic controls (NdM), and treated with Neem (300 mg/kg), cold aqueous extract of Plathymenia (100 mg/kg), water (negative control) and insulin (3 IU/day) - positive control; and association between plants. The treatment was performed by orogastric gavage for a period of 28 consecutive days, and weekly weight and daily feed intake were performed. Data were analyzed using ANOVA and Tukey-Kramer’s pos-hoc test, with a significance level of 5% using the SPSS25.0 software. The results are expressed on average ± EPM. Results: There was a significant difference in glycated hemoglobin levels in rats submitted to insulin treatment (6.18 ± 0.36) compared to those submitted to treatment with Neem (10.12 ± 1.29, p=0.047), Plathymenia+Neem (12.09 ± 0.38, p=0.006) and water (10.86 ± 1.26, p=0.015). However, no significant difference was observed between the reduction in glycated hemoglobin levels in the groups submitted to insulin treatment compared to the group treated with Plathymenia (7.30 ± 0.68, p=0.911). Conclusion: The results allow us to evaluate a non-inferiority condition in relation to the use of the Plathymenia when compared to treatment with insulin therapy, positive control in the treatment of type 1 diabetes mellitus. The Plathymeniamay present as a herbal option in the treatment of the disease and prevention of complications. Further studies are necessary to evaluate the effect of the extract on other aspects related to the pathology.

Objective: To investigate the anti-hyperglycemic effects of Plathymenia reticulata hydroalcoholic extract and related changes in body weight, lipid profile and the pancreas. Methods: Diabetes was induced in 75 adult male Wistar rats via oral gavage of 65mg/Kg of streptozotocin. Rats were allocated to one of 8 groups, as follows: diabetic and control rats treated with water, diabetic and control rats treated with 100mg/kg or 200mg/kg of plant extract, and diabetic and control rats treated with glyburide. Treatment consisted of oral gavage for 30 days. Blood glucose levels and body weight were measured weekly. Animals were sacrificed and lipid profile and pancreatic tissue samples analyzed. Statistical analysis consisted of ANOVA, post-hoc Tukey-Kramer, paired Student's t and χ 2 tests; the level of significance was set at 5%. Results: Extract gavage at 100mg/kg led to a decrease in blood glucose levels in diabetic rats in the second, third (198.71±65.27 versus 428.00±15.25) and fourth weeks (253.29±47.37 versus 443.22±42.72), body weight loss (13.22±5.70 versus 109.60±9.95) and lower cholesterol levels (58.75±3.13 versus 80.11±4.01) in control rats. Extract gavage at 200mg/Kg led to a decrease in glucose levels on the fourth week in diabetic rats, body weight loss in the second, third and fourth weeks in control rats, and lower cholesterol levels in diabetic and control rats. Islet hyperplasia (p=0.005) and pancreatic duct dilation (p=0.047) were observed in diabetic and control rats. Conclusion: Plathymenia extract reduced blood glucose levels in diabetic rats, and body weight in control rats, and promoted pancreatic islet hyperplasia in diabetic and control rats.

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Background: Androgen deficiency in aging male (ADAM) is characterized by hypogonadism with symptoms such as reduced sexual desire, muscle mass loss, among others. The treatment with testosterone gel and the results around weight and other indicators are the research objects. Objective: Analysis of association between ADAM and obesity in the outpatient population studied and to verify the outcomes of the testosterone gel treatment. Materials & Methods: From a group of 126 outpatients of University Hospital Mário Palmério, 40 were selected with total testosterone lower than 300ng/dL, upon the signature of written informed consent form and the realization of laboratory tests. After new testosterone dosage and urologic evaluation, 6 patients were treated for an average time of 6 months. Initially the dosage was 50 mg/day, with medical consultations and laboratory tests to verify the effects and to adjust the dosage. The variables analyzed were BMI, abdominal circumference, weight, muscle mass, body and visceral fat, in addition to testosterone serum dosages, lipid profile, amongst others, considering the test t among the beginning and end of treatment, defining the significance level by p<0,05. Results: Significant increase of total testosterone levels (p<0,001) and a tendency of improvement in the free testosterone levels (p=0,061) and no significant reduction of BMI (p=0,4308), abdominal circumference (p=0,1695), weight (p=0,999), body fat (p=0,194) and muscle mass (p=0,632), while visceral fat increased (p=0,5265). Vitamin D had no significant increase (p=0,2422). Conclusion: The total testosterone level was increased after the testosterone gel treatment with statistical significance, however there must be new research with more subjects with ADAM to prove the benefits of this treatment.

Introduction: Neem (Azadirachta indica A. Juss, Meliaceae) is a tree native to India that has several medicinal effects. It has been reported that the leaves and oil of Neem seeds present antihyperglycemic/hypoglycemic activity. Plathymenia reticulata benth, known as “vinhático”, is a Brazilian cerrado tree that has properties of pancreatic islet hyperplasia and glycemic control in diabetic rats. Objective: To verify weight gain correlating with feed intake in rats with type 1 and non-diabetic diabetes mellitus, undertreatment with Neem and Plathymenia and the association between them. Methodology: Diabetes was induced by intraperitoneal streptozotocin (65mg/kg) administration after a 24-hour fast. The diagnosis was made using a blood glucose value above 200mg/dl. The study was conducted in 60 male adult Wistar rats, weighing between 180 and 220 grams, divided into 9 groups, between diabetics (DM) and non-diabetic controls (NDC), and treated with Neem (300 mg/kg), cold aqueous extract of Plathymenia (100 mg/kg), water (negative control) and insulin (3 IU/day) – positive control; and association between plants. The treatment was performed by orogastric gavage for a period of 28 consecutive days, and weekly weight and daily feed intake were performed. The data were analyzed using ANOVA and Tukey-Kramer’s pos-hoc test, Pearson correlation with a significance level of 5% through the SPSS25.0 software. The results are expressed on average ± EPM. Results: There was lower weight gain in diabetic rats undergoing neem treatment, compared with positive and negative control (-13.00 ± 5.13 vs 150.40 ± 6.80, vs 15.79 ± 7.25, p&lt;0.001); the average daily feed intake was higher in rats treated with neem, compared with positive and negative control (42.00 ± 0.00 vs 26.00 ± 1.26 vs 33.83 ± 0.00; p=0,001). There was no significant difference between the other diabetic groups, except for positive control – insulin. There was also lower weight gain in control animals with Neem, compared with negative control (53.50 ± 4.21 vs 80.00 ± 5.76, p=0.010). The average daily food intake was higher in control animals with Neem compared to negative control (24.00 ± 0.00 vs 15.00 ± 0.00, p=0.029). There was a significant negative correlation between weight gain and food intake in the animals studied (p=0.005). Conclusion: The results allow evaluating a lower weight gain, with higher average daily food intake, in rats treated with Neem, both diabetic and control. This effect may indicate possible use of plant extract in prediabetics, obese diabetics and in the treatment of obesity.