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.

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