The purpose of this systematic review was to investigate the scientific evidence to support the use of direct renin inhibitors (DRIs) in diabetic nephropathy (DN). MEDLINE was searched for articles reported until 2018. A standardized dataset was extracted from articles describing the effects of DRIs on plasma renin activity (PRA) in DN. A total of three clinical articles studying PRA as an outcome measure for DRIs use in DN were identified. These clinical studies were randomized controlled trials (RCTs): one doubleblind crossover, one post hoc of a double-blind and placebo-controlled study, and one open-label and parallel-controlled study. Two studies reported a significant decrease of albuminuria associated with PRA reduction. One study had a DRI as monotherapy compared with placebo, and two studies had DRI as add-in to an angiotensin II (Ang II) receptor blocker (ARB). Of 10,393 patients with DN enrolled in five studies with DRI, 370 (3.6%) patients had PRA measured. Only one preclinical study was identified that determined PRA when investigating the effects of aliskiren in DN. Moreover, most of observational preclinical and clinical studies identified report on a low PRA or hyporeninemic hypoaldosteronism in DM. Renin inhibition has been suggested for DN, but proof-of-concept studies for this are scant. A small number of clinical and preclinical studies assessed the PRA effects of DRIs in DN. For a more successful translational research for DRIs, specific patient population responsive to the treatment should be identified, and PRA may remain a biomarker of choice for patient stratification.
Introdução: Segundo as orientações do Ministério da Saúde e da Organização Mundial da Saúde, a gestante deve optar pelo parto transpélvico, caso não tenha nenhuma indicação de cesárea. Apesar disso, Brasil é um dos países que mais realiza cesárea no mundo todo, sendo que apenas 15% são realmente necessárias. Objetivo: Realizar um estudo comparativo em relação ao estado clínico da parturiente e do recém-nascido após a realização de parto transpélvico e cesárea. Material e Métodos: Foram coletados dados de 50 gestantes com idade gestacional entre 38 a 40 semanas quando realizaram o parto, através da análise de prontuário e questionário aplicado às puérperas, e contemplando o estado de saúde tanto da puérpera como do recém-nascido. Resultados: Com as informações levantadas, foi traçado um perfil das gestantes. O estudo estatístico não demonstrou significado estatístico na comparação das vias de parto com relação aos seguintes aspectos: ocorrência e intensidade da dor após o parto (P = 0,14), Apgar do 1º minuto (P = 0,73) e Apgar do 5º minuto (P = 0,53). Apenas o tempo de permanência mostrou-se significativo (P = 0,02), sendo encontrado um maior tempo de permanência do parto transpélvico. Conclusão: Apesar de a literatura demonstrar maiores vantagens tanto para a paciente como para o recém-nascido quando realizado o parto transpélvico, o presente estudo não encontrou diferenças significativas entre as duas vias de parto.Palavras Chave: Parto transpélvico, Cesárea, Período pós-parto, Recém-nascido, Estudo comparativo ABSTRACTIntroduction: According to the guidelines of the Ministry of Health and the World Health Organization, pregnant woman should opt for transpelvic delivery, if she has no indication for cesarean section. Nonetheless, Brazil is one of the most performing cesarean section countries in the world, but only 15% of the cases the method are really needed. Objective: To perform a comparative study regarding the clinical status of parturient and newborn after transpelvic and cesarean delivery. Material and Methods: Data were collected from 50 pregnant women with gestational age between 38 and 40 weeks when they delivered, through analysis of medical records and questionnaire applied to postpartum women and considering the health status of both the postpartum and the newborn. Results: With the information gathered, a profile of the pregnant woman was drawn. The statistical study did not show statistical significance in the comparison of the pathways regarding the following aspects: occurrence and intensity of pain after delivery (P = 0.14), 1st minute Apgar score (P = 0.73) and 5th minute Apgar score (P = 0.53). Only the length of stay was significant (P = 0.02), and a longer time of transpelvic delivery was found. Conclusion: Although the literature demonstrates greater advantages for both the patient and the newborn when performing transpelvic delivery, the present study found no significant differences between the two routes of delivery.Keywords: Transpelvic delivery; Cesarean section; Postpartum period; Infant, newborn; Comparative study
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