Objective To evaluate the performance of published first-trimester prediction algorithms for pre-eclampsia (PE) in a prospectively enrolled cohort of women. Method

Objective To compare performance of multimarker algorithm, risk profiles and their sequential application in prediction of preeclampsia and determining potential intervention targets.Study Design Maternal characteristics, ultrasound variables and serum biomarkers were collected prospectively at first trimester. Univariate analysis identified preeclampsia associated variables followed by logistic regression analysis to determine the prediction rule. Combined characteristics of the cardiovascular, metabolic and the personal risk factors were compared to the multimarker algorithm and the sequential application of both methods.Results Out of 2433 women, 108 developed preeclampsia (4.4%). Probability scores considering nulliparity, prior preeclampsia, body mass index, diastolic blood pressure and placental growth factor had an area under the receiver operating characteristic curve 0.784 (95% CI = 0.721-0.847). While the multimarker algorithm had the lowest false negative rate, sequential application of cardiovascular and metabolic risk profiles in screen positives reduced false positives by 26% and identified blood pressure and metabolic risk in 49/54 (91%) women with subsequent preeclampsia as treatable risk factors.Conclusion Sequential application of a multimarker algorithm followed by determination of treatable risk factors in screen positive women is the optimal approach for first trimester preeclampsia prediction and identification of women that may benefit from targeted metabolic or cardiovascular treatment.

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The majority of pregnancies that develop HELLP syndrome can be predicted in the first trimester. © 2015 John Wiley & Sons, Ltd.

ResumoDiversos estudos têm investigado o efeito do exercício nos sintomas da depressão e qualidade de vida (QV) em idosos depressivos. Entretanto, os poucos estudos realizados com idosos clinicamente diagnosticados apresentaram resultados controversos devido aos diferentes tipos e intensidades do treinamento físico. O objetivo do presente estudo foi comparar diferentes intervenções com exercícios físicos na QV e nos sintomas depressivos em idosos depressivos. Foram selecionados idosos com depressão maior, divididos em grupo exercício (n=31) e controle (n=21). O grupo exercício foi randomizado em Treinamento Aeróbio (TA) (n=9), Treinamento de Força (n=6) e exercícios generalizados de Baixa Intensidade (BI) (n=16). A diferença entre os momentos e grupos foi analisada pelos testes de Wilcoxon e Mann Whitney, respectivamente. Após três meses de intervenção, somente os grupos aeróbio (p=0,01) e força (p=0,02) reduziram significativamente os sintomas depressivos. Além disso, TA apresentou melhora nos aspectos físicos (p=0,02) e tendência à significância para redução da dor (Z=-1,7; p=0,08), enquanto o TF apresentou tendência à significância estatística na melhora da Capacidade física (p=0,08), e melhora nos aspectos físicos (p=0,05), sociais (p=0,05) e saúde mental (p=0,05). Já o GC apresentou piora no aspecto social (p=0,02) e nenhuma alteração foi vista para o grupo BI. O presente estudo mostrou que tanto o TA quanto o TF com intensidade moderada podem contribuir para a redução dos sintomas de depressão e melhora da qualidade de vida, especialmente dos aspectos físicos. E ainda, que tais alterações podem ser dependentes de aspectos fisiológicos causados pelo exercício, e não somente pelo contato social. PalavRas-chaveExercício; Qualidade de vida; Depressão maior; Envelhecimento. tion, only aerobic (p=0.01) and strength (p=0.02) groups showed significant reduction of depressive symptoms. Moreover, TA showed improvement in physical aspect (p=0,02) and trend to significant results to pain (Z=-1,7; p=0,08), while TF showed trend to significant results to physical capacity (p=0,08), physical aspect (p=0,05), social aspect (p=0,05), and mental health (p=0,05 abstRact Several studies have investigated the effect of exercise on depressive symptoms and quality of life in depressive elderly. However, few studies have used elderly people clinically diagnosed and showed controversies results due to the different types and intensities of exercises. The goals of this study were to compare different interventions with physical exercise on quality of lifein and depressive symptoms in depressive elderly. We selected elderly with major depression, divided between exercise group (n=51) and control (n=21). The exercise group was randomized in aerobic training (n=9), strength training (n=6), and generalized exercise of low intensity (n=16). We analyzed the difference between moments and groups through Wilcoxon and Mann Whitney test, respectively. After three months of interven

Background Microbiota-derived uremic toxins have been associated with inflammation that could corroborate with endothelial dysfunction (ED) and increase cardiovascular risk in patients with chronic kidney disease (CKD). This trial aimed to evaluate the effect of the prebiotic fructooligosaccharide (FOS) on endothelial function and arterial stiffness in nondialysis CKD patients. Methods In a double-blind controlled trial, 46 nondiabetic CKD patients were randomized to receive 12 g/day of FOS or placebo (maltodextrin) for 3 months. Total p-cresyl sulfate (PCS) and indoxyl sulfate by high-performance liquid chromatography, urinary trimethylamine N-oxide by mass spectrometry, C-reactive protein, interleukin-6 (IL-6), serum nitric oxide and stroma-derived factor-1 alfa were measured at baseline and at the end of follow-up; endothelial function was assessed through flow-mediated dilatation (FMD) and arterial stiffness by pulse wave velocity (PWV). Results The mean (± standard deviation) age of the study participants was 57.6 ± 14.4 years, with an estimated glomerular filtration rate of 21.3 ± 7.3 mL/min/1.73 m2. During the follow-up, regarding the inflammatory markers and uremic toxins, there was a significant decrease in IL-6 levels (3.4 ± 2.1 pg/mL versus 2.6 ± 1.4 pg/mL; P = 0.04) and a trend toward PCS reduction (55.4 ± 38.1 mg/L versus 43.1 ± 32.4 mg/L, P = 0.07) only in the prebiotic group. Comparing both groups, there was no difference in FMD and PWV. In an exploratory analysis, including a less severe ED group of patients (FMD ≥2.2% at baseline), FMD remained stable in the prebiotic group, while it decreased in the placebo group (group effect P = 0.135; time effect P = 0.012; interaction P = 0.002). Conclusions The prebiotic FOS lowered circulating levels of IL-6 in CKD patients and preserved endothelial function only in those with less damaged endothelium. No effect of FOS in arterial stiffness was observed.

a b s t r a c tStudy Objective: The main aim of this study is to evaluate the impact of adolescent pregnancy in the future contraceptive choices. A secondary aim is to verify whether these choices differ from those made after an abortion. Design: Retrospective study. Setting: Adolescent Unit of a tertiary care center. Participants: 212 pregnant teenagers. Interventions: Medical records review. Main Outcome Measures: Intended pregnancy rate and contraceptive methods used before and after pregnancy. For contraceptive choices after pregnancy we considered: Group 1 -teenagers who continued their pregnancy to delivery (n 5 106) and Group 2 -the same number of adolescents who chose to terminate their pregnancy. Results: The intended pregnancy rate was 14.2%. Prior to a pregnancy continued to delivery, the most widely used contraceptive method was the male condom (50.9%), followed by oral combined contraceptives (28.3%); 18.9% of adolescents were not using any contraceptive method. After pregnancy, contraceptive implant was chosen by 70.8% of subjects (P ! .001) and the oral combined contraceptives remained the second most frequent option (17.9%, P 5 .058). Comparing these results with Group 2, we found that the outcome of the pregnancy was the main factor in the choices that were made. Thus, after a pregnancy continued to delivery, adolescents prefer the use of LARC [78.4% vs 40.5%,OR: 5,