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1.
European J Med Plants ; 2022 Apr; 33(4): 48-59
Article | IMSEAR | ID: sea-219482

ABSTRACT

Aims: Nauclea vanderguchtii (N. vanderguchtii) species belongs to the family Rubiaceae and it is widely used in traditional Cameroonian medicine against inflammatory diseases such as arthritis, rheumatism and gastric disorders. The present study was aimed to evaluate anti-inflammatory effect of a methanol extracts of leaves, stems, roots and barks with multiparametric analyses through in vitro assays and an in vivo model. Methodology: Leaves, stems, barks and roots of N. vanderguchtii were air-dried and a methanolic extract was further obtained. Red blood cell membrane stabilization and protein denaturation were carried out as screening assays for anti-inflammatory activity in vitro, following by Diphenyl picryl-hydrazyl (DPPH), 2,2’- azino-bis – (3 - ethylbenzothiazoline -6- sulfonique (ABTS) and Ferric Reducing Antioxidant Power ( FRAP) antioxidant activity. Furthermore, the anti-inflammatory capacity of leaves and stems methanolic extract was evaluated in vivo by carrageenan-induced oedema. Results: Each part of Nauclea vanderguchtii, effectively and significantly stabilized red blood cell membrane. The methanol leaves extract exhibited better effect (53.12%), followed by stems (50.55%), barks (50.98%) and roots (49.6%) compare to an ibuprofen (51.16%), a standard reference drug. Those extracts also inhibited the denaturation of the egg albumin (P ? .05; P ? .01). Methanol stem and leaves extracts from plant were the effective scavengers of ABTS - radical (95.92 ± 0.37%), DPPH - radical (91.12 ± 0.13%). FRAP of methanolic extract was concentration-dependent. Moreover, methanol leaves extract of Nauclea vanderguchtii, significantly (P<.01) prevented paw edema with the maxima 58.97% (200 mg / kg). Conclusion: This study shows that N. vanderguchtii extracts possess significant anti-inflammatory and antiradical activities. These activities are more pronounced in leaves than other parts of plant and justify the traditional use.

2.
Braz. j. med. biol. res ; 53(4): e8770, 2020. tab, graf
Article in English | LILACS | ID: biblio-1089354

ABSTRACT

Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (P<0.001) and FES (P<0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Respiration, Artificial/methods , Motion Therapy, Continuous Passive/methods , Cytokines/blood , Critical Illness/therapy , Nitrosative Stress/physiology , Biomarkers/blood , Critical Illness/rehabilitation , Oxidative Stress/physiology , Electric Stimulation/methods , Quadriceps Muscle/physiopathology , Inflammation/immunology , Inflammation/metabolism , Intensive Care Units
3.
Braz. j. med. biol. res ; 48(11): 953-964, Nov. 2015. tab, graf
Article in English | LILACS | ID: lil-762901

ABSTRACT

Cocos nucifera (L.) (Arecaceae) is commonly called the “coconut tree” and is the most naturally widespread fruit plant on Earth. Throughout history, humans have used medicinal plants therapeutically, and minerals, plants, and animals have traditionally been the main sources of drugs. The constituents of C. nucifera have some biological effects, such as antihelminthic, anti-inflammatory, antinociceptive, antioxidant, antifungal, antimicrobial, and antitumor activities. Our objective in the present study was to review the phytochemical profile, pharmacological activities, and toxicology of C. nucifera to guide future preclinical and clinical studies using this plant. This systematic review consisted of searches performed using scientific databases such as Scopus, Science Direct, PubMed, SciVerse, and Scientific Electronic Library Online. Some uses of the plant were partially confirmed by previous studies demonstrating analgesic, antiarthritic, antibacterial, antipyretic, antihelminthic, antidiarrheal, and hypoglycemic activities. In addition, other properties such as antihypertensive, anti-inflammatory, antimicrobial, antioxidant, cardioprotective, antiseizure, cytotoxicity, hepatoprotective, vasodilation, nephroprotective, and anti-osteoporosis effects were also reported. Because each part of C. nucifera has different constituents, the pharmacological effects of the plant vary according to the part of the plant evaluated.


Subject(s)
Animals , Humans , Anti-Infective Agents/pharmacology , Cocos/chemistry , Phytotherapy , Plant Extracts/pharmacology , Protective Agents/pharmacology , Analgesics/pharmacology , Anti-Inflammatory Agents/pharmacology , Anticonvulsants/pharmacology , Antihypertensive Agents/pharmacology , Bone and Bones/drug effects , Cocos/toxicity , Hypoglycemic Agents/pharmacology
4.
Braz. j. med. biol. res ; 47(11): 960-965, 11/2014. tab, graf
Article in English | LILACS | ID: lil-723901

ABSTRACT

In cardiomyocytes, calcium (Ca2+) release units comprise clusters of intracellular Ca2+ release channels located on the sarcoplasmic reticulum, and hypertension is well established as a cause of defects in calcium release unit function. Our objective was to determine whether endurance exercise training could attenuate the deleterious effects of hypertension on calcium release unit components and Ca2+ sparks in left ventricular myocytes of spontaneously hypertensive rats. Male Wistar and spontaneously hypertensive rats (4 months of age) were divided into 4 groups: normotensive (NC) and hypertensive control (HC), and normotensive (NT) and hypertensive trained (HT) animals (7 rats per group). NC and HC rats were submitted to a low-intensity treadmill running protocol (5 days/week, 1 h/day, 0% grade, and 50-60% of maximal running speed) for 8 weeks. Gene expression of the ryanodine receptor type 2 (RyR2) and FK506 binding protein (FKBP12.6) increased (270%) and decreased (88%), respectively, in HC compared to NC rats. Endurance exercise training reversed these changes by reducing RyR2 (230%) and normalizing FKBP12.6 gene expression (112%). Hypertension also increased the frequency of Ca2+ sparks (HC=7.61±0.26 vs NC=4.79±0.19 per 100 µm/s) and decreased its amplitude (HC=0.260±0.08 vs NC=0.324±0.10 ΔF/F0), full width at half-maximum amplitude (HC=1.05±0.08 vs NC=1.26±0.01 µm), total duration (HC=11.51±0.12 vs NC=14.97±0.24 ms), time to peak (HC=4.84±0.06 vs NC=6.31±0.14 ms), and time constant of decay (HC=8.68±0.12 vs NC=10.21±0.22 ms). These changes were partially reversed in HT rats (frequency of Ca2+ sparks=6.26±0.19 µm/s, amplitude=0.282±0.10 ΔF/F0, full width at half-maximum amplitude=1.14±0.01 µm, total duration=13.34±0.17 ms, time to peak=5.43±0.08 ms, and time constant of decay=9.43±0.15 ms). Endurance exercise training attenuated the deleterious effects of hypertension on calcium release units of left ventricular myocytes.


Subject(s)
Animals , Male , Calcium/physiology , Heart Ventricles/metabolism , Hypertension/therapy , Motor Activity/physiology , Myocytes, Cardiac/metabolism , Physical Conditioning, Animal/methods , Calcium Signaling/physiology , Exercise Test/methods , Heart Ventricles/cytology , Hypertension/metabolism , Rats, Inbred SHR , Rats, Wistar , Ryanodine Receptor Calcium Release Channel/genetics , Ryanodine Receptor Calcium Release Channel/metabolism , Tacrolimus Binding Proteins/genetics , Tacrolimus Binding Proteins/metabolism
5.
Braz. j. med. biol. res ; 43(11): 1042-1046, Nov. 2010. ilus, tab
Article in English | LILACS | ID: lil-564130

ABSTRACT

We determined the effects of exercise training and detraining on the morphological and mechanical properties of left ventricular myocytes in 4-month-old spontaneously hypertensive rats (SHR) randomly divided into the following groups: sedentary for 8 weeks (SED-8), sedentary for 12 weeks (SED-12), treadmill-running trained for 8 weeks (TRA, 16 m/min, 60 min/day, 5 days/week), and treadmill-running trained for 8 weeks followed by 4 weeks of detraining (DET). At sacrifice, left ventricular myocytes were isolated enzymatically, and resting cell length, width, and cell shortening after stimulation at a frequency of 1 Hz (~25°C) were measured. Cell length was greater in TRA than in SED-8 (161.30 ± 1.01 vs 156.10 ± 1.02 μm, P < 0.05, 667 vs 618 cells, respectively) and remained larger after detraining. Cell width and volume were unaffected by either exercise training or detraining. Cell length to width ratio was higher in TRA than in SED-8 (8.50 ± 0.08 vs 8.22 ± 0.10, P < 0.05) and was maintained after detraining. Exercise training did not affect cell shortening, which was unchanged with detraining. TRA cells exhibited higher maximum velocity of shortening than SED-8 (102.01 ± 4.50 vs 82.01 ± 5.30 μm/s, P < 0.05, 70 cells per group), with almost complete regression after detraining. The maximum velocity of relengthening was higher in TRA cells than in SED-8 (88.20 ± 4.01 vs70.01 ± 4.80 μm/s, P < 0.05), returning to sedentary values with detraining. Therefore, exercise training affected left ventricle remodeling in SHR towards eccentric hypertrophy, which remained after detraining. It also improved single left ventricular myocyte contractile function, which was reversed by detraining.


Subject(s)
Animals , Male , Rats , Myocardial Contraction/physiology , Myocytes, Cardiac/physiology , Physical Conditioning, Animal , Ventricular Remodeling/physiology , Blood Pressure/physiology , Cardiovascular Deconditioning/physiology , Rats, Inbred SHR , Ventricular Function, Left/physiology
6.
Genet. mol. res. (Online) ; 6(4): 1072-1084, 2007. ilus
Article in English | LILACS | ID: lil-520042

ABSTRACT

Industrial ethanol fermentation is a complex microbiological process to which yeast cells must adapt for survival. One of the mechanisms for adaptation is thought to involve chromosome rearrangements. We found that changes in chromosome banding patterns measured by pulsed-field gel electrophoresis can also be produced in laboratory media under simulated industrial conditions. Based on analysis of their generational variation, we found that these chromosome changes were specific to the genetic backgrounds of the initial strains. We conclude that chromosome rearrangements could be one of the factors involved in yeast cell adaptation to the industrial environment.


Subject(s)
Chromosomal Instability , Chromosomes, Fungal/genetics , DNA, Fungal/genetics , Ethanol/metabolism , Saccharomyces cerevisiae/genetics , Adaptation, Physiological , Biotechnology , DNA Fingerprinting , DNA, Fungal/isolation & purification , Fermentation , Karyotyping , Bioreactors/microbiology , Saccharomyces cerevisiae/growth & development , Saccharomyces cerevisiae/physiology
8.
Braz. j. med. biol. res ; 34(6): 791-6, Jun. 2001. graf
Article in English | LILACS | ID: lil-285855

ABSTRACT

We demonstrate here that acute third ventricle injections of GR 113808, a highly selective 5-HT4 antagonist, decrease water intake induced by a previous salt load while potentiating drinking elicited by hypovolemia induced by previous subcutaneous administration of polyethylene glycol in male Wistar rats (200 + or - 20 g). At the dose of 160 nmol/rat, third ventricle injections of GR 113808 induced a significant reduction of water intake in salt-loaded animals after 120 min as compared to salt-loaded animals receiving third ventricle injections of saline (salt load + GR = 3.44 + or - 0.41 ml, N = 12; salt load + saline = 5.74 + or - 0.40 ml, N = 9). At the dose of 80 nmol/rat, GR 113808 significantly enhanced water intake in hypovolemic animals after 120 min as compared to hypovolemic animals receiving third ventricle injections of saline (hypovol + GR = 4.01 + or - 0.27 ml, N = 8; hypovol + saline = 2.41 + or - 0.23 ml, N = 12). We suggest that central 5-HT4 receptors may exert a positive drive on water intake due to hyperosmolarity and a negative input on drinking provoked by hypovolemia.


Subject(s)
Animals , Male , Rats , Drinking/drug effects , Hypovolemia/metabolism , Indoles/pharmacology , Serotonin Antagonists/pharmacology , Third Ventricle , Injections, Intraventricular , Osmolar Concentration , Rats, Wistar
9.
Braz. j. med. biol. res ; 32(10): 1217-22, Oct. 1999. graf
Article in English | LILACS | ID: lil-252271

ABSTRACT

We have demonstrated that central administration of zinc in minute amounts induces a significant antidipsogenic action in dehydrated rats as well as in rats under central cholinergic and angiotensinergic stimulation. Here we show that acute third ventricle injections of zinc also block water intake induced by central ß-adrenergic stimulation in Wistar rats (190-250 g). Central inhibition of opioid pathways by naloxone reverses the zinc-induced antidipsogenic effect in dehydrated rats. After 120 min, rats receiving third ventricle injections of isoproterenol (160 nmol/rat) exhibited a significant increase in water intake (5.78 ± 0.54 ml/100 g body weight) compared to saline-treated controls (0.15 ± 0.07 ml/100 g body weight). Pretreatment with zinc (3.0, 30.0 and 300.0 pmol/rat, 45 min before isoproterenol injection) blocked water intake in a dose-dependent way. At the highest dose employed a complete blockade was demonstrable (0.54 ± 0.2 ml/100 g body weight). After 120 min, control (NaAc-treated) dehydrated rats, as expected, exhibited a high water intake (7.36 ± 0.39 ml/100 g body weight). Central administration of zinc blocked this response (2.5 ± 0.77 ml/100 g body weight). Naloxone pretreatment (82.5 nmol/rat, 30 min before zinc administration) reverted the water intake to the high levels observed in zinc-free dehydrated animals (7.04 ± 0.56 ml/100 g body weight). These data indicate that zinc is able to block water intake induced by central ß-adrenergic stimulation and that zinc-induced blockade of water intake in dehydrated rats may be, at least in part, due to stimulation of central opioid peptides


Subject(s)
Animals , Male , Rats , Dehydration , Drinking/drug effects , Isoproterenol/pharmacology , Naloxone/pharmacology , Neurotransmitter Agents/administration & dosage , Receptors, Adrenergic, beta/drug effects , Thirst/drug effects , Zinc/administration & dosage , Analysis of Variance , Injections, Intraventricular , Neurotransmitter Agents/pharmacology , Opioid Peptides/drug effects , Rats, Wistar , Time Factors , Zinc/pharmacology
10.
Braz. j. med. biol. res ; 32(10): 1243-8, Oct. 1999. graf
Article in English | LILACS | ID: lil-252275

ABSTRACT

We have demonstrated that acute third ventricle injections of lead acetate (PbAc) exert a powerful antidipsogenic effect and induce a significant increase in renal sodium excretion. In the present study we confirm the antidipsogenic effect of lead and demonstrate that central administration of this metal, in minute amounts, significantly reduces salt intake both during dehydration and after central angiotensinergic stimulation. Adult male Wistar rats had the third ventricle cannulated seven days before the experiments. During this period they had free access to distilled water and hypertonic saline solution (1.5 percent). After a 24-h period of fluid deprivation, experimental animals received third ventricle injections of PbAc (0.3, N = 8 and 3.0 nmol/rat, N = 14) while controls received sodium acetate (NaAc; 3.0 nmol/rat, N = 10). Rats treated with PbAc at the highest dose showed a significant reduction both in water and hypertonic saline intake when compared to controls. When the effect of lead administration on angiotensin II-induced water and salt intake was studied, normohydrated animals received third ventricle injections of angiotensin II (9.6 nmol/rat) after pretreatment with 3.0 nmol/rat of PbAc (experimental group, N = 10) or NaAc (controls, N = 8). The group pretreated with PbAc presented a significant reduction in both water and salt intake compared to controls. Thus, this study confirms the antidipsogenic effect of central lead injections and demonstrates that the presence of lead in the brain exerts a significant inhibition of sodium appetite


Subject(s)
Rats , Animals , Male , Angiotensin II/pharmacology , Appetite/drug effects , Drinking/drug effects , Organometallic Compounds/administration & dosage , Sodium, Dietary/administration & dosage , Analysis of Variance , Body Fluids/drug effects , Injections, Intraventricular , Organometallic Compounds/pharmacology , Rats, Wistar
11.
Rev. bras. cir. cardiovasc ; 13(4): 285-94, out.-dez. 1998. tab, graf
Article in Portuguese | LILACS | ID: lil-229769

ABSTRACT

From November, 1986 to April, 1997; 92 orthotopic heart transplants were performed, with recipient mean age of 44,9 years (range 3 to 63 years). Recipient diagnoses included dilated cardiomyopathy in 42 (44.6 per cent) ischemic cardiomyopathy in 23 (25 per cent), Chagas disease in 21 (22.8 per cent), valve disease in 3 (3.2 per cent) patients. The surgical technique used (described by Lower e Shumway, in 1960, with minor modification) was satisfactory and without complication. Graft ischemic time - Longer in heart transported from other institutions compared to side-by-side transplantation - was always less than 4 hours. The most common chronic complications of immunosuppressive therapy were: arterial hyperthension (84.6 per cent), hyperuricemia (75.4 per cent) and hypercholesterolemia (63 per cent). Regarding infections, viral were the most common ones with 92 (45.6 per cent) followed by bacterial with 35 (38.0 per cent), and protozoal with 15 (16.3 per cent) cases. Among bacterial infections, 7 occurred in the surgical wound, with good evolution. Among those infections caused by protozoal, 7 (46.6 per cent) were due to Trypanossoma cruzi. The overall mortality rate within 30 days of transplantation was 17.3 per cent, with infection, neurologic complications and rejection as major causes. From 30 days to 1 year of transplantation, the mortality rate was 10.3 per cent, with infection and rejection as primary causes. And after one year post-transplantation, the mortality rate was 14 per cent, with several different causes: sudden death, infection, rejection and others. The actuarial survival estimates at 1, 2, 3, 4, 5, and 6 years were 71.6 per cent, 66.5 per cent, 60.5 per cent, 54.4 per cent, 54.4 per cent and 54.4 per cent, respectively. There were no follow-up losses, and all the surviving patients are in functional type I of the NYHA. Cardiac transplantation procedure is possible in our community with accetable survival and post-operative complication rates acceptable, even though different from international statistics.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Heart Transplantation , Graft Rejection/mortality , Follow-Up Studies , Graft Survival , Infections/epidemiology , Infections/etiology , Time Factors , Tissue Donors , Heart Transplantation/adverse effects , Heart Transplantation/methods , Heart Transplantation/mortality , Treatment Outcome
12.
An. Fac. Med. Univ. Fed. Pernamb ; 43(2): 127-32, 1998. tab, graf
Article in Portuguese | LILACS | ID: lil-236657

ABSTRACT

A hiperatividade simpática durante o período pós-opratório tem sido responsabilizada como competente causal do íleo paralitico pós-operatório. Foi realizado estudo prospectivo randômico, avaliando os efeitos do beta-bloqueio pré-operatório com propranolol, em pacientes esquistossomóticos hepatoesplênicos sobre a atividade mioelétrica do cólon esquerdo durante o período de íleo paralítico pós-operatório comparando com pacientes esquistossomóticos similares não beta-bloqueados. Três pares de eletrodos bipolares foram fixados no cólon esquerdo durante a cirurgia para o tratamento da hipertensão portal esquistossomótica em ambos os grupos e obtidos os registros duas vezes ao dia da atividade contrátil colônica durante o período de íleo paralítico, utilizando um sistema de aquisição de dados (DATA Q Série 200) que capta frequêcias entre 0,02 a 10 Hz, sendo os sinais previamente amplificados, filtrados e separados em Atividade Elétrica de Controle (AEC) e Atividade Elétrica de Resposta (AER). Não foi observado diferenças estatisticamente significativas nos parâmetros eletromiográficos entre dois grupos, exeto pela presença de um maior número de contrações de curta duração no segundo dia de pós-operatório no grupo beta-bloqueado. Pode-se concluir que o beta-bloqueio adrenérgico pré-operatório, com propranolol,não determina diferenças na atividade miolétrica do cólon esquerdo, compatíveis com uma resolução mais precoce ou mais tardia do íleo paralítico pós-operatório em pacientes esquistossomóticos


Subject(s)
Humans , Male , Female , Adult , Middle Aged , 1-Propanol/administration & dosage , Adrenergic beta-Antagonists , Intestinal Pseudo-Obstruction , Myoelectric Complex, Migrating , Schistosomiasis
13.
Braz. j. med. biol. res ; 21(5): 1069-77, 1988. ilus, tab
Article in English | LILACS | ID: lil-63615

ABSTRACT

1. The mutagenicity of serum and urine from fuinea pigs treated with a single oral dose (500 mg/Kg) of benznidazole and nifurtimox was assayed using the Salmonella/plate incorporation test with strain TA100 and a nitroreductase-deficient derivative, TA100NR. 2. The urine and blood of animals treated with nifurtimox were not mutagenic for either tester strain. 3. The urine and blood of animals receiving benznidazole were mutagenic to the TA100 but not to the TA100NR strain. Similar results were obtained with nitrofurantoin-treated animals. Maximum mutagenicity values were obtained in serum and urine of treated animals 90 min and 24 h after administration, respectively. 4. Mutagenicity induced by benznidazole in the serum and urine of treated animals was not altered when assayed in anaerobic environments. 5. These results indicate that benznidazole and nifurtimox are not metabolized by the mammalian host into stable mutagenic derivatives detectable by the Ames test. Based on these data, we suggest that the potential cancer risk to patients treated with these drugs is small but should be further evaluated


Subject(s)
Guinea Pigs , Animals , Male , Female , Mutagenicity Tests , Mutation , Nifurtimox/metabolism , Nitroimidazoles/metabolism
14.
J. bras. ginecol ; 94(1/2): 7-9, 1984.
Article in Portuguese | LILACS | ID: lil-21881

ABSTRACT

Os autores apresentam o caso de uma paciente portadora de carcinoma da mama estadio IV, com metastases no interior de um leiomioma uterino. Fazem uma revisao sobre a frequencia do acometimento uterino por metastases de orgaos extrapelvicos e discutem a importancia desse achado em pacientes portadores de carcinoma da mama


Subject(s)
Middle Aged , Humans , Female , Breast Neoplasms , Leiomyoma , Neoplasm Metastasis , Uterine Neoplasms
17.
Rev. bras. ginecol. obstet ; 3(3): 115-9, 1981.
Article in Portuguese | LILACS | ID: lil-4445

ABSTRACT

Em 19 maternidades da cidade do Recife (Pernambuco, Brasil), em 1979, houve um total de 12 156 cesarianas (incidencia de 28,1%) e 30 953 partos vaginais. A mortalidade materna na operacao cesariana, foi de 3,3 por 1 000.Nas pacientes indigentes, foram realizadas 2 327 cesarianas (incidencia de 11,2%) e 18 414 partos vaginais. A mortalidade materna na operacao cesariana foi de 9 por 1 000. Nas pacientes do INAMPS, foram realizadas 5621 cesarianas (incidencia de 35,4%) e 10226 partos vaginais. A mortalidade materna na operacao cesariana foi de 3 por 1000. Nas pacientes previdenciarias estaduais e militares, foram realizadas 444 cesarianas (incidencia de 42,6%) e 596 partos vaginais. A mortalidade materna na operacao cesariana foi de 2,2 por 1 000. Nas pacientes de clinica particular, foram realizadas 3 764 cesarianas (incidencia de 67,7%) e 1 717 partos vaginais A mortalidade materna na operacao cesariana foi de 0,5 por 1 000. As causas mais frequentes de mortalidade materna foram: hemorragia, eclampsia, infeccao e embolia amniotica. No global, a mortalidade materna na operacao cesariana foi 6,13 vezes maior do que no parto vaginal


Subject(s)
Cesarean Section , Maternal Mortality , Brazil
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