Functional activity of neutrophilic polymorphonuclear leukocytes in the first five days postpartum / Atividade funcional de leucócitos polimorfonucleares neutrofílicos nos primeiros cinco dias após o parto

PURPOSE: To assess the chemotactic activity and phagocytic response of neutrophilic polymorphonuclear leukocytes among women in the first five days postpartum.METHODS: A prospective, cross-sectional clinical-laboratory study was conducted. Data of 31 postpartum women during the first five days after vaginal delivery were compared with those of 24 healthy non-pregnant non-postpartum women matched for age. The inclusion criteria were postpartum, clinically and obstetrically healthy women; vaginal delivery, singleton pregnancy carried to term; non-hypertensive, hyperglycemic, allergic, malnourished or with autoimmune or neoplastic diseases; not having received vaccines or blood products in the last three months. The Control Group was chosen according to the same inclusion criteria but involving non-pregnant non-postpartum women. The chemotactic activity of neutrophilic polymorphonuclear leukocytes was assessed by determining the distance from directed migration to bacterial lipopolysaccharide, in three Boyden chamber assays. The phagocytic response was identified by assessing the Zymosan particles' ingestion in three assays carried out in Leighton tubes. The Student's t-test was used in the statistical analysis, adopting a 5% level of significance.RESULTS: The chemotactic activity of neutrophilic polymorphonuclear leukocytes from postpartum women in the presence of homologous (73.2±6.9) and autologous (78.6±13.9) sera showed a significant increase compared to the values observed in the Control Group (64.1±4.1 and 66.6±5.4). Both chemotactic response and phagocytosis ingestion phase of neutrophilic polymorphonuclear leukocytes were significantly increased (p<0.05) in postpartum women compared to healthy non-pregnant and non-postpartum women.CONCLUSION: There was an increase in the chemotactic activity and phagocytic response of neutrophilic polymorphonuclear leukocytes during the first five days after vaginal delivery in women.

OBJETIVO: Avaliar a atividade quimiotática e a resposta fagocitária dos leucócitos polimorfonucleares neutrofílicos entre puérperas nos cinco primeiros dias após o parto.MÉTODOS: Um estudo clínico-laboratorial prospectivo e transversal foi realizado. Dados de 31 puérperas nos cinco primeiros dias após o parto vaginal foram comparados aos de 24 mulheres saudáveis não gestantes e não puérperas, por meio da idade. Os critérios de inclusão foram puérperas clínica e obstetricamente saudáveis; parto vaginal; gestação de feto único a termo; não hipertensas, hiperglicêmicas, alérgicas ou desnutridas ou portadoras de doenças autoimunes ou neoplasias; sem terem recebido vacinas ou hemoderivados nos últimos três meses. O Grupo Controle foi selecionado utilizando-se os mesmos critérios, mas com mulheres não gestantes e não puérperas. A atividade quimiotática por leucócitos polimorfonucleares neutrofílicos foi avaliada determinando-se a distância da migração dirigida ao lipopolissacarídeo bacteriano em três ensaios utilizando-se câmaras de Boyden. A resposta fagocitária foi identificada por meio da ingestão de partículas de zymosan em três ensaios, que foram realizados em tubos de Leighton. Na análise estatística, empregou-se o teste tde Student, adotando-se o nível de significância de 5%.RESULTADOS: A atividade quimiotática dos leucócitos polimorfonucleares neutrofílicos de mulheres no pós-parto, na presença de soro homólogo (73,2±6,9) e autólogo (78,6±13,9), mostrou diferença significante quando comparada aos valores observados no Grupo Controle (64,1±4,1 e 66,6±5,4). A resposta quimiotática e a etapa de ingestão da fagocitose por leucócitos polimorfonucleares neutrofílicos apresentaram acréscimos expressivos (p<0,05) em puérperas ao compararem-se aos valores de mulheres saudáveis não gestantes e não puérperas.CONCLUSÃO: Houve um aumento da atividade quimiotática e da resposta fagocitária por leucócitos polimorfonucleares neutrofílicos nos primeiros cinco dias após parto vaginal nas mulheres.

Valores séricos de imunoglobulinas e dos componentes do complemento em gestantes com ruptura prematura de membranas / Immunoglobulin serum values and complement components in pregnant women with premature rupture of the membranes

OBJETIVO: a ruptura prematura de membranas (RPM) tem sido motivo para muitas indagações, dentre as quais os mecanismos imunes envolvidos. Diante da escassez de estudos relacionados ao tema, este trabalho teve como objetivo avaliar os valores séricos de imunoglobulina A (IgA), imnoglobulina G (IgG), imunoglobulina M (IgM), C3 e C4 em gestantes com RPM. MÉTODOS: neste estudo transversal, foram incluídas 36 mulheres grávidas, com idade gestacional entre 23 e 37 semanas. Deste total, 15 mulheres tiveram diagnóstico laboratorial e clínico de RPM. Foram excluídas as pacientes com início do trabalho de parto, sinais clínicos de infecção ou disfunções clínicas com repercussão sistêmica. Concentrações séricas de IgA, IgM e IgG, C3 e C4 foram avaliadas nas pacientes com (grupo de estudo) e sem RPM (grupo controle). A correlação entre as dosagens, o número de partos e o tempo de ruptura foi determinada pelo coeficiente de correlação de Spearman (valor de r). RESULTADOS: os níveis séricos de IgA (média±DP) foram significativamente mais altos nas pacientes do grupo controle do que nas pacientes do grupo de estudo (271,0±107,0 versus 202,9±66,1, respectivamente; p=0,024). Não houve diferença estatística quando os níveis de IgM, IgG, C3 e C4 foram comparados entre os grupos. Não foi notada associação significativa entre o número de partos e as dosagens de IgA, IgM, IgG, C3 e C4 (r entre -0,009 e 0,027; p>0,05). O tempo de ruptura médio das pacientes do grupo de estudo foi de 19,1 horas (uma a 72 horas), sem nenhuma associação com as dosagens séricas avaliadas. CONCLUSÕES: mulheres grávidas com RPM apresentam níveis de IgA significativamente mais baixos do que as pacientes grávidas normais. A variável "número de partos" não atua como um fator de confusão na análise comparativa das dosagens obtidas em pacientes com ou sem RPM, assim como também não houve associação entre o tempo de ruptura e as dosagens séricas de imunoglobulinas e complementos.

PURPOSE: the premature rupture of membranes (PROM) has been a reason for many investigations, amongst which the involved immune mechanisms. Ahead of the scarcity of studies related to the subject, this work had as objective to evaluate the serum values of IgA, IgG, IgM, C3 and C4 in pregnant women with pre-term PROM. METHODS: in this transversal study, 36 pregnant women had been enclosed, with gestational age between 23 and 37 weeks. Of this total, 15 women had had laboratorial and clinical diagnosis of PROM. Patients with beginning of the childbirth work, clinical signals of infection, clinical dysfunction with systemic repercussion had been excluded. Serum concentrations of immunoglobulin (IgA), immunoglobulin M (IgM) and immunoglobulin G (IgG), C3 and C4 had been evaluated in the patients with (study group) and without PROM (control group). Correlation among dosages; number of childbirths and time of rupture was determined by Spearman coefficient correlation (r value). RESULTS: serum levels of IgA (average±SD) had been significantly higher in the patients of the control group (271.0±107.0 versus 202.9±66.1; respectively, control and study group; p=0.024). There was no statistical difference when the levels of IgM, IgG, C3 and C4 had been compared between two groups. Significant association was not noticed between the number of childbirths and the IgA, IgM, IgG, C3 and C4 dosages (Spearman; r between -0,009 and 0,027; p>0,05). The average time of rupture of study group patients was of 19.1 hours (one - 72 hours), without association with the evaluated serum dosages. CONCLUSIONS: pregnant women with PROM show levels of IgA significantly lower than normal pregnant patients. The variable "number of childbirths" does not act as a factor of confusion in the comparative analysis of the dosages obtained in patients with or without PROM, as well as also it did not have association between the time of rupture and the immunoglobulin and complements...

Organización conductual de neonatos hijos de madres con un trastorno del estado de ánimo

resumen está disponible en el texto completo

Summary Background: Recent research has found that newborns, whose mothers present a mood disorder, show at this age a profile of dysregulation characterized by an impaired performance according to the Brazelton Neonatal Behavioral Assessment Scale, indeterminate hipersomnia high levels of stress related hormones (norepinephrine and cortisol) right frontal EEG activation deficient responsivity to facial expressions and impairment of sympathetic response characterized by lower vagal tone. Newborns from mothers who were depressed during pregnancy show to be more irritable, more difficult to console, and have less developed motor tone than newborns from nondepressed mothers. The mother's behavior, related to the newborn, is characterized by two predominant interaction styles: withdrawn or intrusive, which seem to have differential negative effects on their infants, due to inadequate stimulation and arousal modulation. The mother's mood and anxiety disorders may affect the newborn due to exposure of the fetus to the maternal biochemical imbalance. Because the longer exposure to an intrauterine environment marked by high levels of cortisol and norepinephrine was likely to result in less optimal outcomes, the newborns of mother who were depressed only at the beginning of pregnancy were likely to show more optimal profiles than those of mothers reporting symptoms of depression and accompanying biochemical imbalances at the middle and at the end of pregnancy. Studies on prepartum health behaviors provide evidence for the indirect effects of maternal depression on the prepartum environment. Depressed mothers are less likely to seek prepartum care and are more likely to smoke, drink, and use cocaine during pregnancy than non depressed mothers. Objective: To compare the systems of behavior organization of those infants born from high neonatal risk mothers with or without mood disorder. Method: An observational, analytical and longitudinal case-control study was designed. A sample of 53 women, 18 to 40 years old and with a 16-35 weeks pregnancy was selected for this study. From this sample, 24 women did not have a mood disorder diagnosis and had a mean age of 27.7 ± 5.3 and 29 women had this diagnosis and a mean age of 30 ± 6.7 years. Mean gestational age of infants at birth was 39.4 ± 1.3 and 39.1 ± 1.2, respectively. This study was carried out from April 2003 to June 2004. Women participated in this study after signing their acceptance. The Neonatal Behavioral Assessment Scale (NBAS), an instrument used to detect the presence of alterations during the first 2 months of life of newborns, was applied to 53 infants at two different moments: 3 days and 27-30 days after birth. Women were assigned to the case (diagnosis of mood disorder) or control group (without mood disorder) after the application of the Edimburgh Postnatal Depression Scale (EDPS) and the structured interview for axis I and II of the DSM-IV. ANOVA tests were used for comparisons between the study groups (cases and controls) as independent variables, and the pretest and post test change, as the dependent variables. Initial values, the interval in days between the evaluations and gestational age were considered covariables in the analysis. This analysis was done for each of the 6 clusters or segments of the NBAS which are: social interaction, motor system, state organization, state regulation, autonomic system, and the cluster of supplementary items. These were also considered for the total score. Results: During the first evaluation, all infants performed satisfactorily, a fact that indicates that at birth they were in good conditions for their future development. When reviewing changes of the 6 analyzed clusters, the only differences found were in motor maturity. Infants from depressed mothers showed a slight difference (adjusted mean 0.971 ± 2.6 points) when compared with babies from non-depressed mothers (adjusted mean 2.033 ± 2.6 points) [F(1,49)=3.83,p=0.05]. The rest of the segments from the NBAS did not show a statistical difference. All results were favorable in all clusters for mothers without mood disorder, independently from the covariables. Conclusion: Behavior organization of infants born to women with mood disorder tends to show delayed motor maturity. Even though we did not find evidence of delayed development in the other clusters, a trend could be observed. Decreased motor tone and lower activity levels, lethargy, and stress behaviors were noted in the infants of depressed mothers, suggesting that infants were floppy, relatively unresponsive, and reminiscent of newborns who are small for date. This behaviors might contribute to the later difficulties noted in the interactions of depressed mothers and their infants. It is important to further study the effects of maternal depression in the development of behavior organization in newborns. It is also important to study the biochemical disturbances in the mother secondary to her depression, and their effect in the biochemical balance of her neonate. Cortisol has a great influence on the cerebral development and it is associated to the inhibition of neurogenesis in hypothalamus. This inhibition perhaps may be the cause of depression in the newborn. The mother's anxiety during pregnancy may have a great influence on the behavior of the newborn. In this study, the mother was undergoing a high risk pregnancy, with some previous abortions, low pregnant age and other perinatal risks. Under this conditions, mothers are likely to present psychological distress.

Quantificação das populações e subpopulações de linfócitos em gestantes com pré-eclâmpsia / Lymphocyte and lymphocyte subset analyses in women with preeclampsia

OBJETIVO: analisar a relação do sistema imunológico com a pré-eclâmpsia, comparando-se populações e subpopulações de linfócitos em gestantes saudáveis e com pré-eclâmpsia. MÉTODOS: foram estudadas 40 gestantes, sendo 20 saudáveis e 20 com doença hipertensiva específica da gestação. Amostras de sangue periférico foram obtidas de todas as gestantes e realizou-se quantificação de populações e subpopulações de linfócitos (CD4+, CD8+, relação CD4+/CD8+, CD3+ e CD19+). A análise estatística foi realizada pelo teste de Mann-Whitney. RESULTADOS: os resultados encontrados foram: contagem de linfócitos menores nas pré-eclâmpticas (grupo de estudo 2295,10ñ1328,16, grupo controle 3892,80ñ1430,85, p<0,05), assim como de CD4+ (grupo de estudo 1188,80ñ625,61, grupo controle 1742,25ñ628,40, p<0,05), CD8+ (grupo de estudo 774,00ñ371,31, grupo controle 1175,70ñ517,72, p<0,05), CD3+ (grupo de estudo 1958,65ñ983,78, grupo controle 2916,95ñ1117,88, p<0,05). Os demais testes não apresentaram diferenças estatisticamente significantes nos dois grupos. CONCLUSÕES: conclui-se que há diminuição no número de linfócitos, CD4+, CD8+ e CD3+ na pré-eclâmpsia.

Evaluación familiar y del desarrollo de dos niñas, hijas de padres con VIH/SIDA

Objetivos: Describir las pautas de interacción de dos familias con VIH/SIDA con la infección ubicada en los padres y evaluar a dos niñas de estas familias en su organización conductual alrededor de los cuarenta días de vida y el desarrollo mental y motor a los seis y doce meses de edad. Material y métodos: A través del genograma se evaluaron los sistemas familiares de dos niñas, hijas de padres infectados por VIH/SIDA; las pequeñas, a su vez, fueron evaluadas con la Escala de Conductas Neonatales de Brazelton (NBAS) entre los 39 y 44 días después del nacimiento y a través de las Escalas de Desarrollo de Nancy Bayley (BSID-II) a los seis y doce meses de edad. Resultados: En los dos casos la organización familiar corresponde a una pareja de adultos-jóvenes con VIH positivo en etapa de bebés y con hijos no enfermos; en el primer caso la madre se define como la transmisora; en el segundo el padre. Hay un debilitamiento en el subsistema de los padres. Las relaciones de parejas de los padres presentan ambivalencias. A medida que la VIH/SIDA avanza, las alianzas dividen a las familias y excluyen de la colaboración contra la enfermedad a varios miembros, lo que sobrecarga a las abuelas maternas. Las jerarquías y los límites son difusos, lo cual impide una contención estable y firme a los hijos. Las dos familias se encuentran estancadas en la etapa de estrés situacional. En el NBAS las dos lactantes obtuvieron una ejecución de buena a excelente (puntajes 7, 8 y 9) en los diferentes conglomerados; en el BSID-II, se advirtió que en ambos casos, en los primeros seis meses el desarrollo mental y motor cursó dentro de los límites normales; mientras que a los 12 meses el primer caso continuó con un desarrollo normal y en el segundo no fue posible evaluar con precisión el desarrollo, debido a una conducta de oposicionismo. Conclusiones: Ambos sistemas familiares presentan una organización con enfermo crónico y en particular con VIH-SIDA. Este estudio nos muestra que la evaluación en el desarrollo motor y mental de las dos niñas cursa conforme a lo esperado y que en la organización actual existe la estructura familiar con un proceso de parentalización (inversión de roles) y desamparo para las niñas.

Objective: To describe the family patterns of interaction of two girls born to parents infected with AIDS/HIV, and their behavioral organization around forty days, also the mental and motor development at six and twelve months. Methodology: The two family systems of the two girls with both parent infected by AIDS/HIV, were evaluated using a genogram; they were also appraised with the Brazelton Neonatal Behavioral Assesment Scale (NBAS), between days 39 and 44; and with the Bayley Scale of Infant Development (BSID-II) at six and twelve months of age. Results: In the two cases, the family organization belongs to a young adult couple with HIV positive and two healthy sons; in the first case, the mother is identified as the transmitter; in the second, the father is the spreading agent. There is a weakening effect in the parental subsystem. The couples relations are ambivalent. As the HIV/AIDS advances, the alliances divide the family, excluding several members from the collaboration effort against the illness; this overloads the maternal grandmothers. Hierarchies and limits become diffused, resulting in a lack of a firm and stable emotional contention for the children. The two families are stalled in a situational stress period. In respect to the NBAS the two infants obtained performance from good to excelent (scores 7,8,9) across the clusters; in the BSID-II both cases had a normal score in the first six months of their mental and motor development, while at twelve months of age, the first case continued with a normal development, but the second case was not precisely evaluated due to oppositional behavior. Conclusions: Both family systems are identified with an organization affected by the HIV presence, their structure is promoting a parentalization (role reversal) process and neglect for the children; though the motor and mental development of the two girls were found according to the expected norm for their age.

El método de elementos finitos y su aplicación en la investigación odontológica / The finite elements method and its application to dental research

Hace aproximadamente dos siglos, basado en la teoría de la elasticidad y mediante la aplicación de diferentes ecuaciones, matemáticos franceses y alemanes propusieron un modelo teórico para predecir los esfuerzos a los que está sometido un cuerpo bajo carga. La solución de este problema fue muy compleja debido al escaso desarrollo tecnológico de la época. Sólo en 1956, Turner, Clough, Martin y Topp presentaron el Método Computarizado de Elementos Finitos (MEF), el cual resuelve con gran aproximación las múltiples ecuaciones utilizadas en esta predicción. El MEF es un procedimiento ejecutado en un computador, que tiene el potencial de simular un modelo matemático equivalente a un objeto real, compuesto por diferentes materiales y de forma complicada. Es un método numérico versátil, aplicable en todos los campos de las ciencias exactas, principalmente en las ingenierías, civil, mecánica, biomédica y nuclear, asimismo, en geomecánica, hidráulica, medicina y odontología. La literatura presenta varios estudios que demuestran su utilidad en la investigación odontológica. Este artículo pretende ilustrar su uso y aplicabilidad en implantología, ortodoncia, ortopedia maxilar, prostodoncia y cirugía maxilofacial

Importância e análise crítica do teste de Kleihaüe-Betke na profilaxia da isoimunizaçåo Rh nos dias atuais / Importance and critical analysios of the Kleihaüer-Betke tests in the prevent isoimmunization Rh in the actual days

O teste de Kleihaüer-Beike, apesar de ser pouco usado atualmente, tende a apresentar grande valor na profilaxia da isoimunizaçåo materna. Principalmente nos casos em que ocorre hemorragia feto-materna maciça, onde a dose preestabelecida de 30 mg de imunoglobulina anti-Rh, para impedir a isoimunizaçåo, pode ser insuficiente. Este trabalho visa esclarecer a importância do teste a vantagem de sua realizaçåo levando em conta a realizaçåo custo/benefício, sendo um método simples e pouco dispendioso, evita gastos maiores com as possíveis complicaçöes da isoimunizaçåo. Destarte, nossa proposiçåo foi revisar e atualizar na literatura tal metodologia, com o desiderato de minuir custos em eventuais situaçöes onde se torna impositiva a realizaçåo deste