O programa de assistência pré-natal nos Cuidados de Saúde Primários em Portugal: uma reflexão / The prenatal care program in Primary Care in Portugal: a reflection / El programa de vigilancia prenatal en la Atención Primaria en Portugal: una reflexión

A melhoria da qualidade dos cuidados prestados à grávida e ao recém-nascido é uma das áreas de intervenção prioritária do Plano Nacional de Saúde. Embora se reconheça que as medidas introduzidas nos últimos anos têm contribuído para diminuir os valores da mortalidade materna e perinatal, é necessário referir, também, que continuam a ocorrer gravidezes não planeadas que, não raras vezes, resultam do início tardio, ou mesmo da ausência, da assistência pré-natal. Neste artigo, procuramos refletir sobre a assistência pré-natal no contexto de saúde reprodutiva, de forma a constituir um contributo para os enfermeiros que prestam uma assistência integral e humanizada às grávidas e às suas famílias. Concluímos que a assistência pré-natal engloba um conjunto de cuidados específicos dirigidos a um grupo vulnerável, constituindo uma área muito importante na avaliação dos cuidados de saúde primários.

The quality improvement of care provided to the pregnant women and newborn is one of the priority areas for intervention of the National Health Plan. While acknowledging that the measures introduced in recent years have contributed to lower the values of maternal and perinatal mortality, it should also be mentioned that unplanned pregnancies continue to occur, and that they often result in a delayed or absent prenatal surveillance. In this paper, we seek to reflect on the prenatal surveillance program under Primary Health Care relating to quality of health care provided in the context of reproductive health. We concluded that prenatal surveillance includes a set of specific care services targeted at a vulnerable group, constituting an important and susceptible area of evaluation in primary care.

Mejorar la calidad de la atención a embarazada y recién nacido es una de las áreas prioritarias de intervención del plan nacional de salud. Aunque se reconoce que las medidas adoptadas en los últimos años han contribuido a reducir los valores de la mortalidad materna y perinatal, es necesario mencionar, también, que embarazos no planificados siguen produciéndose a menudo resultado de la aparición, o incluso ausencia, de vigilancia prenatal. En este artículo, reflexionamos sobre el programa de vigilancia prenatal en el marco de la atención primaria de salud, vinculándola con la calidad de la atención de la salud en el contexto de la salud reproductiva. Concluimos que la vigilancia prenatal comprende un conjunto de cuidados específicos dirigidos a un grupo vulnerable, lo que constituye un área sensible y evaluación importante en atención primaria.

Clinico-hematological profile of Chediak-Higashi syndrome: Experience from a tertiary care center in south India.

Introduction: Chediak-Higashi syndrome (CHS) is a rare autosomal recessive disorder characterized by partial ocular and cutaneous albinism, increased susceptibility to pyogenic infections, the presence of large lysosomal-like organelles in most granule-containing cells and a bleeding tendency. The abnormal granules are most readily seen in blood and marrow leukocytes, especially granulocytes; and in melanocytes. Other clinical features include silvery hair, photophobia, horizontal and rotatory nystagmus and hepatosplenomegaly. Materials and Methods: The clinico-hematological profile of a series of 5 cases of CHS encountered at JIPMER Hospital with diagnostic work-up done in the Department of Pathology over the last 6 years is presented. The diagnostic work-up included complete hemogram with peripheral smear, bone marrow examination, skin and liver biopsies. Results: The age of the patients ranged from 5 months to 3 years. All patients had silvery hair and partial albinism and presented with fever and recurrent chest infection. Two patients were stable. Three patients were in accelerated phase; of them, 1 patient with associated hemophagocytic syndrome had a rapidly fulminant course. Peripheral blood smear showed anomalously large granules in the leukocytes. Skin biopsy showed sparse, coarse melanin pigment in the epidermis, and liver biopsy done in 2 patients with accelerated phase showed portal lymphohistiocytic aggregates. Conclusions: The diagnostic hallmark of CHS is the occurrence of giant inclusion bodies (granules) in the peripheral leukocyte and their bone marrow precursors. The case series is being presented because of the rarity of CHS and varied spectrum of clinical and hematological presentation.

Electron microscopic evaluation of the secretory mechanisms of renin from juxtaglomerular cells / Evaluación con microscopía electrónica de los mecanismos secretorios de renina desde las células juxtaglomerulares

Although the structure and the functions of juxtaglomerular cells (JG) have been well defined, there is still a controversy about the secretory mechanisms of renin from these cells. It has been assumed that exocytosis is the main secretory mechanism in these cells in many studies, while others suggest that secretion occurs in a quite different way in these cells. There are several studies suggesting that diacrine secretion, which is very difficult to visualize, might be the other mechanism for secretion of renin. This study is an attempt to find the answers of these questions by identifying the fine structural features of the secretory granules in juxtaglomerular cells. Cyclosporin A (CyA) has been used in the current experimental study since it has already been reported that this drug increases the number of JG cells and stimulates secretion of Renin. Twelve female Sprague-Dawley rats had daily intraperitoneal injections of CyA for ten weeks. Tissue specimens from the kidneys of these animals were examined by electron microscopy. Fine structural characteristics of the secretory granules of juxtaglomerular cells have been examined. Considerable amount of granules, which goes to the exocytotic process, have been observed. Additionally, several cells, which their granules had been secreting their contents in a different way, were found. This was interpreted as the secretion type of diacrine secretion. In conclusion, this in vivo study presents morphologic evidences demonstrating that both exocytosis and diacrine secretion might occur in JG cells. We also had a chance to observe secretory granule probably exhibiting "diacrine secretion", which is very difficult to visualize, at electron microscope level for the first time. This report also provides morphologic proof which shows that these two distinct secretory mechanisms might occur simultaneously in the same juxtaglomerular cell.

Aunque la estructura y las funciones de las células yuxtaglomerulares (JG) han sido bien definidas, todavía existe controversia acerca de los mecanismos de secreción de renina en estas células. Se ha supuesto, en muchos estudios, que la exocitosis es el principal mecanismo de secreción de estas células, mientras que otros autores sugieren que la secreción se produce de una manera muy diferente en estas células. Hay varios estudios que plantean que la secreción diacrina, que es muy difícil de visualizar, podría ser otro mecanismo para la secreción de renina. Este estudio tiene como objetivo encontrar las respuestas a estas interrogantes mediante la identificación de las características estructurales de la secreción de gránulos en las células yuxtaglomerulares. Ciclosporina A (CyA) se ha utilizado en el estudio experimental actual, debido a que se ha informado que este medicamento aumenta el número de células JG y estimula la secreción de renina. Doce ratas hembras Sprague-Dawley fueron diariamente inyectadas por vía intraperitoneal, con CyA durante diez semanas. Las muestras de tejido renal de estos animales fueron examinadas a través de microscopía electrónica. Detalladas características estructurales han sido examinadas en los gránulos secretores de las células yuxtaglomerulares. Se ha observado una cantidad considerable de gránulos, que va con el proceso de exocitosis. Además, se encontaron células que habían secretado el contenido de sus gránulos de manera diferente. Esto fue interpretado como secreción de tipo diacrina. En conclusión, este estudio in vivo presenta evidencias morfológicas que demuestran que tanto la exocitosis y la secreción diacrina podría ocurrir en células JG. También tuvimos la oportunidad de observar probables gránulos secretores, que mostrarían "la secreción diacrina", que es muy difícil de visualizar, a nivel de microscopía electrónica. Este informe también proporciona la prueba morfológica que demuestra que estos dos mecanismos...

Ultrastructural studies on the respiratory tract of mice inoculated intranasally with L. fermentum

The ultrastructural modifications of the respiratory tract of mice produced by the intranasally inoculated L. fermentum was evaluated. The genus Lactobacillus has been largely studied from the probiotic effect point of view in different ecological systems. Lactobacilli inoculated in 4 intranasal doses (1 x 10(9) CFU/dose) do not produce fundamental changes at the ultrastructural level in the organs of the respiratory tract studied. The most important finding was the presence of a cellular type with intracellular structures surrounded by membranes exhibiting electron dense paracristalline material parallel arranged.

Evaluation of mast cells in oral lichen planus and oral lichenoid reaction.

Recent attention has been directed towards the role of mast cells in the pathogenesis of oral lichen planus. Mast cells are responsible for trafficking of inflammatory cells into the connective tissue that in turn helps in progression and maintenance of the chronicity of oral lichen planus. In the present study we have evaluated the mast cell count and its cell types using toluidine blue stain, in oral lichen planus and compared it with oral lichenoid reactions. We have observed an increase in mast cell count in both these conditions in comparison to normal mucosa. Also, a significant difference in the types of mast cells in oral lichen planus and oral lichenoid reactions has been noted, possibly suggesting that the role of mast cell is different in these conditions.

The structure of the nasal chemosensory system in squamate reptiles. 1. The olfactory organ, with special reference to olfaction in geckos.

The luminal surface of the chemosensory epithelia of the main olfactory organ of terrestrial vertebrates is covered by a layer of fluid. The source of this fluid layer varies among vertebrates. Little is known regarding the relative development of the sources of fluid (sustentacular cells and Bowman's glands) in reptiles, especially in gekkotan lizards (despite recent assertions of olfactory speciality). This study examined the extent and morphology of the main olfactory organ in several Australian squamate reptiles, including three species of gekkotans, two species of skinks and one snake species. The olfactory mucosa of two gekkotan species (Christinus marmoratus and Strophurus intermedius) is spread over a large area of the nasal cavity. Additionally, the sustentacular cells of all three gekkotan species contained a comparatively reduced number of secretory granules, in relation to the skinks or snake examined. These observations imply that the gekkotan olfactory system may function differently from that of either skinks or snakes. Similar variation in secretory granule abundance was previously noted between mammalian and non-mammalian olfactory sustentacular cells. The observations in gekkotans suggests that the secretory capacity of the non-mammalian olfactory sustentacular cells show far more variation than initially thought.

Zinc accumulation in phosphate granules of Ucides cordatus hepatopancreas

Amorphous phosphate granules are present in vertebrate and invertebrate organisms. The functions attributed to these structures depend on their mineral contents and organic matrix composition. In the present study we have determined zinc concentrations in the hepatopancreas of the crab Ucides cordatus from regions contaminated with zinc, and the elemental composition of hepatopancreal phosphate granules. Organisms were collected from the contaminated areas of Sepetiba Bay (SB) and Guanabara Bay (GB), and from a non-contaminated area, Ribeira Bay (RB). The first two sites are located near the metropolitan region of Rio de Janeiro city, Brazil. Atomic absorption spectroscopy (AAS) showed a significant difference (P<0.05) for zinc concentration in the hepatopancreas from organisms collected at the contaminated sites GB (210 + or - 20 µg/g dry weight) and SB (181 + or - 16 µg/g dry weight) compared to the non-contaminated site RB (76 + or - 14 µg/g dry weight). Phosphate granules isolated from hepatopancreatic tissue were studied by electron diffraction (ED), energy dispersive X-ray analysis (EDX) and electron spectroscopic imaging (ESI). ED of granules presented no diffraction spots, indicating that these structures are in an amorphous state, while EDX of granules isolated from a contaminated area contained P, Ca and Zn. Mg, Cl and Fe were also found in some of the spectra. ESI showed that O, P and Ca were colocalized in the mineralized layers of most granules observed. The correlation between the results obtained by AAS and those obtained by microanalytical techniques suggests that the hepatopancreatic granules of U. cordatus may be related to the phenomenon of heavy metal retention

Langerhans cell histiocytosis

The authors present a rare case of Langerhans cell histiocytosis in a 31 year old female patient with vulvar, peri-anal and oral lesions, diabetes insipidus, pulmonary skin and bone infiltrations. Skin biopsy immunohistochemistry presented positive S100 protein and vimentine, but the diagnosis was done with the demonstration of Birbeck granules with eletronic mucroscopy. The treatment was based on systemical chemotherapy although vulvar lesion has a bad response to chemotherapy.

Ultrastructural characteristics of liver fluke associated human cholangiocarcinoma cell lines.

The ultrastructure of a cholangiocarcinoma cell line (HuCCA-l) originally established from an intrahepatic bile duct tumor of a patient seropositive for a liver fluke infection was studied by scanning (SEM) and transmission (TEM) electron miscroscopy. With the SEM, the surface of HuCCA-1 cells were found to be covered with microvilli. The size of these microvilli varied from cell to cell and they were irregularly distributed. The TEM clearly revealed the presence of cytokeratin filaments, an intracytoplasmic lumen, tight junctions at the apices and desmosomes at the lateral surfaces of neighboring cells, all of which are characteristics of adenocarcinoma cell origin. However, the tumor mass that developed in a nude mouse following subcutaneous injection of these cells was found to exhibit some morphological changes. Specifically, about 20-30% of the tumor cells, particularly those lining the base of the tumor tubules, exhibited electron dense tonofilaments typical of squamous cells. However, this alteration was reversible as the cell line (HuCCA-1Nu) derived from this nude mouse-passage did not exhibit any characteristics reminiscent of squamous cells. These observations are consistent with those occasionally found in human cases reported previously by other investigators. Altogether, the data showed that squamous transformation of adenocarcinoma cells can occur under appropriate conditions. It further showed that reversion to adenocarcinoma cells can occur when the microenvironment is changed.

Scanning electron microscopy of acinar cells of rat submandibular salivary glands

1. The submandibular salivary gland of rats was observed by high-resolution scanning electron microscopy employing the aldehyde-osmium-DMSO-osmium method. 2. The intracellular membranous components and sponge-like structures of basement membrane containing the fine collagen fibrils of acinar cells were clearly identified in three dimensional images. The granular endoplasmic reticulum and Golgi apparatus showed the luminal surface. The mitochondria were small, ranging in diameter from 0.3 to 0.5 µm, and revealed their cristae. The secretory granules ranged in diameter from 0.3 to 1.4 µm. ribosome granules were attached to the surfaces of cisterns, and measured 20 to 25 nm in diameter. 3. The contact areas between the acinar cells revealed numerous cytoplasmic protrusions. In the striated duct cells, the mitochondria were arranged vertically and surrounded by nasal infoldings of the plasma membranes. At high magnification, the mitochondrial cristae were visualized in their three-dimensional characteristics

Estudo morfométrico ultra-estrutural do dimorfismo sexual em células de ductos granulosos de glândulas submandibulares de camundongos / Ultrastructural morphometric study of sex dimorphism in cells of the ductus granulosus of the submandibular glands of mice

O dimorfismo sexual existente na célula secretora do ducto granuloso em glândulas submandíbulares de camundongos adultos foi estudado em nível do microscópio de luz e eletrônico. Em cortes semifinos determinou-se o volume nuclear (Bach, 1963), e as fraçöes de volume celular ocupados pelo núcleo e citoplasma (Chalke=ley 1943). Em 20 eletromicrografias por animal, com aumento final de 15.000x, utilizando o sistema teste de multiproposiçäo de Weibel et al. (1966) obteve-se os vários valores morfométricos relativos, que multiplicados pelo volume citoplasmático, nos forneceram os respectivos valores absolutos. Os resultados mostraram a existência de um dimorfismo sexual em nível subcelular. A célula secretora do ducto granuloso da glândula submandibular do camundongo macho é mais alta e mais volumosa que a da fêmea. Observou-se também que o retículo endoplasmático granular e o complexo de Golgi säo mais desenvolvidos naquelas células do animal macho; bem como, os vacúolos de condensaçäo säo maiores, mas em menor número. O volume total dos grânulos de secreçäo é marcadamente maior nos animais machos, apesar de estarem em menor número em relaçäo à célula secretora do camundongo fêmea. As mitocôndrias possuem um maior volume uma maior superfície naquele tipo celular nos camundongos fêmeas

Patterns of transient expression of the arenavirus nucleocapsid protein gene in transfected cells

Los genes clonados de las proteínas de nucleocápside, N, de los arenavirus Junín y LCM (choriomeningitis linfocitaria) se insertaron en el vector de expresión pKG4 regulado por el promotor tardío del virus SV40. Cuando estas construcciones se utilizaron para transfectar las líneas celulares BHK-21 (fibroblastos de hamster lactante) y CV-1 (fibroblastos de riñón de mono verde africano) se observó la expresión transiente de un polipéptido de tamaño e inmunoreactividad indistinguible de la proteína N sintetizada durante una infección viral. El análisis por inmunofluorescencia reveló un patrón de distribución intracelular semejante al observado en células infectadas. Este patrón presentó variaciones desde una tinción citoplásmica difusa hasta gránulos citoplásmicos dispersos o concentrados en la zona perinuclear. La asociación de la proteína N con gránulos basófilos es semejante a la descripta en el efecto citópático causado por los arenavirus en las células infectadas, y podría relacionarse con las características fisicoquímicas de la proteina N, que contiene numerosas secuencias de aminoácidos básicos capaces de interactuar con ácidos ribonucleicos celulares

A light & electron microscopic study on apoptotic bodies in acute aflatoxin B1 induced injury in the rat liver.

A subnecrogenic dose of aflatoxin B1 (AFB1) was injected intraperitoneally into 8-10 wk old male rats of the Holzman strain. Cytoplasmic and sinusoidal eosinophilic bodies were seen in the liver which appeared at 30 h and reached a maximum at 48 h. Electron microscopically some of the cytoplasmic structures were seen to be of mitochondrial origin whereas others resembled apoptotic bodies. The sinusoidal bodies were similar to apoptotic bodies.

Secretory granules in rat submandibular acinar cells during experimental Chagas disease

The fine structure of rat submandibular glands has been compared in control and infected-rats with y strain of Trypanosoma cruzi at day 18 of infection. In the acinar cells of the infected rats the secretory granules exhibit a variety of morphological types suggesting and early form of secretion product or a new secretory protein

An Electron Microscopic Study on Mast Cell Degranulation and Regeneration in Rats

The morphdogical changes in mast cells, induced by horseradish peroxidase (HRP) and distilled water were studied, using light and electron microscopy. The mesenteries of rats sacrificed at 30 minutes; at 1, 2, 4 and 18 hours; and at 1, 2, 3 and 6 weeks after an intraperitoneal injection of 250 microgram or 500 microgram of HRP or 10 ml of distilled water were used for observation of degranulation rates and morphological changes in cell organelles during specified time intervals. The results were as follows: 1) A distinct increase in the mast cell degranulation was observed in the mesenteries after injection of HRP. In particular, all mast cells were disrupted or degranulated significantly 18 hours after injection of distilled water. 2) The degranulating mast cells of the group injected with HRP showed a progressive decrease in electron density of the granules, formation of perigranular cavities, and extrusion of the granules after partial loss of the plasma membrane. 3) At 2 weeks after injection of HRP, some indicators of the early stage of regeneration, that is, peripherally placed nucleus, the expanded Golgi area containing numerous vesicles, and progranules in these vesicles, were observed. 4) After 6 weeks, the morphological characteristics of most mast cells in the group injected with HRP were nearly the same as those of the control group. 5) In degranulating mast cells of the group injected with distilled water, partial rupture of the plasma and cytoplasm with wide dispersion of the granules.

An Ultrastructural Study of Urticaria Pigmentosa

To investigate ultrastructural characteristics of mast cells in urticaria pigmentosa in comparison to mast cells in other conditions and to search for the possible differences of ultrastuctural features amog different types of urticaria pigmentosa as well as those from normal mast cells, 4 cases of urticaria pigmentosa and 1 case of mastocytosis associated with capillary hemangioma were studied by both light and electron microscopic examinations. The cases of urticaria pigmentosa consisted of one case of blister type from a 3 month old ma1e infant, 2 cases of maculo-papular type both from 10 month old male infants, and a case of nodular type from a 14 month old boy. Ultrastructural features of mast cells in urticaria pigmentosa, in general; a) appeared relatively immature; b) mast cells in nodular type of urticaria pigmentosa were mostly round shaped while other types showed spindle or oblong shapes; c) mast cells in the maculo-papular type and those in hemangioma were similar and resembled normal mast cells; and d) marked degranulation of mast cells in the form of expulsion of granules, perigranular vacuole formation and intracellular disolution of granules for the blister type of urticaria pigmentosa.

Electron Microscopic Observations on the Morphological Changes of Rat Mesentric Mast Cells Induced by Morphine HCl

The effects of morphine HCI on the rat mesenteric mast cells were studied with the electron microscopy. The materials were prepared for electron microscopy by osmium tetroxide fixation and embedding in Epon. The rat mesenteric mast cells showed no distinct morphological changes due to morphine HCl, but the mast cell granlues were changed in various ways. For instance, they formed dusters, showed granular lysis, and an appearance of electron transparency. Frequently, some granules appeared in the extracellular space and the boundary of the granules was not evident. From the results mentioned above, it was suggested that rat mesenteric mast cell granules were affected by morphine HCl in the shape, the granular matrix, and the granular boundaries.