Detecção molecular e isolamento de Mycoplasma spp. em psitacídeos no estado de Pernambuco, Brasil / Molecular detection and isolation of Mycoplasma spp. in psittacines in Pernambuco state, Brazil

Objetivou-se com este estudo investigar a ocorrência de Mycoplasma spp., Mycoplasma galissepticum (MG) e Mycoplasma synoviae (MS) em psitacídeos de cativeiro localizado no estado de Pernambuco, Brasil. Foram estudadas 85 aves provenientes do Parque Estadual Dois Irmãos, localizado no estado do Pernambuco, Brasil. De cada psitacídeo analisado foram obtidas três amostras por meio de swabs da cloaca, palato e conjuntiva totalizando 255 amostras. As amostras coletadas foram submetidas à extração de DNA e à reação em cadeia da polimerase (PCR), sendo as positivas submetidas ao isolamento em ágar Frey. O DNA de Mycoplasma spp. foi detectado em 16,47% (14/85) dos psitacídeos estudados. Das 255 amostras analisadas, 6,66% (17/255) foram positivas para a presença de Mycoplasma spp., sendo 41,18% (7/17) provenientes da conjuntiva, 35,29% (6/17) do palato e 23,53% (4/17) da cloaca. Nenhuma amostra foi positiva para MG ou MS na PCR. Os resultados obtidos permitem confirmar a presença do DNA de Mycoplasma spp. em conjuntiva, palato e cloaca nas aves estudadas. Foram detectadas colônias semelhantes a membros da classe Mollicutes em 17,64% das amostras (3/17). Esse é o primeiro relato da presença de Mycoplasma spp. em psitacídeos de cativeiro no Nordeste do Brasil.

The aim of this study was to investigate the occurrence of Mycoplasma spp., Mycoplasma galissepticum (MG) and Mycoplasma synoviae (MS) in captive psittacines. Eighty-five wild birds from Parque Estadual Dois Irmãos, Pernambuco state, northeastern Brazil, were used. From each psittacid analyzed three samples were obtained through cloaca, palate and conjunctiva swabs, totaling 255 samples. Samples collected were submitted to DNA extraction and Polimerase Chain Reaction (PCR). Mycoplasma spp. DNA was detected in 16.47% (14/85) of psittacines studied. From 255 samples, 6.66% (17/255) were positive for Mycoplasma spp.: 41.18% (7/17) of positivity in conjunctiva, 35.29% (6/17) in palate and 23.53% (4/17) in cloaca. There was no positive sample for MG or MS in PCR. Similar colonies were found for members of the Mollicutes Class in 17.64% of the samples (3/17). The results confirmed Mycoplasma spp. DNA in conjunctiva, palate and cloaca from the wild birds analyzed. This is the first record of Mycoplasma spp. in captive psittacines from northeastern Brazil.

Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery: a randomized clinical trial.

BACKGROUND: We determined the association between combined spinal-epidural (CSE) anaesthesia and an increase in maternal intrapartum temperature and intrapartum fever. METHODS: A randomized, open clinical trial was performed with 70 pregnant women, 35 receiving CSE and 35 receiving only non-pharmacological methods of pain relief during delivery. Association between CSE and changes in the patient's temperature, the risk of maternal fever, and other maternal and perinatal outcomes was determined at a 5% significance level. Number needed to harm (NNH) was calculated for maternal fever. RESULTS: Patients receiving CSE anaesthesia during vaginal delivery experienced a significant increase in intrapartum temperature and five (14%) developed fever, whereas no cases occurred in the group receiving only non-pharmacological methods of pain relief (P=0.027). None of the women who developed fever received antibiotics or were submitted to further investigation; however, all progressed without complication. No case of chorioamnionitis or any maternal or neonatal infection was detected. NNH for maternal fever was 7.0 (95% confidence interval: 3.8-51.9). CONCLUSIONS: The use of CSE is associated with a significant increase in maternal temperature and in the incidence of intrapartum maternal fever. However, the increase in maternal temperature does not appear to provoke any deleterious effects on the mother or child.

Randomized clinical trial comparing the efficacy of the vaginal use of metronidazole with a Brazilian pepper tree (Schinus) extract for the treatment of bacterial vaginosis

A 7.4 percent vaginal extract of the Brazilian pepper tree (Schinus terebinthifolius Raddi) was compared with 0.75 percent vaginal metronidazole, both manufactured by the Hebron Laboratory, for the treatment of bacterial vaginosis, used at bedtime for 7 nights. The condition was diagnosed using the combined criteria of Amsel and Nugent in two groups of 140 and 137 women, aged between 18 and 40 years. Intention-to-treat analysis was performed. Women were excluded from the study if they presented delayed menstruation, were pregnant, were using or had used any topical or systemic medication, presented any other vaginal infections, presented hymen integrity, or if they reported any history suggestive of acute pelvic inflammatory disease. According to Amsel’s criteria separately, 29 patients (21.2 percent) treated with the extract and 87 (62.1 percent) treated with metronidazole were considered to be cured (P < 0.001). According to Nugent’s score separately, 19 women (13.9 percent) treated with the extract and 79 (56.4 percent) treated with metronidazole were considered to be cured (P < 0.001). Using the two criteria together, the so-called total cure was observed in 17 women (12.4 percent) treated with the extract and in 79 women (56.4 percent) treated with metronidazole (P < 0.001). In conclusion, the cure rate for bacterial vaginosis using a vaginal gel from a pepper tree extract was lower than the rate obtained with metronidazole gel, while side effects were infrequent and non-severe in both groups.

Randomized clinical trial comparing the efficacy of the vaginal use of metronidazole with a Brazilian pepper tree (Schinus) extract for the treatment of bacterial vaginosis.

A 7.4% vaginal extract of the Brazilian pepper tree (Schinus terebinthifolius Raddi) was compared with 0.75% vaginal metronidazole, both manufactured by the Hebron Laboratory, for the treatment of bacterial vaginosis, used at bedtime for 7 nights. The condition was diagnosed using the combined criteria of Amsel and Nugent in two groups of 140 and 137 women, aged between 18 and 40 years. Intention-to-treat analysis was performed. Women were excluded from the study if they presented delayed menstruation, were pregnant, were using or had used any topical or systemic medication, presented any other vaginal infections, presented hymen integrity, or if they reported any history suggestive of acute pelvic inflammatory disease. According to Amsel's criteria separately, 29 patients (21.2%) treated with the extract and 87 (62.1%) treated with metronidazole were considered to be cured (P < 0.001). According to Nugent's score separately, 19 women (13.9%) treated with the extract and 79 (56.4%) treated with metronidazole were considered to be cured (P < 0.001). Using the two criteria together, the so-called total cure was observed in 17 women (12.4%) treated with the extract and in 79 women (56.4%) treated with metronidazole (P < 0.001). In conclusion, the cure rate for bacterial vaginosis using a vaginal gel from a pepper tree extract was lower than the rate obtained with metronidazole gel, while side effects were infrequent and non-severe in both groups.

Doppler velocimetry of the uterine, umbilical and fetal middle cerebral arteries in pregnant women undergoing tocolysis with oral nifedipine.

OBJECTIVES: To evaluate Doppler velocimetry (resistance index (RI) and peak systolic velocity (PSV)) in the maternal-fetal circulation before and 5 and 24 h after tocolysis with oral nifedipine. METHODS: This was a prospective, observational, analytic cohort study performed in 47 pregnant women undergoing nifedipine tocolysis, each subject acting as her own control. Doppler assessment of uterine, umbilical and fetal middle cerebral (MCA) arteries was performed before and 5 and 24 h after an initial 20-mg sublingual dose, which was repeated twice at 20-min intervals if contractions failed to diminish. The maintenance dose consisted of 20 mg orally every 6 h for 24 h up to a total of 100-120 mg nifedipine. We analyzed whether there was a time effect and compared values at the different time-points. RESULTS: The MCA-RI had decreased significantly after 24 h of tocolysis (0 h = 0.85; 5 h = 0.85; 24 h = 0.81; P = 0.001), with no differences in uterine or umbilical arteries or in the MCA to umbilical artery ratio. The MCA-PSV had reduced significantly after 5 h (0 h = 41.5 cm/s; 5 h = 34.7 cm/s; P = 0.001), returning close to baseline levels between 5 and 24 h. The PSV increased significantly between 5 and 24 h in the right uterine artery (5 h = 55.1 cm/s; 24 h = 65.0 cm/s; P = 0.037) and in the umbilical artery (5 h = 28.4 cm/s; 24 h = 33.1 cm/s; P = 0.038). CONCLUSIONS: Nifedipine tocolysis is associated with a reduction in RI in the MCA but not in the uterine or umbilical arteries, a reduction in PSV in the MCA after 5 h but returning to baseline within 24 h, and an increase in PSV between 5 and 24 h in the umbilical and right uterine arteries.

Comparison of sublingual versus vaginal misoprostol for the induction of labour: a systematic review.

BACKGROUND: The induction of full-term labour in women with a live fetus remains a major challenge in modern obstetrics. OBJECTIVES: To determine, using the best level of evidence available, the efficacy and safety of sublingual administration of misoprostol compared with vaginal misoprostol in the third trimester of pregnancy for the induction of labour, according to initial doses, in women with a live, full-term fetus and an unripe cervix. SEARCH STRATEGY: Pubmed/Medline, Lilacs and Scielo databases were consulted, as well as clinical trials registered in the Cochrane Register from January 1996 to February 2008, using the keywords 'misoprostol', 'labour, obstetric', 'delivery, obstetric', 'induced labour' and 'parturition' with the search limits of 'clinical trials' and 'randomised clinical trials'. SELECTION CRITERIA: This review contains randomised clinical trials in which the sublingual and vaginal routes of administration of misoprostol were compared. Participants were pregnant women with an indication for induction of labour and a live fetus more than 37 weeks of gestational age. DATA COLLECTION AND ANALYSIS: The primary analysis compared sublingual and vaginal routes of administration of misoprostol. Secondary analyses compared different routes and initial doses of misoprostol. Statistical analysis included odds ratios and their respective 95% CI. To evaluate the heterogeneity of the studies, the I-squared test was used, studies being considered heterogeneous when I 2 was greater than 50%. MAIN RESULTS: Five good quality clinical trials involving a total of 740 women were eligible, and all were included. No statistically significant difference was found between the sublingual and the vaginal misoprostol groups with respect to the rate of vaginal delivery not achieved within 24 hours (OR 1.27, 95% CI 0.87-1.84), uterine hyperstimulation syndrome (OR 1.20, 95% CI 0.61-2.33) or caesarean section (OR 1.33, 95% CI 0.96-1.85). An increased risk of uterine tachysystole was found in the sublingual misoprostol group (OR 1.70, 95% CI 1.02-2.83). When the studies were grouped according to the initial dose of misoprostol, no significant difference was found between sublingual or vaginal groups. AUTHOR'S CONCLUSIONS: The sublingual route of administration is as effective as the vaginal route in inducing labour in full-term pregnancies with live fetuses. However, the safety, adverse effects, optimal dose and perinatal outcome related to this route of administration remain to be established, and it cannot be recommended for routine use in obstetric practice.

Sublingual vs. vaginal misoprostol for induction of labor.

OBJECTIVE: To compare sublingual with vaginal misoprostol for the induction of labor. METHODS: This double-blind clinical trial randomized 150 women to receive every 6 h 25 mug of sublingual misoprostol and vaginal placebo or 25 mug of vaginal misoprostol and sublingual placebo. Maternal and neonatal outcomes were analyzed and risk ratios (RRs) with 95% confidence intervals (CIs) calculated. The significance level was 5%. RESULTS: Vaginal delivery rates were 57% in the sublingual group and 69% in the vaginal group (RR, 0.8; 95% CI, 0.6-1.1). There were 11 cases of fetal distress in the sublingual group and 4 cases in the vaginal group (RR, 2.7; 95% CI, 0.9-8.2). There were no significant differences in the number of doses needed, interval between first dose and delivery, incidence of contractility disturbances, or neonatal results. CONCLUSION: The administration of misoprostol 25 mug by the sublingual route was neither more effective nor safer than the same dose administered vaginally.