The Project Appropriate Birth and a reduction in caesarean section rates: an analysis using the Robson classification system.

OBJECTIVE: The objective of this study was to assess caesarean section (CS) rates before and after the implementation of the Project Appropriate Birth (PPA), based on the Robson ten group classification system. DESIGN: A before-and-after study. SETTING: Maternity hospital in South Brazil. POPULATION: All pregnant women attending from April 2016 to April 2017 (period 1, pre-implementation of PPA) and from June 2017 to June 2018 (period 2, post-implementation of PPA). METHODS: Maternal and obstetric characteristics were evaluated, including Robson's classification, based on the characteristics of pregnancy and childbirth. A chi-square test and crude and adjusted relative rates were used to analyse the study variables. The significance level was set at 5%. MAIN OUTCOME MEASURES: The CS rate for each group, their contribution to the overall CS rate and the differences in these contributions before and after PPA implementation. RESULTS: The CS rates decreased from 62.4 to 55.6%, which represented a 10.9% reduction after the implementation of the PPA. Pregnant women in Robson classification groups 1-4 had a 21.4% reduction in CS rates, ranging from 49.1 to 38.6%. The greatest contributors to the overall CS rates were group 5 and group 2, accounting for more than 60% of the CS deliveries. CONCLUSION: The study results suggest that Project Appropriate Birth had an impact on the reduction of CS rates, especially in Robson classification groups 1 through 4, which indicates that providing mothers with evidence-based interventions for labour and childbirth assistance contributed to reduce CS rates. TWEETABLE ABSTRACT: The Project Appropriate Birth is an innovative project that has demonstrated promising results, suggesting that interventions based on scientific evidence can lead to real changes in childbirth care, contributing to reduce CS rates. The aim of the PPA is to promote activities to improve childbirth care and encourage vaginal delivery. In this study, 6238 pregnant women admitted to the hospital for delivery were included and classified into one of the Robson 10-group classification. Findings revealed a 10.9% reduction in the overall CS rate and a 21.4% reduction for pregnant women in Robson classification groups 1 through 4, after the implementation of the PPA.

The fox tapeworm, Echinococcus multilocularis, in grey wolves and dogs in Slovakia: epidemiology and genetic analysis.

Echinococcus multilocularis, the causative agent of human alveolar echinococcosis, is an important emerging parasite in the northern hemisphere. In epidemiological studies, the highest attention is being paid to foxes as the main reservoir hosts responsible for geographic expansion from multiple focal populations and the invasion of urban habitats, but little information is available on the parasite distribution in other carnivores. Hence, the study was designed to obtain updated information about the occurrence and genetic diversity of E. multilocularis in grey wolves and dogs in Slovakia. Faecal samples of wolves were collected from three locations under a certain level of environmental protection in the central and eastern parts of the country, and the presence of the parasite DNA was detected in 35.7% of 112 samples, with the highest rate (51.2%) recorded in the Poloniny National Park in north-eastern Slovakia. Among 110 faecal dog samples, E. multilocularis was detected in three faeces from segregated Roma settlements in the eastern part of the country, which accounted for an overall positivity of 2.7%. Sequence analysis of two mitochondrial genes, 12S rRNA and NADH dehydrogenase subunit 1, revealed four haplotypes in 13 isolates from wolves and dogs originating from four sites in eastern and central Slovakia, with all samples bearing a European-type pattern of E. multilocularis. The more than one-third positivity rate of E. multilocularis in wolf faecal samples dispersed over a large part of the country has corroborated the extensive circulation of the parasite in wildlife and confirmed the need to improve intervention control strategies.

Gender influence on manganese induced depression-like behavior and Mn and Fe deposition in different regions of CNS and excretory organs in intraperitoneally exposed rats.

Manganese (Mn) is an essential metal for mammals. It can modulate the action of endogenous substances, as neurotransmitters, but in excess also can trigger known neurotoxic effects. Many studies have been conducted assessing Mn neurotoxicity. However, Mn bioaccumulation in different brain tissues and behavior effects involving gender-specific studies are conflicted in the literature. Therefore, the aim of this work was to compare Mn effects, after 30days of intraperitoneal treatment, in male and female rats, submitted to forced swim and open field tests. After that, were evaluated Mn and Fe tissue levels in CNS, liver, and kidneys. Wistar rats were divided into saline, Mn 1mg/kg, Mn 5mg/kg, and imipramine (as forced swim control). Then, animals were euthanized by anesthesia overdose followed by decapitation and the collected tissue were striatum, hippocampus, brainstem, cortex, cerebellum, hepatic tissue, and renal tissue. Mn and Fe were determined by ICP-MS. There was a dose-dependent effect on accumulation of Mn in the cerebellum and brainstem to the dosage of 5mg/kg. In hippocampus there were bioaccumulation differences between gender and dose, and an increase of Fe in the groups exposed to Mn. Excess metals in the brain dissected has a strong influence on memory and learning processes and suggests pro-depressive effects, possibly triggered by the reduction of monoamines due to excessive metal bioaccumulation. It was concluded that, under this experimental design, Mn exposure cause metal deposition on dissected CNS, liver and kidney. There an effect at lower doses that was gender-dependent and males had more pronounced behavioral damage compared to females, although with increasing dose, females had an indication of motor damage.

Orthognathic surgery with or without induced hypotension.

This study involved a retrospective evaluation of patients subjected to surgery for dentofacial deformities treated without induced controlled hypotension (group I, n=50) and a prospective evaluation of patients who were subjected to surgery under hypotensive general anaesthesia (group II, n=50). No statistical differences were found between the study groups with regard to the duration of surgery. However, there were statistically significant differences in the need for blood transfusion and the occurrence of bradycardia during the maxillary down-fracture. Hypotensive anaesthesia decreased the need for a blood transfusion and the occurrence of bradycardia, and is therefore considered highly beneficial for patients undergoing orthognathic surgery.

Influência do consumo de álcool nas alterações antropométricas: uma revisão sistemática / Influence of alcohol consumption on anthropometric changes: a systematic review

Contexto: Por apresentar alta densidade energética (7,1 calorias/grama), a adição do etanol a dieta pode resultar em modificações antropométricas. Objetivos: Investigar evidências sobre as alterações antropométricas associadas a ingestão de álcool. Métodos: Revisão sistemática realizada entre outubro e dezembro de 2012 nas bases de dados LILACS, PubMed e SCIELO com os seguintes unitermos: “alcohol drinking”; “ethanol”; “alcoholic beverages”; “alcoholic moderate consumption”; “alcohol”; “anthropometry”; “body composition”; “body constitution”; “overnutrition” “obesity”; “malnutrition”; “body weight” e “nutritional status”. Resultados: Vinte estudos envolvendo oito transversais, sete longitudinais, quatro experimentais e um estudo de caso-controle foram selecionados. Sobre a freqüência e quantidade de consumo alcoó- lico foi encontrado associações positivas, negativas, ou inexistentes entre a ingestão de álcool e as medidas antropométricas. No entanto, observou-se mais evidências positivas entre álcool e modificações nas medidas adiposas, principalmente em indivíduos do sexo masculino. Conclusão: O consumo de álcool esteve associado positivamente a obesidade abdominal, principalmente em homens. Futuras pesquisas devem ser realizadas para determinar classificações padronizadas de bebedores e funções específicas de diferentes tipos de bebidas na modificação das medidas antropométricas (AU)

Background: As its high energy density (7.1 calories/gram), the addition of ethanol diet may result in anthropometric changes. Objectives: To investigate the evidence on anthropometric changes associated with alcohol intake. Methods: A systematic review carried out between October and December 2012 in the databases LILACS, PubMed and SCIELO with the following keywords: “alcohol drinking”; “ethanol”; “alcoholic beverages”; “alcoholic moderate consumption”; “alcohol”; “anthropometry”; “body composition”; “body constitution”; “overnutrition” “obesity”; “malnutrition”; “body weight” e “nutritional status”. Results: Twenty studies involving eight transverse, longitudinal seven, four experimental and one casecontrol study were selected. On the frequency and amount of alcohol consumption was found positive associations, negative, or nonexistent between alcohol intake and anthropometric measurements. However, there was more positive evidence of alcohol and measures changes in the fat, particularly in male subjects. Conclusion: Alcohol consumption was positively associated with abdominal obesity, especially in men. Future research should be conducted to determine standard classifications of drinkers and specific functions of different types of drinks in the modification of anthropometric measurements (AU)

Comparative analysis of genetic toxicity of antiretroviral combinations in somatic cells of Drosophila melanogaster.

Nucleoside reverse-transcriptase inhibitor (NRTI) drugs are a major component of highly-active antiretroviral therapy (HAART). NRTI combinations have been demonstrated as producing a sustained reduction in plasma viremia with an increased CD4 count, thereby showing clear clinical benefits. Therefore, the secondary effects caused by the combination of two NRTIs, mainly those related to amplification of genotoxic effects, due to increased risk of DNA damage caused by these drugs, should be carefully examined. We employed the standard version of the wing SMART in Drosophila melanogaster to obtain more detailed knowledge about the genotoxic profile of NRTI combinations of AZT+ddI, AZT+3TC and AZT+d4T. Our results showed that all combinations increased the frequencies of induction of mutant spots. The combinations AZT+ddI and AZT+3TC were shown to induce recombination rates ranging from 86.38% to 98.36% while AZT+d4T showed a large discrepancy between recombination and mutation percentages. The combination index demonstrated that 3TC and d4T produced antagonism while ddI showed synergistic effects in combination with AZT.

A new model for the transmission of Helicobacter pylori: role of environmental reservoirs as gene pools to increase strain diversity.

Twenty-five years after the first successful cultivation and isolation of Helicobacter pylori, the scientific community is still struggling to understand the way(s) this bacterium is transmitted among the human population. Here, both epidemiologic and microbiologic evidence addressing this matter is reviewed and explored to conclude that most H. pylori successful colonizations are derived from direct person-to-person contact and that even though exposure of humans to H. pylori from environmental sources is a very common event, in most occasions the host is able to fight off infection. In addition, under a new model developed here, we propose that the near elimination of environmental reservoirs is the main responsible for the lower prevalence observed in the more industrialized countries by acting on two levels: by decreasing the number of direct infections and by diminishing the number of intraspecies recombination events for producing strain variation within H. pylori.

Development and application of a novel peptide nucleic acid probe for the specific detection of Helicobacter pylori in gastric biopsy specimens.

In this work, a fluorescence in situ hybridization (FISH) method for the rapid detection of Helicobacter pylori using a novel peptide nucleic acid (PNA) probe is reported. Laboratory testing with several different bacterial species, including other Helicobacter spp., has shown that this probe is highly specific for H. pylori strains. In addition, the PNA FISH method has been successfully adapted for detection of the pathogen in paraffin-embedded gastric biopsy specimens.

Evolução da população e da mortalidade em Niterói, Rio de Janeiro, Brasil, 1979 a 1997 / Demographic and mortality trends in Niterói, Rio de Janeiro, Brazil, 1979 to 1997

A análise da série histórica de 1979-1997 permite perceber a evolução demográfica e da mortalidade no Município de Niterói, Rio de Janeiro, Brasil, ao longo dessas décadas. A população apresentou um declínio na velocidade de crescimento, com alteração significativa de sua estrutura etária. Observa-se, na série temporal, o declínio da mortalidade por doenças do aparelho circulatório, a tendência geral de declínio das doenças infecto-parasitárias, com acentuado aumento a partir de 1996, decorrente da mudança de classificação das doenças (CID-9 para CID-10). Quanto à mortalidade infantil, destaca-se o predomínio dos óbitos na faixa neonatal. O desvendar das doenças e agravos dentro dos grandes grupos revela a importância das doenças isquêmicas do coração e doenças cerebrovasculares, dos homicídios, acidentes de transporte e da AIDS.

[Demographic and mortality trends in Niterói, Rio de Janeiro, Brazil, 1979 to 1997]. / Evolução da população e da mortalidade em Niterói, Rio de Janeiro, Brasil, 1979 a 1997.

An analysis of the 1979-1997 historical series points to demographic and mortality trends in Niterói, Rio de Janeiro State, over the course of those two decades. There was a drop in the rate of population increase, with a significant change in the age structure. In the time series, there was a decline in mortality from cardiovascular diseases and an overall downward trend in mortality from infectious and parasitic diseases, albeit with a sharp increase beginning in 1996 resulting in a change in disease classification (ICD-9 to ICD-10). As for infant mortality, there was a predominance of deaths in the neonatal group. An analysis of major groups of diseases and injuries highlights the importance of ischemic heart disease and cerebrovascular diseases, homicides, traffic accidents, and AIDS.

Identification of a high-risk heterosexual population for HIV prevention trials in Rio de Janeiro, Brazil. Projeto Praço Onze Study Group.

The study of interventions to prevent HIV transmission requires access to populations with a high rate of HIV transmission. We estimated HIV incidence among heterosexual males and females who were seen at an HIV testing site in Rio de Janeiro, Brazil. Stored sera from individuals who visited the site between March and December 1998 were analyzed using the sensitive/less sensitive (S/LS) assay and a chart abstraction was performed. During the study period, 6353 serum samples were tested. Of those tested, 1203 were found to be HIV-seropositive or indeterminate, of which 1050 (87%) remained available for further testing. In addition, 84 serum samples, representing 63 adults, were found to produce results suggesting early HIV infection. Of these, 14 were heterosexual and female (median age, 38 years), and 19 were heterosexual and male (median age, 25 years). The estimated HIV seroincidence was 1.9 (95% confidence limits (CL), 0.9%-3.9%) and 2.8 (95% CL, 1.4%-5.3%) per 100 person-years among heterosexual women and men, respectively. A survey on willingness to participate in future placebo-controlled HIV vaccine trials in this population indicated that 54.5% and 53.9% of heterosexual women and men, respectively, indicated that they would definitely be willing to participate. We have identified a heterosexual population in Rio de Janeiro with a high rate of HIV transmission willing to participate in placebo-controlled vaccine trials. This study demonstrates the usefulness of the newly described S/LS assay, which allows one to estimate HIV incidence from single serum specimens.

[Cases of american cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in the towns of Cosmópolis and Indaiatuba-region of Campinas, in São Paulo, Brazil]. / Casos de leishmaniose tegumentar americana por Leishmania (Viannia) braziliensis nos Municípios de Cosmópolis e Indaiatuba-região de Campinas, Estado de São Paulo, Brasil.

A study was carried out to identify Leishmania species involved in skin lesions of patients from Cosmópolis and Indaiatuba, State of São Paulo, Brazil. The epidemiological data of cutaneous leishmaniasis in two cities suggested a epidemic situation in 1994. The lesions were clinically characteristic of cutaneous leishmaniasis and five out six patients responded positively to Montenegro's intradermal test. The histopathology of skin lesions were characterized by two patterns: exudative-cellular reaction and exudative granulomatous reaction. The clinical and histopathological parameters suggested Leishmania (Viannia) braziliensis as the possible etiologic agent. In agreement, it was difficult to isolate and maintain the parasite in the laboratory. Characterization by in situ hybridization with kDNA amastigotes from lesions fragments confirmed that Leishmania (Viannia) braziliensis was the parasite responsible for the studied cutaneous lesions.

Pele decidua - uma rara genodermatose / Deciduous skin - a rare genodermatosis

Os autores descrevem dois casos de pele decidua, provavelmente os primeiros assinalados no Brasil desta rara genodermatose que parece ser de transmissao hereditaria autossomica recessiva. Sao analisados os aspectos clinicos, a possivel interferencia climatica sobre sua evolucao e os achados histopatologicos, sendo comparados todos esses dados com a escassa literatura publicada sobre a doenca

Zigomicose subcutanea. / Subcutaneous zygomycosis

Apresenta-se o relato de um caso de zigomicose subcutanea, micose rara, descrita em algumas regioes tropicais. No Brasil o maior numero de casos foi descrito no estado da Bahia.Sao feitas consideracoes sobre a doenca, comparando-se com os achados do presente caso. Neste, e admitida a possibilidade do vetor mecanico ter sido o anelidio vulgarmente chamado "sanguessuga" (Gen Hirudo)

[Giant granulo-cellular Abrikosov's tumor]. / Tumor gránulo-celular de Abrikossoff gigante.

A case of Abrikossoff's granular-cell tumor is reported because of its unusually large dimensions (12.5 X 10.5 X 8.0 cm.), weight (700 g.) and supra-umbilical localization. Ample surgical excision of the tumor and reconstruction of the abdominal wall with silastic and skin graft were performed. Comments are made about the clinical, histopathological and histogenetic aspects of the neoplasia.

Elastose perfurante serpiginosa - relato de quatro casos. / Elastosis perforans serpiginosa - report of 4 cases

Sao relatados quatro casos de elastose perfurante serpiginosa, ocorridos em jovens brancos, de 12 a 16 anos. Dois pacientes eram do sexo masculino e dois do feminino.O inicio da molestia ocorreu nas idades de tres a 12 anos A evolucao variou de dois a 13 anos. As lesoes eram eritemato-papulosas, ceratosicas e tinham disposicoes arciforme e serpiginosa.Raramente eram isoladas. Em todos os casos as lesoes se localizaram nos membros superiores.Um dos pacientes apresentava tambem lesoes nos joelhos e coxas.Em um caso havia associacao com alopecia ofiasica e monogolismo ou sindrome de Down e em outro com nevo pigmentado congenito gigante da regiao peitoral direta. Foram abordados alguns aspectos histopatologicos e patogeneticos da afeccao

Intradermal responses to common bacterial antigens: influences of sex and clinical condition.

Intradermal responses to antigens of 12 common bacteria were evaluated in 218 dermatologic and 155 respiratory patients. Women responded more frequently than men and respiratory patients responded significantly more frequently than dermatologic patients to certain antigens. Interpretation of interspecies associations of responses suggested that certain organisms may be key species in the development of bacterial hypersensitivity.

Contact dermatitis in Salvador, Brazil.

In Salvador, Brazil, 536 patients were patch tested with 24 contact allergens. The most common sensitizers included potassium dichromate, thimerosal, hydroquinone, nitrofurazone ointment and nickel sulfate. The results of this South American study are compared with those published by North American and European dermatologists. Low frequencies of positive reactions were encountered in Salvador to some substances, including mercury bichloride and p-phenylenediamine. The influences of climate and life style in determining patterns of contact sensitivity are discussed.