Association between contraceptive method chosen after induced abortion and incidence of repeat abortion in Northern Portugal.

OBJECTIVES: In Portugal, a country with strong Catholic roots, elective termination of pregnancy at women's request is still stigmatised, especially if it is a repeat abortion. The objectives of this study were to determine the incidence of repeat abortion, taking into account the contraceptive method chosen after the index abortion event, and characterise the risk factors for repeat abortion. METHODS: This was a retrospective cohort study of 988 women who requested termination of pregnancy during 2015 in a Portuguese tertiary care public hospital. Contraception was given free of charge after the index event. The occurrence of a repeat induced abortion was evaluated during a 24 month follow-up period. RESULTS: Forty-nine (5.0%) of the 988 women had a repeat abortion. Users of long-acting reversible contraception (LARC) had fewer repeat abortions compared with users of non-LARC methods. Overall repeat abortion was 0.8% in subcutaneous contraceptive implant users, 1.5% in intrauterine contraceptive device (IUCD) users, 2.8% in vaginal ring users and 5.8% in oral contraceptives users (p < 0.05). Cox hazards ratio (HR) analysis showed that method choice after abortion correlated significantly with the probability of repeat abortion (p < 0.05). Using women choosing oral contraception as the reference group, the HRs (95% CIs) for repeat abortion were as follows: IUCD 0.282 (0.084, 0.942), contraceptive implant 0.142 (0.019, 1.050), vaginal ring 0.508 (0.175, 1.477). CONCLUSION: Even though highly effective contraceptive methods are freely accessible in Portugal, other challenges must be managed to improve outcomes, such as a timely, patient-centred counselling approach.

Perinatal mortality classification: an analysis of 112 cases of stillbirth.

This was a retrospective cohort analysis of stillbirths that occurred from January 2004 to December 2013 in our institution. We compared Tulip and Wigglesworth classification systems on a cohort of stillbirths and analysed the main differences between these two classifications. In this period, there were 112 stillbirths of a total of 31,758 births (stillbirth rate of 3.5 per 1000 births). There were 99 antepartum deaths and 13 intrapartum deaths. Foetal autopsy was performed in 99 cases and placental histopathological examination in all of the cases. The Wigglesworth found 'unknown' causes in 47 cases and the Tulip classification allocated 33 of these. Fourteen cases remained in the group of 'unknown' causes. Therefore, the Wigglesworth classification of stillbirths results in a higher proportion of unexplained stillbirths. We suggest that the traditional Wigglesworth classification should be substituted by a classification that manages the available information.

[Relation between fatigue and autonomic disturbances in multiple sclerosis]. / Relação entre fadiga e distúrbios autonômicos na esclerose múltipla.

Fatigue is a common symptom in multiple sclerosis (MS). The objective of this study was to relate fatigue and autonomic disturbances in MS. Fifty patients with MS relapsing remitting clinical form participated in this study. Thirty three (66%) were women and 17 (34%) men. Score less or equal to 3.5 in the EDSS. Five non invasive cardiovascular tests were applied in all patients for the sympathetic and parasympathetic evaluation. The results obtained in the hand grip test were increased in the blood pressure of 14.62 +/- 9.13 mmHg for the group with fatigue and of 21.68 +/- 7.18 mmHg for the non fatigue group. This difference was statistically significant (p<0.05). Conclusion is that there is a loss in the capacity to increase blood pressure in patients with fatigue suggesting a sympathetic dysfunction.

Relação entre fadiga e distúrbios autonômicos na esclerose múltipla / Relation between fatigue and autonomic disturbances in multiple sclerosis

A fadiga é sintoma comum na esclerose múltipla (EM). O objetivo deste estudo é relacionar a fadiga nos portadores de EM aos distúrbios autonômicos. Participaram deste estudo, 50 pacientes portadores de EM na forma clínica remitente recorrente. Trinta e três (66 por cento) eram mulheres e 17 (34 por cento) homens; pontuação menor ou igual a 3,5 na Escala de EDSS. Foram aplicados em todos os pacientes cinco testes cardiovasculares, já padronizados, para avaliação das funções simpáticas e parassimpáticas. Os resultados encontrados no teste do exercício isométrico foram elevações da pressão arterial de 14,62±9,13 mmHg para o grupo com fadiga e de 21,68±7,18 mmHg para o grupo sem fadiga, sendo estatisticamente significante (p<0,05) a diferença entre os grupos. Conclui-se que há prejuízo na capacidade de elevar a pressão arterial diante de um exercício físico nos portadores de fadiga desta casuística, sugerindo uma disfunção simpática.

Fatigue is a common symptom in multiple sclerosis (MS). The objective of this study was to relate fatigue and autonomic disturbances in MS. Fifty patients with MS relapsing remitting clinical form participated of this study. Thirty three (66 percent) were women and 17 (34 percent) men. Score less or equal to 3.5 in the EDSS. Five non invasive cardiovascular tests were applied in all patients for the sympathetic and parasympathetic evaluation. The results obtained in the hand grip test were increase in the blood pressure of 14.62±9.13 mmHg for the group with fatigue and of 21.68±7.18 mmHg for the non fatigue group. This difference was statistically significant (p<0.05). Conclusion is that there is a loss in the capacity to increase the blood pressure in patients with fatigue suggesting a sympathetic dysfunction.

Estudo da açäo depressora inespecífica do suco extraído das folhas de Bryophyllum calcynum Salisb. (Crassulaceae) sobre o sistema nervoso central: comparaçäo com os efeitos da difenidramina / Study on the innespecific depressive action of the leaves juice of Bryophillum calycinum Salisb. (Crassulaceae) in the central nervous system: comparison whith diphenhydramine effects

Bryophyllum calcynum Salisb (Crassulaceae) é uma planta largamente utilizada em regiöes tropicais e subtropciais como medicaçäo tópica em afecçöes cutäneas de natureza alérgica. Tal utilizaçäo foi fundamentada sob o ponto de vista farmacológico, por um trabalho (NASSIS, 1991) que demonstra ser o suco extraído das folhas desta planta, um potente antagonista dos receptores H1 a nível periférico em ratos. Durante a realizaçäo do referido trabalho, foi verificada uma aparente açäo depressora central exercida pelo suco caracterizada por sonolência e imobilidade dos animais. No presente trabalho, a proposta foi estudar tal açäo, verificando se realmente o suco exercia açäo depressora significativa sobre o SNC. Os experimentos realizados demonstraram que o suco (4,0g/Kg) inibe a atividade locomotora em campo aberto, e potência o tempo de sono induzido por pentobarbital em ratos. Resultados similares foram obtidos com a administraçäo de difenidramina (20mg/Kg), indicando a necessidade de realizaçäo de experimentos mais especificos para a verificaçäo de uma eventual açäo anti-histamínina central