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1.
Sci Rep ; 13(1): 153, 2023 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-36599871

RESUMO

Pre-eclampsia is associated with postnatal cardiac dysfunction; however, the nature of this relationship remains uncertain. This multicentre retrospective cohort study aimed to determine the prevalence of pre-eclampsia in women with pre-existing cardiac dysfunction (left ventricular ejection fraction < 55%) and explore the relationship between pregnancy outcome and pre-pregnancy cardiac phenotype. In this cohort of 282 pregnancies, pre-eclampsia prevalence was not significantly increased (4.6% [95% C.I 2.2-7.0%] vs. population prevalence of 4.6% [95% C.I. 2.7-8.2], p = 0.99); 12/13 women had concurrent obstetric/medical risk factors for pre-eclampsia. The prevalence of preterm pre-eclampsia (< 37 weeks) and fetal growth restriction (FGR) was increased (1.8% vs. 0.7%, p = 0.03; 15.2% vs. 5.5%, p < 0.001, respectively). Neither systolic nor diastolic function correlated with pregnancy outcome. Antenatal ß blockers (n = 116) were associated with lower birthweight Z score (adjusted difference - 0.31 [95% C.I. - 0.61 to - 0.01], p = 0.04). To conclude, this study demonstrated a modest increase in preterm pre-eclampsia and significant increase in FGR in women with pre-existing cardiac dysfunction. Our results do not necessarily support a causal relationship between cardiac dysfunction and pre-eclampsia, especially given the population's background risk status. The mechanism underpinning the relationship between cardiac dysfunction and FGR merits further research but could be influenced by concomitant ß blocker use.


Assuntos
Cardiomiopatias , Cardiopatias , Pré-Eclâmpsia , Humanos , Gravidez , Feminino , Pré-Eclâmpsia/epidemiologia , Resultado da Gravidez , Estudos Retrospectivos , Volume Sistólico , Função Ventricular Esquerda , Retardo do Crescimento Fetal/epidemiologia , Cardiomiopatias/complicações , Cardiomiopatias/epidemiologia
2.
Eur J Hosp Pharm ; 30(5): 279-283, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-34853014

RESUMO

OBJECTIVES: To assess the impact of self-administration of medicines (facilitated by a midwife formulary) on postnatal women's knowledge of certain post-delivery medications, awareness of the Green Bag Scheme, factors contributing to constipation, pain satisfaction, adherence, and time released to midwives plus feedback from these women and their midwives. METHODS: The study was conducted in consented postnatal women, who self-administered medications from their bedside lockers. The mode of delivery and parity were recorded. Data were compared in women who self-administered to those who did not. Midwives used our established midwife formulary to write their essential unprescribed medications. Direct interview questionnaires were used to obtain their knowledge on chosen post-delivery medicines, pain satisfaction, the Green Bag Scheme and factors contributing to constipation. Regular medicines counts were used to check adherence. Midwives' time not administering these self-administered medications was estimated. Self-reported questionnaires were used to obtain feedback from participants and midwives. Responses were analysed proportionately and where appropriate by simple statistics. RESULTS: Women (n=203) who self-administered were compared with those (n=401) who did not. Greater medicines' knowledge and better (96% vs 79%) pain satisfaction were found in self-administering women. Knowledge of each contributing factor to constipation varied. Mode of delivery and parity had no impact on these outcomes. Adherence seemed high 96% (195/203). Awareness of the Green Bag Scheme was poor (66/604). Most women, 94% (191/203) found the service helpful and 89% (178/200) would take part again. At least 224 hours were released to midwives by these self-administering women. 164/203 (81%) midwives felt the scheme was beneficial. CONCLUSIONS: Self-administering women had better pain satisfaction, medication knowledge and adherence. The need to improve engagement in the Green Bag Scheme was flagged. This service, supported by use of a midwife formulary, can release time to midwives to do other tasks including care for women with more complex issues. A business case for this service is under review.


Assuntos
Adesão à Medicação , Tocologia , Dor , Conhecimento do Paciente sobre a Medicação , Satisfação do Paciente , Período Pós-Parto , Humanos , Feminino , Autoadministração , Farmacêuticos , Formulários Farmacêuticos como Assunto , Autorrelato , Dor/psicologia
3.
Antonie Van Leeuwenhoek ; 99(4): 761-71, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21229313

RESUMO

The present study was undertaken to determine the role of glutathione peroxidase3 (gpx3) in phospholipid protection in cells. Wild-type (WT) cells showed an overall increase in phospholipids upon 50 µM cadmium (Cd)-treatment, whereas an untreated gpx3Δ strain showed a drastic reduction in overall phospholipids which was further reduced with 50 µM Cd. In WT cells, Cd-exposure increased the short chain fatty acids and decreased the unsaturated fatty acids and the magnitude was high in Cd-treated gpx3Δ cells. Purified recombinant gpx3p showed higher activity with phospholipid hydroperoxides than shorter hydroperoxides. An increase in gpx activity was observed in Cd-treated WT cells and no such alteration was observed in gpx3Δ. WT cells treated with Cd showed an increase in MDA over untreated, while untreated gpx3Δ cells themselves showed a higher level of MDA which was further enhanced with Cd-treatment. Iron, zinc and calcium levels were significantly altered in WT and gpx3Δ cells during Cd-treatment.


Assuntos
Cádmio/farmacologia , Glutationa Peroxidase/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Fosfolipídeos/metabolismo , Saccharomyces cerevisiae/enzimologia , Antioxidantes/química , Antioxidantes/metabolismo , Ácidos Graxos/análise , Ácidos Graxos/biossíntese , Glutationa Peroxidase/genética , Fosfolipídeos/análise
4.
Best Pract Res Clin Obstet Gynaecol ; 24(4): 539-49, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20542471

RESUMO

Infective complications following induced abortions are still a common cause of morbidity and mortality. This review focusses on defining the strategies to improve care of women seeking an induced abortion and to reduce infective complications. We have considered the evidence for screening and cost-effectiveness for antibiotic prophylaxis. Current evidence suggests that treating all women with prophylactic antibiotics in preference to screening and treating is the most cost-effective way of reducing infective complications following induced abortions. The final strategy to prevent infective complications should be individualized for each region/area depending on the prevalence of organisms causing pelvic infections and the resources available.


Assuntos
Aborto Induzido/efeitos adversos , Antibioticoprofilaxia/métodos , Doença Inflamatória Pélvica/etiologia , Aborto Induzido/métodos , Adolescente , Adulto , Antibioticoprofilaxia/economia , Azitromicina/economia , Azitromicina/uso terapêutico , Análise Custo-Benefício , Doxiciclina/economia , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Metronidazol/economia , Metronidazol/uso terapêutico , Doença Inflamatória Pélvica/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Gravidez , Doenças Bacterianas Sexualmente Transmissíveis/tratamento farmacológico , Adulto Jovem
5.
Endocrinology ; 148(12): 5769-79, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17872369

RESUMO

The human corpus luteum (hCL) is an active, transient, and dynamic endocrine gland. It will experience extensive tissue and vascular remodeling followed by 1) demise of the whole gland without any apparent scarring or 2) maintenance of structural and functional integrity dependent on conceptus-derived human chorionic gonadotropin (hCG). Because cortisol has well-characterized roles in tissue remodeling and repair, we hypothesized that it may have a role in controlling luteal dissolution during luteolysis and would be locally produced toward the end of the luteal cycle. Glucocorticoid-metabolizing enzymes [11beta-hydroxysteroid dehydrogenase (11betaHSD) types 1 and 2] and the glucocorticoid receptor (GR) were assessed in hCL and cultures of luteinized granulosa cells (LGC) using immunofluorescence and quantitative RT-PCR. Furthermore, the effect of cortisol on steroidogenic cell survival and fibroblast-like cell activity was explored in vitro. The hCL expressed 11betaHSD isoenzymes in LGC and nuclear GR in several cell types. hCG up-regulated the expression and activity of 11betaHSD type 1 (P < 0.05) and down-regulated type 2 enzyme (P < 0.05) in vitro and tended to do the same in vivo. Cortisol increased the survival of LGC treated with RU486 (P < 0.05) and suppressed the activity of a proteolytic enzyme associated with luteolysis in fibroblast-like cells (P < 0.05). Our results suggest that, rather than during luteolysis, it is luteal rescue with hCG that is associated with increased local cortisol generation by 11betaHSD type 1. Locally generated cortisol may therefore act on the hCL through GR to have a luteotropic role in the regulation of luteal tissue remodeling during maternal recognition of pregnancy.


Assuntos
Corpo Lúteo/metabolismo , Glucocorticoides/metabolismo , 11-beta-Hidroxiesteroide Desidrogenases/metabolismo , Células Cultivadas , Gonadotropina Coriônica/farmacologia , Corpo Lúteo/efeitos dos fármacos , Feminino , Expressão Gênica/efeitos dos fármacos , Células da Granulosa/efeitos dos fármacos , Células da Granulosa/metabolismo , Humanos , Hidrocortisona/farmacologia , Imuno-Histoquímica , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Mifepristona/farmacologia , Gravidez , Receptores de Glucocorticoides/genética , Receptores de Glucocorticoides/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa
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