Sick leave due to occupational mental disorders in Brazil Northeastern states: an ecological study.

Introduction: Although work provides many benefits, occupational mental disorders, such as mental distress, depression, and stress-related illnesses have significantly increased. Objectives: This study aims to identify and present the spatial distribution of the major mental and behavioral disorders that lead to sick leave in Brazil Northeastern states. Methods: This descriptive study with an ecological time series design aimed to identify the distribution of occupational mental and behavioral disorders in Brazil Northeastern states. Data collection included downloading information from the Observatório de Segurança e Saúde no Trabalho (SmartLab, Occupational Health and Safety Observatory) from 2012 to 2018. Data were analyzed using Python. Results: Grants of sick leave according to the type of illness were recorded for nonaccident-related leave (B31) and accident-related leave (B91). Bahia had the highest number of cases reported for B31, as did Rio Grande do Norte for B91. Rio Grande do Norte and Alagoas stood out with the highest rates of sick leave due to mental and behavioral disorders. Phobic-anxiety disorders had the highest number of notifications. The building construction industry had the highest number of work-related notifications. Conclusions: This study has contributed to identifying the main occupational disorders. Public policies need to be implemented to tackle the public health crisis which directly impacts on domestic social and economic conditions.

Introdução: Mesmo diante dos benefícios que a atividade laboral proporciona, tem-se observado um aumento significativo no número de trabalhadores com sofrimento psíquico, depressão e doenças associadas ao estresse. Objetivos: Identificar e apresentar a distribuição espacial por estado do Nordeste dos principais transtornos mentais e comportamentais que geram afastamento da atividade laboral. Métodos: Realizou-se um estudo descritivo com desenho ecológico de série temporal, cuja finalidade é identificar a distribuição de transtornos mentais e comportamentais em trabalhadores da região Nordeste. Para a coleta de dados, utilizou-se o Observatório de Segurança e Saúde no Trabalho (SmartLab) mediante o download das informações notificadas no período de 2012 a 2018. A análise foi realizada por meio da linguagem de programação Python. Resultados: As concessões de auxílios por afastamento conforme o tipo de doença foram registradas para afastamentos não acidentários (B31) e acidentários (B91). A Bahia apresentou um maior número de casos notificados para B31, assim como o Rio Grande do Norte para B91. O Rio Grande do Norte e Alagoas se destacaram como os estados que concentram o maior percentual de casos de afastamento por transtornos mentais e comportamentais. Os transtornos fóbico-ansiosos obtiveram o maior número de notificações entre os estados. A atividade de construção de edifícios se revelou com os maiores números de notificações relacionadas ao trabalho. Conclusões: Este estudo contribuiu para a identificação dos principais transtornos que acometem os trabalhadores. É necessário que sejam adotadas políticas públicas no enfrentamento da crise de saúde pública que impacta diretamente as condições sociais e econômicas do país.

Complications of collagen biostimulators in Brazil: Description of products, treatments, and evolution of 55 cases.

BACKGROUND: Complications of temporary and permanent fillers have been extensively studied. However, there is a lack of comparative data regarding poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and polycaprolactone (PCL) known as collagen biostimulators. AIMS: This study addressed the complications of collagen biostimulators concerning their diagnosis, type of product, treatment, and monitoring. PATIENTS/METHODS: An electronic questionnaire was sent to Brazilian dermatologic ultrasound experts to identify complications related to biostimulators. The type of biostimulator, location of application, number of vials injected, application plan, time between injection treatment and complication, injector profile, treatment, and prognosis were assessed. RESULTS: Fifty-five cases were identified, of which 49.1% were caused by PLLA-Elleva®, 23.6% by CaHA (alone or combined with hyaluronic acid), 20.0% by PLLA-Sculptra®, and 7.3% by PCL. The most affected area was the face (72.7%), with nodules being the most common clinical form (89.1%), generally occurring late (60.0%) (>1 month). Only one case was injected at an incorrect depth (musculoaponeurotic system-SMAS). Despite several treatments, including saline (45.5%), hyaluronidase (25.5%), diluted corticosteroids (23.6%), and energy-based devices (10.9%), only five cases showed complete resolution. Hyaluronidase was beneficial in complications related to fillers when there was an association of calcium hydroxyapatite with hyaluronic acid (p < 0.01). CONCLUSIONS: Complications from collagen biostimulators were more common on the face, typically manifesting about 1 month after treatment. These issues seemed to be related more to the properties of the products rather than inadequate technique. Furthermore, hyaluronidase demonstrated efficacy only in cases where there was an association with HA.

Brain Neuroplasticity after Treatment with Antiseizure: A Review.

Epilepsy is a disease characterized by the periodic occurrence of seizures. Seizures can be controlled by antiseizure medications, which can improve the lives of individuals with epilepsy when given proper treatment. Therefore, this study aimed to review the scientific literature on brain neuroplasticity after treatment with antiseizure drugs in different regions of the brain. According to the findings, that several antiseizure, such as lamotrigine, diazepam, levetiracetam, and valproic acid, in addition to controlling seizures, can also act on neuroplasticity in different brain regions. The study of this topic becomes important, as it will help to understand the neuroplastic mechanisms of these drugs, in addition to helping to improve the effectiveness of these drugs in controlling the disease.

Glycerol inoculation in eggs of young broiler breeders at different embryonic periods.

Small eggs have lesser amounts of nutrients to be used by the embryo, and the yolk glycerol is the main substrate for glycogen production, which is the main energy source in the last days of incubation. Thus, the present study aimed to assess the effect of a glycerol injection in light weight eggs at 2 different days of incubation. To this end, 336 light eggs (55.6 to 58.6 g) from 32-wk-old broiler breeders were incubated. The eggs were divided into 3 treatment groups: 1 group inoculated with saline solution on the 17th d of embryonic development (E17) (control group), the second group injected with a 6 mg glycerol/mL solution at E17, and the third group injected with 6 mg glycerol/mL on the 18th d of incubation (E18). Incubation parameters, liver and muscle glycogen, and broilers performance at 7 d of age were evaluated. Glycerol administration in ovo did not influence hatchability, period of embryonic death or early hatching. Chicks exposed to glycerol in ovo feeding (IOF) used more yolk than birds inoculated with saline solution. Glycerol inoculation at E18 enhanced liver glycogen deposition (P = 0.001) and also improved broilers performance at 7 d, although this improvement in performance and glycogen reserves was not observed when eggs were inoculated at 17 d of incubation. Birds receiving glycerol IOF at E18 showed higher feed intake and body weight gain when compared to the control group and the group inoculated at E17. It was found that glycerol inoculation in light eggs at the 18th d of incubation contributed to raise liver glycerol levels and also to improve broilers performance at 7 d.

Antiphospholipid Antibody Syndrome and Infertility.

Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies (aPLs), thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. The objective of the present study was to review the pathophysiology of APS and its association with female infertility. A bibliographic review of articles of the past 20 years was performed at the PubMed, Scielo, and Bireme databases. Antiphospholipid antibody syndrome may be associated with primary infertility, interfering with endometrial decidualization and with decreased ovarian reserve. Antiphospholipid antibodies also have direct negative effects on placentation, when they bind to the trophoblast, reducing their capacity for invasion, and proinflammatory effects, such as complement activation and neutrophil recruitment, contributing to placental insufficiency, restricted intrauterine growth, and fetal loss. In relation to thrombosis, APS results in a diffuse thrombotic diathesis, with global and diffuse dysregulation of the homeostatic balance. Knowing the pathophysiology of APS, which is closely linked to female infertility, is essential for new therapeutic approaches, specialized in immunomodulation and inflammatory signaling pathways, to provide important advances in its treatment.

A Síndrome do anticorpo antifosfolípide (SAF) é uma doença sistêmica, autoimune e pró-trombótica caracterizada por anticorpos antifosfolípides, trombose, aborto recorrente, complicações durante a gestação, e, ocasionalmente, trombocitopenia. O objetivo do presente estudo foi revisar a fisiopatologia da SAF e sua associação com a infertilidade feminina. Foi feita uma revisão bibliográfica dos últimos 20 anos nas bases de dados PubMed, Scielo e Bireme. A SAF pode estar associada à infertilidade primária, interferindo na decidualização endometrial e com baixas reservas ovarianas. Os anticorpos antifosfolípides também apresentam efeito negativo direto na placentação, se ligando ao trofoblasto e diminuindo sua capacidade de invasão, além de efeitos pró-inflamatórios, tais como ativação do sistema de complemento e recrutamento de neutrófilos, contribuindo para a insuficiência placentária, crescimento intrauterino restrito e perda fetal. Quanto a trombose, a SAF resulta em distúrbios trombóticos difusos, com uma desregulação do balanço homeostático. Conhecer a fisiopatologia da SAF, que apresenta associação importante com a infertilidade feminina, é essencial para novas abordagens terapêuticas, principalmente no que tange imunomodulação e os caminhos de ativação inflamatórios.

Teaching-Learning Process of Medical Students with Real Anatomical Parts: A Practical Intervention Strategy / Proceso de Enseñanza-Aprendizaje de los Estudiantes de Medicina con Piezas Anatómicas Reales: Una Estrategia de Intervención Práctica

SUMMARY: The COVID-19 pandemic caused several changes in the teaching of human anatomy, among them the use of different teaching methodologies based on E-learning. However, studies evaluating electronic tools have not provided clear evidence of effective student learning. Thus, this was the first study to evaluate medical students after completing human anatomy courses in the E- learning modality. We recruited first term (Group A, n=25) and second term (Group B, n=13) medical students. We applied a practical assessment based on 50 human anatomy markingson real anatomical specimens and cadavers, to be completed in Questionnaire 01 (Phase I). After detecting low scores on Questionnaire 01 by both groups, we applied a practical and face-to-face tutoring system for 14 days (Phase II). Afterwards, we re-evaluated both groups by repeating the same scores (Questionnaire 02, Phase III). According to the paired analysis of questionnaires 01 and 02 by Student's T-test, both groups showed significant increase in the final scores obtained in questionnaire 02 (Phase III). The evidence showed that the remote format lecture system weakened the learning and retention process of basic anatomical knowledge by medical students. On the other hand, in-person practical teaching proved to be efficient in the formative process of the students, a fact proven by the significant increase in the scores of the students in the 02 questionnaire, for both groups.

La pandemia por COVID-19 provocó varios cambios en la enseñanza de la anatomía humana, entre ellos el uso de diferentes metodologías de enseñanza basadas en E-learning. Sin embargo, los estudios que evalúan las herramientas electrónicas no han proporcionado evidencia clara de un aprendizaje efectivo de los estudiantes. Este fue el primer estudio que evaluó a estudiantes de medicina luego de cursar cursos de anatomía humana en la modalidad E-learning. Reclutamos estudiantes de medicina de primer término (Grupo A, n=25) y segundo término (Grupo B, n=13). Se aplicó una evaluación práctica basada en 50 marcas de anatomía humana sobre especímenes anatómicos reales y cadáveres, para ser completado en el Cuestionario 01 (Fase I). Tras detectar puntuaciones bajas en el Cuestionario 01 por parte de ambos grupos, se aplicó un sistema de tutorías prácticas y presenciales durante 14 días (Fase II). Posteriormente, reevaluamos ambos grupos repitiendo las mismas puntuaciones (Cuestionario 02, Fase III). Según el análisis apareado de los cuestionarios 01 y 02 por la prueba T de Student, ambos grupos mostraron aumento significativo en los puntajes finales obtenidos en el cuestionario 02 (Fase III). La evidencia mostró que el sistema de conferencias en formato remoto debilitó el proceso de aprendizaje y retención de conocimientos anatómicos básicos por parte de los estudiantes de medicina. Por otro lado, la docencia práctica presencial demostró ser eficiente en el proceso formativo de los alumnos, hecho que demuestra el aumento significativo de las puntuaciones de los alumnos en el cuestionario 02, para ambos grupos.

Age-related oxidative stress and antioxidant capacity in heat-stressed broilers.

We aimed to evaluate the effects of acute heat stress (HS) and age on the redox state in broilers aged 21 and 42 days. We evaluated the expression of genes related to antioxidant capacity, the production of hydrogen peroxide (H2O2), and the activity of antioxidant enzymes in the liver, as well as oxidative stress markers in the liver and plasma. The experiment had a completely randomized factorial design with two thermal environments (thermoneutral and HS, 38°C for 24 h) and two ages (21 and 42 days). Twenty-one-day-old animals exposed to HS showed the highest thioredoxin reductase 1 (TrxR1) (P<0.0001) and glutathione synthetase (GSS) (P<0.0001) gene expression levels. Age influenced the expression of the thioredoxin (Trx) (P=0.0090), superoxide dismutase (SOD) (P=0.0194), glutathione reductase (GSR) (P<0.0001) and glutathione peroxidase 7 (GPx7) (P<0.0001) genes; we observed greater expression in birds at 21 days than at 42 days. Forty-two-day-old HS birds showed the highest H2O2 production (222.31 pmol dichlorofluorescein produced/min×mg mitochondrial protein). We also verified the effects of age and environment on the liver content of Glutathione (GSH) (P<0.0001 and P=0.0039, respectively) and catalase (CAT) enzyme activity (P=0.0007 and P=0.0004, respectively). Higher GSH content and lower CAT activity were observed in animals from the thermoneutral environment compared with the HS environment and in animals at 21 days compared with 42 days. Broilers at 42 days of age had higher plasma creatinine content (0.05 v. 0.01 mg/dl) and higher aspartate aminotransferase activity (546.50 v. 230.67 U/l) than chickens at 21 days of age. Our results suggest that under HS conditions, in which there is higher H2O2 production, 21-day-old broilers have greater antioxidant capacity than 42-day-old animals.

Desejo e culpa: a sedução diabólica em Eça de Queiroz / Desire and guilt: the diabolical seduction in Eça de Queiroz

O presente texto pretende, a partir de visita à obra clássica de Eça de Queiroz (1880/1963), O mandarim, localizar elementos deste romance fantástico que pos-sam nos oferecer pistas de trabalho, em ato literário, para compreender alguns con-ceitos da teoria psicanalítica freudo-lacaniana. Considerando que a associação entre o desejo inconsciente e a sedução diabólica é desde Freud uma constante, inter-rogamos, a partir do recurso do pacto, utilizado por Queiroz, as implicações e os desdobramentos clínico-teóricos a partir de três pontos conceituais. São eles, em particular, a questão das movimentações narcísicas que marcam um sujeito no inte-rior do par dialético insatisfação e busca de realização; o conceito de gozo como o que se inscreve, além do princípio de prazer; e a dimensão da culpa que se realiza via masoquismo face à não assunção do sujeito pela responsabilidade quanto ao seu desejo e que se localiza no personagem principal do romance no campo do maso-quismo mora

In vivo induction of insulin-like growth factor-I receptor and CD44v6 confers homing and adhesion to murine multiple myeloma cells.

One of the main characteristics of multiple myeloma (MM) cells is their specific homing and growth in the bone marrow (BM). Differences between stroma-dependent and -independent MM cell lines may reveal key molecules that play important roles in their homing to the BM. We addressed this topic with a murine MM model, including the in vivo 5T33MM (5T33MMvv) stroma-dependent cell line and its in vitro stroma-independent variant (5T33MMvt). Fluorescence-activated cell-sorting analysis showed expression of insulin-like growth factor (IGF)-I receptor and CD44v6 on all 5T33MMvv cells but not on 5T33MMvt cells. Checkerboard analysis and adhesion assays revealed IGF-I-dependent chemotaxis toward BM-conditioned medium and involvement of CD44v6 in the adhesion to BM stroma of only 5T33MMvv cells. However, when 5T33MMvt cells were injected in vivo (5T33MMvt-vv), after 18 h the MM cells harvested from BM were IGF-I receptor and CD44v6 positive. This up-regulation was confirmed in 5T33MMvt-vv cells isolated from terminally diseased animals. These ST33MMvt-vv cells exhibited IGF-I-dependent chemotaxis and CD44v6-dependent adhesion to BM stroma. In vitro culture of the 5T33MMvt-vv cells could completely down-regulate IGF-I receptor and CD44v6. In fact, we could show that direct contact of 5T33MMvt cells with BM endothelial cells is a prerequisite for IGF-I receptor and CD44v6 up-regulation. These data indicate that the BM microenvironment is capable of up-regulating molecules such as IGF-I receptor and CD44v6, which facilitate homing of MM cells to the BM and support their adhesion to BM stroma.

Microcephaly Diagnosis: Maternal Perspectives About the Organization of the Health Care Network / Diagnóstico de la microcefalia: perspectivas maternas acerca de la organización de la red de atención a la salud / Diagnóstico da microcefalia: perspectivas maternas sobre a organização da rede de atenção à saúde

Objetivo: entender a organização da Rede de Atenção à Saúde (RAS) a partir de vivências de mães e de familiares no processo assistencial para o diagnóstico de microcefalia. Materiais e métodos: pesquisa descritiva e exploratória, de abordagem qualitativa, realizada com 14 mães de crianças com microcefalia. Para a definição da amostra, foram elencados os seguintes critérios de inclusão: ser mãe de criança diagnosticada com microcefalia decorrente do zika vírus, ter parido e ser residente do município de Mossoró, Rio Grande do Norte, Brasil. Enquanto critérios de exclusão, foram especificados: mães que não aceitaram participar do estudo. A população desta investigação foi definida no ano de 2018. Para a análise dos dados, foi empregado o método da análise temática do conteúdo de Minayo. Resultados: os resultados foram divididos nas seguintes categorias: 1. acesso aos serviços, aos exames e ao acompanhamento profissional; 2. percepção das mães acerca do seguimento na RAS. Foi possível apreender os obstáculos vivenciados na RAS para o diagnóstico e o seguimento das crianças com síndrome congênita decorrente do zika vírus. Conclusões: evidenciou-se a dificuldade de operacionalização de protocolo proposto para a RAS quer seja pelo conhecimento insuficiente acerca da síndrome, impossibilitando a manutenção do fluxo organizacional estabelecido pelo protocolo, quer seja pela escassez de tecnologias duras que auxiliem na efetivação dessa assistência.

Objective: To understand the organization of the Health Care Network (Rede de Atenção à Saúde, RAS) from the experiences of mothers and family members in the assistance process for the diagnosis of microcephaly. Materials and methods: A descriptive and exploratory research study with a qualitative approach, conducted with 14 mothers of children with microcephaly. For the definition of the sample, the following inclusion criteria were listed: being a mother of a child diagnosed with microcephaly due to Zika Virus, having given birth, and being a resident of the municipality of Mossoró, Rio Grande do Norte, Brazil. Regarding the exclusion criterion, the following was specified: mothers who did not accept to participate in the study. The population of this research was defined in 2018. Minayo's method of thematic content analysis was employed for data analysis. Results: The results were divided into the following categories: 1. Access to the services, exams, and professional monitoring; 2. Perception of the mothers about follow-up in the RAS. It was possible to apprehend the obstacles experienced in the RAS for the diagnosis and follow-up of children with congenital syndrome due to the Zika Virus. Conclusions: The difficulty of operationalizing the proposed protocol for the RAS was evidenced, either due to insufficient knowledge about the syndrome, making it impossible to maintain the organizational flow established by the protocol, or to the scarcity of hard technologies that assist in the implementation of this assistance.

Objetivo: entender la organización de la Red de Atención a la Salud (RAS) desde vivencias de madres y de familiares en el proceso asistencial para el diagnóstico de microcefalia. Materiales y métodos: investigación descriptiva y exploratoria, de enfoque cualitativo, realizado con 14 madres de niños con microcefalia. Para definir la muestra, se consideraron los siguientes criterios de inclusión: ser madre de niño diagnosticado con microcefalia resultante del virus zika, haber parido y ser residente del municipio de Mossoró, Rio Grande do Norte, Brasil. Como criterios de exclusión, se especificaron: madres que no aceptaron a participar en el estudio. La población del estudio se definió en el 2018. Para analizar los datos, se empleó el método de análisis temático de contenido de Minayo. Resultados: los resultados se dividieron en las categorías: 1. acceso a los servicios, a las pruebas y al seguimiento profesional; 2. percepción de las madres acerca del seguimiento en la RAS. Se logró aprehender los obstáculos vivenciados en la RAS para o diagnóstico y el seguimiento de los niños con síndrome congénito resultante del virus zika. Conclusiones: se evidenció la dificultad de operacionalización de protocolo propuesto para la RAS, ya sea por el conocimiento insuficiente acerca del síndrome, imposibilitando el mantenimiento del flujo organizacional establecido por el protocolo, ya sea por la escasez de tecnologías duras que auxilien en la efectuación de esta asistencia.

In vivo homing and differentiation characteristics of mature (CD45-) and immature (CD45+) 5T multiple myeloma cells.

Multiple myeloma, a plasma cell malignancy, is predominantly localized in the bone marrow. These tumoral cells display a heterogeneous expression of CD45. It is, however, unclear which subpopulation is responsible for the homing and outgrowth of the myeloma cells. In this work, we investigated the in vivo homing, proliferation, and differentiation of both CD45+ and CD45- cells in two murine myeloma models.5T2MM and 5T33MM in vivo lines of murine multiple myeloma were used. CD45 and IGF-I receptor expression was analyzed by FACS. Proliferative capacity was assessed by in vivo bromodeoxyuridine incorporation. 5TMM cells were separated into CD45+ and CD45- fractions by MACS. Initial homing was investigated in vivo by tracing of radioactively labeled cells. Myeloma cells were detected by FACS and histology. Osteolytic lesions were analyzed by radiography. Both CD45+ and CD45- 5TMM cells were able to home to the bone marrow, although the migration of the latter subset was lower, which was related to a low IGF-I receptor expression. Recipients of both fractions developed myeloma as evidenced by the presence of serum paraprotein, osteolytic lesions, and bone marrow infiltration by myeloma cells. The tumor load in the recipients of CD45- cells was higher than the CD45+ cells, which could be explained by a lower proliferation rate of the latter population. While the separated cells before injection had a homogenous expression of CD45, cells isolated from the bone marrow of these terminally diseased mice had a heterogeneous expression pattern, indicating an in vivo differentiation pattern of CD45- to CD45+ cells and vice versa. We conclude that both CD45+ and CD45- 5TMM subpopulations contain clonogenic myeloma cells with bone marrow homing and proliferative capacity.

Aspectos relacionados às internações por intercorrências gestacionais / Related aspects with hospitalizations due to pregnancy complications

Objetivo: Analisar aspectos relacionados às internações por intercorrências gestacionais. Método: Estudo quantitativo, retrospectivo, realizado em maternidade pública de Teresina, Piauí, Brasil, com 367 prontuários de gestantes internadas na ala de alto risco, no período de 2015-2016. Realizou-se análises descritivas e inferenciais. Resultados: Gestantes possuíam média de 25,1 anos (Desvio padrão=7,2), a maioria com companheiro (68,4%), ensino fundamental incompleto (32,7%), do lar (58,6%) e procedentes do interior do Piauí (47,7%). As intercorrências gestacionais mais frequentes foram: Pré-eclâmpsia Grave (33,9%), Amniorrexe Prematura (16,4%) e Oligohidramnio (16,1%). Os aspectos relacionados à Pré-eclâmpsia Grave foram faixa etária (p-valor=0,03) e situação conjugal (p-valor=0,03); à Amniorrexe Prematura foram situação conjugal (p-valor=0,01), procedência (p-valor=0,03) e Infecção do Trato Urinário (p-valor<0,01); e, ao Oligohidramnio associado à procedência (p-valor=0,01). Conclusão: A assistência no período pré-natal, parto e puerpério deve ser recurso utilizado na prevenção e controle de intercorrências que podem atenuar danos ao binômio mãe e filho. (AU)

Objective: To analyze aspects related to hospitalizations due to pregnancy complications. Method: Quantitative, retrospective study, carried out in a public maternity hospital in Teresina, Piauí, Brazil, with 367 medical records of pregnant women hospitalized in the high-risk ward, in the period 2015-2016. Descriptive and inferential analyzes were carried out. Results: Pregnant women had an average of 25.1 years (standard deviation = 7.2), most with a partner (68.4%), incomplete elementary school (32.7%), home (58.6%) and coming from from the interior of Piauí (47.7%). The most frequent gestational complications were: Severe Preeclampsia (33.9%), Premature Amniorrexis (16.4%) and Oligohydramnios (16.1%). The aspects related to severe preeclampsia were age group (p-value = 0.03) and marital status (p-value = 0.03); Premature Amniorrexis were marital status (p-value = 0.01), origin (p-value = 0.03) and Urinary Tract Infection (p-value <0.01); and the Oligohydramnium associated with the origin (p-value = 0.01). Conclusion: Assistance in the prenatal, childbirth and puerperium period should be a resource used in the prevention and control of complications that can mitigate damage to the mother and child. (AU)

Objetivo: analizar aspectos relacionados con las hospitalizaciones por complicaciones del embarazo. Métodos: Estudio cuantitativo, retrospectivo, realizado en un hospital público de maternidad en Teresina, Piauí, Brasil, con 367 registros médicos de mujeres embarazadas hospitalizadas en la sala de alto riesgo, en el período 2015-2016. Se realizaron análisis descriptivos e inferenciales. Resultados: las mujeres embarazadas tuvieron un promedio de 25.1 años (desviación estándar = 7.2), la mayoría con una pareja (68.4%), escuela primaria incompleta (32.7%), desde casa (58.6%) y provenientes de del interior de Piauí (47.7%). Las complicaciones gestacionales más frecuentes fueron: preeclampsia severa (33.9%), amniorrexis prematura (16.4%) y oligohidramnios (16.1%). Los aspectos relacionados con la preeclampsia severa fueron el grupo de edad (valor p = 0.03) y el estado civil (valor p = 0.03); La amniorrexis prematura fue el estado civil (valor p = 0.01), el origen (valor p = 0.03) y la infección del tracto urinario (valor p <0.01); y el oligohidramio asociado con el origen (valor p = 0.01). Conclusión: La asistencia en el período prenatal, de parto y puerperio debe ser un recurso utilizado en la prevención y el control de complicaciones que pueden mitigar el daño a la madre y al niño. (AU)

Renal technetium-99m-DMSA SPECT in normal volunteers.

UNLABELLED: Dimercaptosuccinic acid (DMSA) renal scintigraphy today is considered a sensitive and useful technique for the detection of cortical abnormalities. Recent studies have suggested that lesion detection can be improved by SPECT imaging. This study investigated normal kidneys using different SPECT modalities. METHODS: Ten young, healthy volunteers with normal clinical history and normal renal ultrasound underwent planar and SPECT DMSA imaging 2 to 4 hr after intravenous injection of 99mTc-DMSA (185 MBq). Analysis of SPECT data was focused on the homogeneity of cortical uptake (comparison of upper and lower pole activity) as well as on the presence or absence of focal cortical defects. RESULTS: No abnormality could be observed on the planar images. SPECT revealed, in seven kidneys (five left and two right), the presence of a hypoactive upper pole. This was visually observed on the coronal slices with up to 35% difference between upper and lower pole. Moreover, three focal cortical defects were visualized on the coronal slices as well as on three-dimensional surface shade displays. CONCLUSION: These normal patterns should be recognized when evaluating a patient with possible renal involvement.

The cost of treatment of Alzheimer's disease in The Netherlands: a regression-based simulation model.

OBJECTIVE: To examine the potential economic impact of treatment of Alzheimer's disease. DESIGN: Regression-based simulation estimation of the long term costs of Alzheimer's disease under a number of treatment scenarios. Data from an epidemiological study conducted in Rotterdam, The Netherlands, was used to simulate disease progression. Comparison of the costs and effectiveness experienced by the patients were used to measure the impact of treatment. PATIENTS AND INTERVENTION: 2 theoretical cohorts of patients with Alzheimer's disease, one of which receives standard treatment, while the other receives a treatment which slows cognitive decline as measured by the Mini-Mental State Examination (MMSE). MAIN OUTCOME MEASURES AND RESULTS: Under one of the scenarios examined, the baseline cost of Alzheimer's disease was 97,866 euro (EUR; 1996 values) per patient over 10 years' follow-up; the cost was almost EUR100,000 under all scenarios. Life expectancy following onset was about 4.5 years and MMSE decline was approximately 2 points per year for a typical prevalent (existing) patient and almost twice as much for incident (newly diagnosed) patients (1.82 vs 3.42 points per year, respectively). Slowing the rate of cognitive decline results in a slightly increased life expectancy, with more time being spent at home and less in a nursing home. Total costs (excluding those of therapy) will decrease, but savings will be modest and may well be less than the cost of therapy. Under the same scenario, total savings were EUR1,571 per patient which corresponds to an annual break-even cost of just EUR453. Decisions regarding the initiation or termination of therapy will affect both the number of patients treated and the costs and potential savings of treatment. CONCLUSIONS: The savings made in treating Alzheimer's disease will almost certainly be small in comparison with total costs and may well be offset by the cost of the treatment itself. Simulation models can be used to estimate the effect of therapy on the costs of care and can be useful tools in clinical decision-making and allocation of resources. These results show the need for further research into the costs and effects of treatment of Alzheimer's disease.

Effect of exercise on portal vein blood flow in man.

PURPOSE: Doppler pulsed flow and electronic scanning allow for instantaneous measurement of portal vein flow. This method was used to monitor alterations in splanchnic blood flow during exercise. METHODS: Measurements of portal vein blood flow were performed in eight healthy males at rest and at 10-min intervals during cycle ergometry at 70% of maximal aerobic capacity. Subjects stopped cycling briefly (approximately 30 s) and stopped breathing while measurements were made. Flow was calculated from values obtained for velocity of red blood cell passage and cross-sectional area of the vessel. RESULTS: Cross-sectional area decreased during exercise, resulting in a significant decrease in flow over time (P = 0.0001 by ANOVA). The flow within the portal vein had decreased by 80% after 60 min of exercise (absolute flow, 0.63 +/- 0.13 L x min(-1) at rest and 0.13 +/- 0.04 L x min(-1) at 60 min). CONCLUSION: Electronic Doppler flow measurement of portal vein flow is a viable, noninvasive technique that can be used to measure splanchnic blood flow. Values obtained as a result of intensive exercise are in line with earlier results obtained with other techniques.

A time-scale sensitometric method for evaluating screen-film systems.

An x-ray sensitometer is used to measure the characteristic curve of radiographic films exposed with fluorescent intensifying screens. The series of relative exposures, necessary to cover the full density range of the film, can be obtained by either time-scale or intensity-scale sensitometric methods. We have developed a convenient method of exposing film-screen systems for time-scale sensitometry. In this method, during exposure the x-ray kilovoltage, tube current and x-ray intensity remain constant and a geometric series of exposures of the film is modulated by varying the exposure time. This time variation can be obtained when a lead disc with different sector openings is rotated in front of the film system by a stepping motor. The conditions normally used are 70 kVp x-rays, 3.5 mm Al total filtration at the tube, and 2.4 m focal spot-film distance. This exposure latitude gives a complete characteristic curve of film-screen systems.

Household pesticide usage in the United States.

A total of 10,000 U.S. households in 25 standard metropolitan statistical areas and 25 counties were included in the United States. More than 8,200 households granted an interview. Nine of every ten households in the United States used some types of pesticide in their house, garden, or yard. Households in the southeastern United States used the most pesticides. Although more than 500 different pesticide formulations were used by the sampled households, 15 pesticides accounted for 65.5% of all pesticides reported in this study. Thirteen of these 15 pesticides were insecticides, one was a herbicide, and one was a rodenticide.

[Model of costs of care for dementia: community-dwelling vs. institutionalization]. / Een kostenmodel van de zorg voor dementerenden: thuiswonen versus opname.

This article describes a model of costs for Alzheimer's Disease. The cost of institutionalization and the cost of living at home for patients with Alzheimer's Disease are calculated and compared. The average yearly cost of living at home is 10,810 Dutch guilders for male patients and 12,771 Dutch guilders for female patients (prices of 1996). Institutionalization is considerably more expensive: the average yearly cost associated with admission to a residential home is 48,180 Dutch guilders and 98,915 versus 102,930 Dutch guilders for costs associated with admission to a specialised respectively nonspecialized nursing home. Differences between men and women could not be taken into account in these last three estimations. The cost of living at home increases when the cost of informal care is included. However, when the cost were valued with a tariff of 29.50 guilders per hour, institutionalisation remains more expensive than living at home. This is also the case for severely demented patients, as the costs of institutions are also related to the level of care.

Carotid endarterectomy and ocular complaints.

The value of a carotid endarterectomy in patients with ocular symptoms such as amaurosis fugax, scotoma, loss of visual acuity or diplopia is considered from an ophthalmological point of view. The concurrent fundus lesions are discussed and the ocular results of two different groups of patients are presented. A first group of 12 patients underwent an endarterectomy for their specific ocular complaints, while a second group of 15 patients with ocular symptoms associated with carotid lesions were treated conservatively. The usefulness of the retro-ocular doppler sonography in the vascular check-up is stressed. A good visual prognosis after carotid endarterectomy can be predicted when the blood velocity in the ophthalmic artery is 0.2 to 0.4 m/sec.

[Radiological differential diagnosis of focal liver lesions with anatomo-pathological correlations]. / Diagnostic différentiel des lésions focales hépatiques avec corrélations anatomopathologiques.

Starting from the macroscopic, microscopic and circulatory characteristics of focal liver lesions, we aimed at assessing the possibilities and the limits of their radiological differential diagnosis. We compared the normal hepatic parenchyma (in terms of: general morphology, cellularity, necrosis, macro- and micro-circulation) and the lesions, assessed following the radiological features of echoreflectivity, RX density, contrast dynamics and specific contrast uptake. The association of morphologic and dynamic features can sometimes lead to an excellent diagnostic specificity (by example: angioma); in other fields, interesting results are noted, but the limits of every modality require further evaluation. This study applies to the following focal lesions: angioma, focal hyperplasia, adenoma, regeneration nodule, hepatocarcinoma, metastasis.