Misoprostol administered sublingually at a dose of 12.5 µg versus vaginally at a dose of 25 µg for the induction of full-term labor: a randomized controlled trial protocol.

BACKGROUND: Various methods are currently used for the induction of labor. Nevertheless, the most effective method with the fewest side effects remains to be established. Misoprostol, administered vaginally, has been routinely used for this purpose; however, other forms of administration are being proposed, including the use of sublingual tablets. No studies have yet compared the effectiveness and safety of 12.5-µg misoprostol administered sublingually compared to a 25-µg vaginal dose of the drug for the induction of labor. METHODS: A triple-blind, multicenter, placebo-controlled, randomized clinical trial will be conducted in Brazil at the Instituto de Medicina Integral Prof. Fernando Figueira and at the Assis Chateaubriand Maternity Teaching Hospital of the Federal University of Ceará. A total of 140 patients with full-term pregnancies, a live fetus, a Bishop score ≤ 6 and a recommendation of induction of labor will be randomized to one of two groups. One group will receive 12.5-µg sublingual tablets of misoprostol and placebo vaginal tablets, while the other group will receive placebo sublingual tablets and vaginal tablets containing 25 µg of misoprostol. The principal endpoint is the rate of tachysystole. The secondary endpoints are vaginal delivery within 24 h of induction, uterine hyperstimulation, Cesarean section, severe neonatal morbidity or perinatal death, severe maternal morbidity or maternal death, and maternal preference regarding the route of administration of the drug. Student's t-test, and the chi-square test of association or Fisher's exact test, as appropriate, will be used in the data analysis. Risk ratios and their respective 95% confidence intervals will be calculated. DISCUSSION: Misoprostol has been identified as a safe, inexpensive, easily administered option for the induction of labor, with satisfactory results. An experimental study has shown that misoprostol administered sublingually at a dose of 25 µg appears to be effective and is associated with greater maternal satisfaction when labor is induced in women with an unfavorable cervix. Nevertheless, the rate of tachysystole remains high; therefore, further studies are required to determine the ideal dose and the ideal interval of time between doses. TRIAL REGISTRATION: ClinicalTrial.gov, NCT01406392 .

Factors associated with malnutrition in hospitalized cancer patients: a croos-sectional study.

INTRODUCTION: The incidence of cancer is increasing worldwide and with it the prevalence of malnutrition, which is responsible for the death of almost 20% of cancer patients. The objective of this study was to identify the factors associated with malnutrition in hospitalized cancer patients. METHODS: Cross-sectional study conducted with 277 hospitalized patients in the Institute of Integrative Medicine Prof. Fernando Figueira from March to November 2013. The nutritional status was classified as well-nourished and moderate/severe malnutrition, according to the Patient-Generated Subjective Global Assessment. The association between moderate/severe malnutrition and demographic, behavioral, socioeconomic, clinical, therapeutic and nutritional variables was investigated through univariate regression and hierarchical Poisson models, with a 5% significance level. RESULTS: The prevalence of malnutrition was 71.1%, being classified as moderate in 35.4% and severe in 35.7%. After multivariate analysis, smokers/ex-smokers low socioeconomic status, performance status ≥2 and age ≥60 years were associated with increased risk of malnutrition. CONCLUSION: There was observed a high prevalence of moderate/severe malnutrition in cancer patients, with the increased risk of malnutrition associated with the presence of factors that can be assessed during hospital admission suggesting a higher alert of the medical and health care staff about the need for nutritional assessment and intervention.

Factors associated with severe maternal morbidity and near miss in the São Francisco Valley, Brazil: a retrospective, cohort study.

BACKGROUND: Maternal mortality remains a major public health issue worldwide, with persistent high rates prevailing principally in underdeveloped countries. The objective of this study was to determine the risk factors for severe maternal morbidity and near miss (SMM/NM) in pregnant and postpartum women at the maternity ward of the Dom Malan Hospital, Petrolina, in northeastern Brazil. METHODS: A retrospective, cohort study was conducted to evaluate the sociodemographic and obstetric characteristics of the women. Patients who remained hospitalized at the end of the study period were excluded. Risk ratios (RR) and their respective 95% confidence intervals (95% CI) were calculated as a measure of relative risk. Hierarchical multiple logistic regression was also performed. Two-tailed p-values were used for all the tests and the significance level adopted was 5%. RESULTS: A total of 2,291 pregnant or postpartum women receiving care between May and August, 2011 were included. The frequencies of severe maternal morbidity and near miss were 17.5% and 1.0%, respectively. Following multivariate analysis, the factors that remained significantly associated with an increased risk of SMM/NM were a Cesarean section in the current pregnancy (OR: 2.6; 95% CI: 2.0 - 3.3), clinical comorbidities (OR: 3.4; 95% CI: 2.5 - 4.4), having attended fewer than six prenatal visits (OR: 1.1; 95% CI: 1.01 - 1.69) and the presence of the third delay (i.e. delay in receiving care at the health facility) (OR: 13.3; 95% CI: 6.7 - 26.4). CONCLUSIONS: The risk of SMM/NM was greater in women who had been submitted to a Cesarean section in the current pregnancy, in the presence of clinical comorbidities, fewer prenatal visits and when the third delay was present. All these factors could be minimized by initiating a broad debate on healthcare policies, introducing preventive measures and improving the training of the professionals and services providing obstetric care.

Effects of Kinesio tape on vascularity, pliability and height of the hypertrophic scar in burns patients: a randomized pilot clinical trial.

Deep burns damage the reticular dermis and may lead to the formation of hypertrophic scars. Compression therapy reduces local vascularity and realigns collagen fibers, resulting in esthetic and functional improvements. This study evaluated the effect of Kinesio tape compression with maximum mechanical tension on vascularity, pliability and the height of hypertrophic scars following deep burns. A single blind, randomized pilot clinical trial was carried out. The elastic compression of Kinesio tape was applied at maximum stretch in the intervention group (n=11) and no stretch in the sham group (n=11). Vascularity, pliability and height (the primary outcomes) were evaluated at 0, 45 and 90 days using the Vancouver Scar Scale (VSS). The association between the VSS scores, the intervention and the evaluation moment were analyzed using linear mixed-effects regression models, while comparisons of means between the groups were performed using the t Student test was. Significance was set at 5%. The mean VSS scores were similar between the groups. Significant improvement occurred in both groups when post-treatment and baseline scores were compared. No further improvement was found in the vascularity, pliability or height of hypertrophic scars resulting from deep burns when an elastic compression of Kinesio tape was used at maximum tension compared to lesser mechanical tension.

Evaluation of ovarian reserve in women with thyroid autoimmunity.

OBJECTIVE: To compare the ovarian reserve of women of reproductive age with and without thyroid autoimmunity (TAI). METHODS: We performed a retrospective analysis of medical records from an assisted reproduction clinic from February 2017 to December 2021. Women aged between18 and 47 years with data on antithyroperoxidase and antithyroglobulin (anti-Tg) antibodies and assessment of ovarian reserve by anti-müllerian hormone (AMH) and antral follicle count (AFC) were included. Among the 188 participants included, 63 were diagnosed with TAI, and 125 had both antibodies negative. AMH and AFC were compared between groups. Subanalysis based on age, types of antibodies, and thyroid function markers were performed. In addition, bivariate analysis and regression models were used. RESULTS: Overall, there was no difference in the median levels of AMH or AFC between the two groups. However, in the subgroup analysis by age, we observed a trend towards lower median levels of AMH in women over 39 years with TAI (0.9 ng/mL vs. 1.5 ng/mL, p=0.08). In a subanalysis according to antibodies, we found a significantly lower median AFC in the group with anti-Tg than in the group without this antibody (8.0 follicles vs. 11.5 follicles, p=0.036). We also found a significantly higher prevalence of anti-Tg in patients with low ovarian reserve compared to those with normal reserve (60.7% vs. 39.3%, p=0.038). CONCLUSIONS: The ovarian reserve of women with TAI appears to be insidiously compromised over the years, with a decreased ovarian reserve in women with anti-Tg.

Clonidine versus captopril for treatment of postpartum very high blood pressure: study protocol for a randomized controlled trial (CLONCAP).

BACKGROUND: The behavior of arterial blood pressure in postpartum of women with hypertension and pregnancy and the best treatment for very high blood pressure in this period still need evidence. The Cochrane systematic review assessing prevention and treatment of postpartum hypertension found only two trials (120 patients) comparing hydralazine with nifedipine and labetalol for the treatment of severe hypertension and did not find enough evidence to know how best to treat women with hypertension after birth. Although studies have demonstrated the effectiveness of treatment with captopril, side effects were reported. Because of these findings, new classes of antihypertensive drugs began to be administered as an alternative therapy. Data on the role of clonidine in this particular group of patients, its effects in the short and long term are still scarce in the literature. OBJECTIVES: To determine the effectiveness of clonidine, compared to captopril, for the treatment of postpartum very high blood pressure in women with hypertension in pregnancy. METHODS/DESIGN: The study is a triple blind randomized controlled trial including postpartum women with diagnosis of hypertension in pregnancy presenting very high blood pressure, and exclusion criteria will be presence of heart disease, smoking, use of illicit drugs, any contraindication to the use of captopril or clonidine and inability to receive oral medications.Eligible patients will be invited to participate and those who agree will be included in the study and receive captopril or clonidine according to a random list of numbers. The subjects will receive the study medication every 20 minutes until blood pressure is over 170 mmHg of systolic blood pressure and 110 mmHg diastolic blood pressure. A maximum of six pills a day for very high blood pressure will be administered. In case of persistent high blood pressure levels, other antihypertensive agents will be used.During the study the women will be subject to strict control of blood pressure and urine output. This proposal has already obtained approval of the local Institutional Review Board of the coordinating center (IMIP, Recife, Brazil) and of the National Council for Ethics in Research (CONEP) of the Brazilian Ministry of Health. TRIAL REGISTRATION: Clinical Trials Register under the number NCT01761916.

Maternal visceral adiposity and fetal biometry in women with obesity and diabetes.

OBJECTIVE: The aim of this study was to compare the correlation of maternal visceral adiposity with sonographic variables related to fetal biometry in the second trimester of pregnancy in mothers who were previously obese versus nonobese and gestational diabetic versus nondiabetic. METHODS: This cross-sectional study included 583 pregnant women who received prenatal care between October 2011 and September 2013 at the Instituto de Medicina Integral Prof. Fernando Figueira, northeast of Brazil. Maternal visceral adiposity was measured by ultrasound examination at the same time as fetal biometry. Gestational age was 14.9±3.2 weeks. The correlation between maternal visceral adiposity and fetal biometric variables was evaluated using Pearson's correlation coefficient. Among the groups, the correlation coefficients were compared using Fisher's Z-test. This test was also used to evaluate the null hypothesis of correlation coefficients between pairs of variables. RESULTS: Maternal visceral adiposity positively correlated with fetal abdominal circumference, estimated fetal weight, head circumference, femur length, and biparietal diameter in pregnant women with obesity, nonobesity, gestational diabetes, and nondiabetes, but the correlation coefficients were statistically similar among the groups. CONCLUSION: Maternal visceral adiposity positively correlated with fetal biometry in the second trimester of pregnancy in the same manner in pregnant women previously obese and nonobese, as well as in pregnant women with gestational diabetes and nondiabetes.

Comparison between 200 µg and 800 µg of vaginal misoprostol for cervical ripening before operative hysteroscopy: A randomized controlled trial.

OBJECTIVE: To compare between 200 and 800 µg of vaginal misoprostol for cervical ripening before operative hysteroscopy. METHODS: Quadruple-blind randomized clinical trial conducted between November 2019 and September 2020 involving 76 patients undergoing cervical dilatation before surgical hysteroscopy at teaching hospitals in Pernambuco, Brazil. Women received the vaginal misoprostol dosage of 200 or 800 µg,10-12 h before operative hysteroscopy. The cervical width was the primary outcome, and secondary outcomes were patient satisfaction, adverse effects, surgical complications, and duration of cervical dilatation. Chi-square tests of association, Fisher's exact and Mann-Whitney U tests were used with an α error of <5%. RESULTS: There was no statistical difference between the groups in the mean of the cervical width (800 µg: 6.5 ± 1.6 mm vs 200 µg: 5.8 ± 1.8 mm, P = 0.055), patient satisfaction, and surgical findings, but the duration of cervical dilatation was lower in the 800-µg group (28.16 ± 28.5 s vs 41.97 ± 31.0 s, P = 0.035). Among the adverse effects, diarrhea was more frequent in the 800-µg group with statistical difference (100% vs 0%; P = 0.01). CONCLUSION: For cervical ripening, 200 µg misoprostol is equally effective with fewer adverse effects than 800 µg before operative hysteroscopy. CLINICALTRIALS: gov: NCT04152317. https://clinicaltrials.gov/ct2/show/NCT04152317.

Fetal transverse cerebellar diameter measured by ultrasound does not differ between genders.

PURPOSE: The aim of this study was to determine the correlation between fetal transverse cerebellar diameter (TCD) and gestational age of male and female fetus in women under low-risk prenatal care between the 13th and 40th week of gestation. METHODS: A cross-sectional study was carried out with 184 pregnant women, at the age of 18 years or more, gestational age ranging from 13 to 40 weeks, with a single fetus. A single TCD measurement by ultrasound was used for each fetus. Correlations between fetal TCD and gestational age were determined for the whole sample and each gender separately. RESULTS: We identified 102 males and 82 female fetuses. A linear correlation was observed between fetal TCD and gestational age for the whole sample (r = 96.9%; p < 0.001). A significant linear correlation was also observed for both males (r = 97.0%; p < 0.001) and females (r = 96.9%; p < 0.001). Comparing the regression lines between genders, no significant difference was observed. CONCLUSIONS: The data of this study suggest TCD fetal ultrasound as a predictive biometric parameter of gestational age independently of fetal gender in the last two trimesters of a pregnancy.

Agreement between methods for diagnosing HPV-induced anal lesions in women with cervical neoplasia.

OBJECTIVE: To evaluate agreement between 3 methods for screening anal intraepithelial lesions: anal cytology, anoscopy and human papillomavirus (HPV) detection by PCR. STUDY DESIGN: This prospective, cross-sectional study screened 324 women with cervical neoplasia for anal neoplasia. Agreement between methods was calculated using the κ coefficient. RESULTS: Of 324 anal cytologies performed, 31.5% (n = 102) were found to be abnormal: low-grade anal lesions were detected in 19.1% (n = 62) of cases, high-grade lesions in 3.1% (n = 10) and atypical squamous cells of undetermined significance in 9.3% (n = 30). With respect to the biopsies, 25.7% (n = 20) were positive, consisting of 7 cases of HPV infection, 5 anal intraepithelial neoplasia (AIN) grade 1, 6 AIN grade 2, and 2 AIN grade 3. Twenty-one samples (6.5%) were inadequate for HPV analysis. Of the 303 adequate samples, 84.2% (n = 255) tested positive for HPV. Agreement between cytology and anoscopy was fair (κ = 0.31). Agreement between PCR for HPV and cytology was slight (κ = 0.08) and no agreement was found between PCR for HPV and anoscopy (κ = 0.00). CONCLUSION: Agreement between the different methods of diagnosing HPV-induced anal lesions is slight to fair; however, anal cytology permits identification of cases in which lesions are present, allowing them to be referred for anoscopy and biopsy.

Factors associated with stress, anxiety, and depression during social distancing in Brazil.

OBJECTIVE: To estimate the prevalence of clinical signs and symptoms of severe/extreme stress, anxiety, and depression, as well as their associated factors, among Brazilians during social distancing. METHODS: This is a cross-sectional study conducted in April/May 2020 with 3,200 Brazilians over 18 years old. Respondents' sociodemographic and clinical data were collected using an online questionnaire, which also included the 21-item Depression, Anxiety and Stress Scale (DASS-21) to assess emotional symptoms. Unadjusted and adjusted prevalence ratios and their respective 95% confidence intervals were estimated using Poisson regression models with robust variance. RESULTS: Our results show the prevalence of severe/extreme stress was 21.5%, anxiety 19.4%, and depression 21.5%. In the final model, sociodemographic, clinical, and Covid-19-related factors were associated with severe/extreme stress, anxiety, and depression in Brazilians during social distancing due to the Covid-19 pandemic. We found the main factors associated with severe/extreme depression to be young women, brown, single, not religious, sedentary, presenting reduced leisure activities, history of anxiety and depression, increased medication use, and Covid-19 symptoms. CONCLUSION: This study may help develop and systematically plan measures aimed to prevent, early identify, and properly manage clinical signs and symptoms of stress, anxiety, and depression during the Covid-19 pandemic.

Visceral Adipose Tissue Depth in Early Pregnancy and Gestational Diabetes Mellitus - a Cohort Study.

Some studies have suggested that abdominal visceral adipose tissue depth (VAD) measured by ultrasound in early pregnancy, may predict the future onset of gestational diabetes mellitus (GDM). Wheter this is true, independent of pre-pregnancy body mass index (BMI), has been debated, leading the current study. A prospective cohort study was completed, in which VAD was measured at around 14 weeks' gestation. GDM was later assessed by an oral glucose tolerance test at 24 to 28 weeks, according to the IADPSG criteria. Logistic regression analysis and receiver operating curve (ROC) analysis were used to estimate the predictive value of VAD, above and beyond pre-pregnancy BMI. 627 pregnant women were enrolled, and 518 completed the study. VAD was measured at a mean of 14.4 weeks' gestation. 87 women (16.8%) subsequently developed GDM. The unadjusted odds ratio (OR) for developing GDM was 1.99 (95% CI 1.59-2.46) per 1-cm increase in VAD. After adjusting for maternal BMI and age, the OR was 2.00 (95% CI 1.61 to 2.50). The ROC under the curve for developing GDM was higher for VAD (0.70, 95% CI 0.63 to 0.75) than for pre-pregnancy BMI (0.57 95% CI 0.50 to 0.64) (p < 0.001). In conclusion, higher VAD may better predict GDM than pre-pregnancy BMI.

Impact of Profound Burn on the Quality of Life of Women Attended at the Referral Outpatient Clinic in the State of Pernambuco.

Analyze the influence of deep-degree burns on the quality of life (QoL) of women at treatment in ambulatory after hospital discharge. A cross-sectional study was conducted at a reference public hospital for burns in Recife, Pernambuco, Brazil, from August 2017 to May 2018. Fifty adult women over 20 years old who suffered deep burns and were in outpatient rehabilitation treatment were included. The variables studied were biological, sociodemographic, and clinical. The dynamometry and goniometry tests and the instruments to verify the QV Burn-Specific Health Scale-Revised were included in the analysis. Multiple linear regression models were fitted to identify factors associated with the six domains of the QoL instrument. The results identified a greater negative influence of burns on the QoL of women when associated with the variables: dark-black skin color, low levels of education, low income, motion impairment in right upper limb and lesions less than 6 months in the face, head and neck region. It should be noticed that the overall QoL score presented a median of 92.0, a score considered high, revealing an important QoL impairment. Deep-degree burn victims had a great impact on physical, emotional, and psychological abilities, acting harmfully on their self-image and causing difficulties in the execution of their daily and professional life activities, which are reinforced by aspects such as social position, level of education, and extent and duration of injury, resulting in a low QoL.

Prenatal factors associated with fetal visceral adiposity.

OBJECTIVE: To assess fetal visceral adiposity and associated factors during pregnancy. METHODS: Secondary analysis of prospective cohort data with 172 pairs (pregnant woman/fetus) treated at public health units. Anthropometric data, metabolic (glucose, glycated hemoglobin, insulin, insulin resistance, total cholesterol and fractions, triglycerides) measures, fetal biometry, and visceral and subcutaneous adiposity in the binomial (pregnant woman/fetus) were evaluated at the 16th, 28th and 36th gestational weeks by ultrasonography. Pearson's correlation coefficient and multiple linear regression were used, with a significance level of 5%. RESULTS: At the 16th week, the mean age of the pregnant women was 26.6±5.8 years and mean weight was 62.7±11.5kg; 47.0% had normal weight, 28.3% were overweight, 13.3% were underweight, and 11.2% were obese. At 36 weeks, 44.1% had inadequate gestational weight gain, 32.5% had adequate gestational weight gain, and 23.3% had excessive gestational weight gain. Fetal visceral adiposity at week 36 showed a positive correlation with maternal variables: weight (r=0.15) and body mass index (r=0.21) at the 16th; with weight (r=0.19), body mass index (r=0.24), and gestational weight gain (r=0.21) at the 28th; and with weight (r=0.22), body mass index (r=0.26), and gestational weight gain (r=0.21) at the 36th week. After multiple linear regression, adiposity at the 28th week remained associated with fetal variables: abdominal circumference (p<0.0001), head circumference (p=0.01), area (p<0.0001), and thigh circumference (p<0.001). At the 36th week, adiposity remained associated with the abdominal circumference of the 28th (p=0.02) and 36th weeks (p<0.001). CONCLUSION: Adiposity was positively correlated with the measurements of the pregnant woman. After the multivariate analysis, the persistence of the association occurred with the abdominal circumference, a central adiposity measurement with a higher metabolic risk.

[Validation of ultrasound diagnosis of fetal anomalies at a reference center in Pernambuco]. / Validação do diagnóstico ultrassonográfico de anomalias fetais em centro de referência.

OBJECTIVE: To validate ultrasound diagnoses of fetal anomalies made in a Fetal Medicine Center in Pernambuco. METHODS: A cross sectional study was performed to validate the diagnosis test, including all high risk pregnant women submitted to obstetrical morphological ultrasound at the 'Instituto de Medicina Integral Professor Fernando Figueira (I.M.I.P.)', from March 2002 to March 2006. Prenatal diagnosis was confirmed after birth. Socio demographic characteristics and pre and postnatal frequencies of fetal anomalies were the variables studied. Agreement between pre and postnatal diagnoses from congenital anomalies were evaluated with the Kappa indicator. Youden's test was applied to validate prenatal ultrasound diagnoses. RESULTS: Nine hundred and eighty nine patients were eligible. After evaluation of inclusion and exclusion criteria 457 patients were included in study. The average maternal age was 24.8 + 6.5 years. Fetal anomaly diagnoses postnatal were confirmed in 257 (56.2%) pregnant women. Prenatal ultrasound diagnosis of fetal anomalies disclosed 96% of sensibility and 79% of specificity, good agreement (K=0.76) between pre and postnatal diagnoses when compared to postnatal results and good diagnostic validity (Y=0.75). CONCLUSION: Prenatal diagnoses of fetal anomalies at a Fetal Medicine center in Pernambuco demonstrate good sensibility, specificity, agreement pre and postnatal and good diagnostic validity.

[Factors associated with bacteriuria after indwelling urethral catheterization in gynecologic surgery]. / Fatores associados à bacteriúria após sondagem vesical na cirurgia ginecológica.

OBJECTIVES: To determine the frequency and risk factors associated to bacteriuria after urinary catheterization in women submitted to elective gynecological surgery. METHODS: A cohort study was carried out among women submitted to gynecological surgery after urinary catheterization. This study took place at the 'Instituto de Medicina Integral Professor Fernando Figueira' from January to May of 2007. Uroculture samples were collected during two periods: in the first 24 hours and seven to ten days after catheter removal. To demonstrate the association between risk factors and bacteriuria, the relative risk was calculated with a confidence interval of 95%. RESULTS: This study included 249 women. At 24 hours after catheter removal, 23.6% of the urocultures collected were positive, while on days 7 to 10 this was reduced to 11.1%. Of all participants studied only 2.4% had symptomatic bacteriuria. Risk of bacteriuria at 7/10 days was reduced when the patient reported a positive history of treatment for vulvovaginitis in the previous three months. However this association was not found after multivariate analysis. There was no significant association with age, education, stage of reproductive phase, number of pregnancies and deliveries, type and duration of surgery, type of anesthetics, use of prophylactic antibiotic, professional who introduced the catheter and time of urinary catheterization. CONCLUSION: Frequency of bacteriruria was 23.6% at 24 hours and 11.1% seven days after catheter removal. There was no association between bacteriuria at 7/10 days and any of the variables analyzed.

Is Moderate Intensity Exercise during Pregnancy Safe for the Fetus? An Open Clinical Trial.

OBJETIVO: Determinar o efeito da caminhada em esteira sobre a frequência cardíaca materna (FCM) e parâmetros cardiotocográficos (batimentos cardiofetais basais [BCFs], movimentos ativos fetais [MAFs], número de acelerações e desacelerações e variabilidade de curta [STV] e longa [LTV] duração da frequência cardíaca fetal) em gestantes na 36a semana. MéTODOS: Foi realizado um ensaio clínico não randomizado e aberto com 88 gestantes saudáveis submetidas a caminhada de moderada intensidade na esteira e a cardiotocografia computadoriza em 3 momentos de 20 minutos (antes, durante e após a caminhada). RESULTADOS: A média dos BCFs diminuiu durante a caminhada, retornando a níveis prévios (antes: 137 bpm; durante: 98 bpm; após: 140 bpm; p < 0,001), com bradicardia ocorrendo em 56% dos fetos nos primeiros 10 minutos do exercício, e em 47% após 20 minutos. A bradicardia fetal não foi observada em outros momentos (antes ou depois). As médias da STV e da LTV foram 7,9, 17,0 e 8,0 milissegundos (p < 0,001) e 7,6, 10,7 e 7,6 bpm (p = 0,002) antes, durante e após a caminhada, respectivamente. A média dos números dos MAFs em 1 hora foi 29,9, 22,2 e 45,5, respectivamente, nos três momentos (p < 0,001). Nas mulheres com sobrepeso/obesidade, a média da FCM foi menor (p = 0,02). Após a análise de regressão logística, duas variáveis permaneceram significativamente associadas a bradicardia: aptidão maternal na 28a semana de gravidez (efeito protetor) e peso materno (aumento do risco). CONCLUSãO: Em fetos saudáveis, o exercício físico mostrou-se seguro, uma vez que, embora os BCFs e os MAFs diminuam durante a caminhada na esteira, foi observado um aumento da SVT e da LTV.

OBJECTIVE: To determine the effect of treadmill walking on maternal heart rate (MHR) and cardiotocographic parameters (basal fetal heart rate [FHR], active fetal movements [AFM], number of accelerations and decelerations, and short-term variation [STV] and long-term variation [LTV] of fetal heart rate) in pregnant women at 36 weeks. METHODS: A nonrandomized, open clinical trial involving 88 healthy pregnant women submitted to moderate intensity walking and computed cardiotocography in 3 20-minute periods (resting, treadmill walking, and postexercise recovery). RESULTS: The mean FHR decreased during walking (resting: 137 bpm; treadmill: 98 bpm; recovery: 140 bpm; p < 0.001), with bradycardia occurring in 56% of the fetuses in the first 10 minutes of exercise, and in 47% after 20 minutes. Bradycardia was not detected in the other phases. The mean STV and HV were 7.9, 17.0, and 8.0 milliseconds (p < 0.001) and 7.6, 10.8 and 7.6 bpm (p = 0.002) in the resting, walking and recovery phases, respectively. The mean number of fetal movements in 1 hour was 29.9, 22.2 and 45.5, respectively, in the 3 periods (p < 0.001). In overweight/obese women, the mean FHR was lower (p = 0.02). Following the logistic regression analysis, two variables remained significantly associated with bradycardia: maternal fitness in the 28th week of pregnancy (protective effect) and maternal weight (increased risk). CONCLUSION: In healthy fetuses, physical exercise proved to be safe, since, although FHR and AFM decreased during treadmill walking, an increase in SVT and LTV was observed.

Effect of spironolactone on the progression of coronary calcification in peritoneal dialysis patients: a pilot study.

INTRODUCTION: There is evidence that aldosterone plays a role in the pathogenesis of vascular calcification. The aim of this study was to evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, on the progression of coronary calcification (CC) in peritoneal dialysis patients and to identify the factors involved in this progression. METHODS: Thirty-three patients with a coronary calcium score (CCS) ≥ 30, detected through multi-detector computed tomography (MDCT) and expressed in Agatston units, were randomly assigned to a group receiving 25mg spironolactone per day for 12 months (spironolactone group) and a control group not receiving this drug. The primary outcome was a percentage change in CCS from baseline to end of the study (relative progression), when a further MDCT was conducted. Patients who had progression of CC were compared with those who did not progress. RESULTS: Sixteen patients, seven in the spironolactone group and nine in the control group, concluded the study. The relative progression of the CCS was similar in both groups, 17.2% and 27.5% in the spironolactone and control groups respectively. Fifty-seven percent of the treated patients and 67% of those in the control group presented progression in the CC scores (p = 0.697). Progressor patients differed from non-progressors because they presented higher levels of calcium and low-density lipoprotein cholesterol and lower levels of albumin. CONCLUSION: In peritoneal dialysis patients, spironolactone did not attenuate the progression of CC. However, large-scale studies are needed to confirm this observation. Disorders of mineral metabolism and dyslipidemia are involved in the progression of CC.

[Mortality caused by congenital anomalies in Pernambuco, Brazil from 1993 to 2003]. / Mortalidade determinada por anomalias congênitas em Pernambuco, Brasil, de 1993 a 2003.

BACKGROUND: To establish magnitude and temporal trend of deaths by congenital malformations in Pernambuco state in Northeast of Brazil, from 1993 to 2003. METHODS: This is an observational descriptive study, with the temporal trend including all cases of death caused by congenital malformations, obtained from the database of the Mortality Information System of the Ministry for Health. RESULTS: From 1993 to 2003, 3.960 infant deaths and 989 stillbirths caused by congenital malformations were registered in Pernambuco. The coefficients of fetal, early neonatal, perinatal, neonatal and infant (< 1 year) mortality were 0.57, 1.20, 1.76, 1.59 and 2.33, respectively. A rising tendency was observed in the temporal curve from 1993 to 2003 when coefficients of early neonatal (p = 0.003), perinatal (p = 0.005), neonatal (p = 0.0007) and infant (p = 0.02) mortality were studied but no statistical significance was detected for the fetal mortality coefficient (p= 0.55). CONCLUSION: From 1993 to 2003 a rising tendency in the coefficients of early neonatal, perinatal, neonatal and infant mortality was found in the state of Pernambuco. This trend may have been be influenced by an improvement in the death registration records and by a decline of infant mortality in the state of Pernambuco.

[Doppler of the umbilical and fetal middle cerebral arteries after magnesium sulfate in preeclampsia]. / Doppler das artérias umbilicais e cerebral média fetal após sulfato de magnésio na pré-eclâmpsia.

BACKGROUND: To compare the ratio between the fetal middle cerebral artery and the umbilical artery using Doppler flow velocimetry indices (resistance index, pulsatility index and A/B relation) before and after administration of magnesium sulfate to pregnant women with severe preeclampsia (pure or superimposed). METHODS: A prospective cohort study was conducted with each pregnant woman representing her own control. Forty severe preeclamptic women were included and underwent Doppler sonography before and 20 minutes after administration of 6g of magnesium sulfate. Analysis variables were the Doppler flow velocimetry indices evaluating the ratio of the fetal middle cerebral artery to the umbilical artery. To compare the mean indices before and after magnesium sulfate for the same patient, the "t-paired" Student test was used. The Stuart-Maxwell c(2) was applied to determine the difference of fetal diagnosis (normal, brain-sparing or reduced middle cerebral artery resistance) before and after magnesium sulfate. RESULTS: No significant difference of the mean ratio between the middle cerebral artery and the umbilical artery, before and after administration of magnesium sulfate was observed. After magnesium sulfate (25.0% x 47.5%; p= 0.01), there was an increased frequency of isolated lower Doppler flow velocimetry indices in the middle cerebral artery. CONCLUSION: Intravenous administration of magnesium sulfate in patients with severe preeclampsia is associated with increased frequency of fetal Doppler diagnosis of reduced resistance in the middle cerebral artery.