Impact of cesarean section in a private health service in Brazil: indications and neonatal morbidity and mortality rates.

OBJECTIVE: To evaluate the incidence of, indications of, and maternal and neonatal morbidity and mortality rates in cesarean sections in a private health service in Brazil. DESIGN: Retrospective and observational study. SETTING: Private health service in Vitória, Espírito Santo, Brazil. METHODS: The patients were interviewed using a structured questionnaire to determine maternal age, gestational age at the time of delivery, number of previous deliveries, type of delivery performed, duration of labor, indications for cesarean delivery, point at which cesarean section was performed, physician responsible for delivery, and maternal morbidity, fetal morbidity, and fetal mortality rates. A descriptive analysis of the data was conducted. Students t-test was performed to compare quantitative variables, and Fishers exact test was performed for categorical variables. RESULTS: A total of 584 patients were evaluated. Of these, 91.8% (536/584) had cesarean sections, while only 8.2% (48/584) had vaginal deliveries. There were no reports of forceps-assisted vaginal deliveries. In 87.49% of the deliveries, the number of gestational weeks was more than 37. In terms of indications for performing cesarean section, 48.5% were for maternal causes, 30.41% were for fetal causes, and 17.17% were elective. Maternal re-hospitalization due to puerperal complications was necessary in 10.42% of the vaginal deliveries and in 0.93% of the cesarean deliveries (p<0.001). Complications were observed in 18.75% of the vaginally delivered newborns and in 17.16% of those delivered by cesarean section. Of the newborns with complications at birth, 40.59% (41/101) had to be admitted to the neonatal intensive care unit. There were no cases of maternal death. There were seven cases of fetal/neonatal death. CONCLUSION: We observed that the vast majority of deliveries in the private sector are performed by cesarean section, without labor, and by the patients obstetrician. We found no serious maternal complications or increased neonatal morbidity rates associated with cesarean section.

Cluster coordination and photoluminescence properties of α-Ag2WO4 microcrystals.

In this paper, we report our initial research to obtain hexagonal rod-like elongated silver tungstate (α-Ag(2)WO(4)) microcrystals by different methods [sonochemistry (SC), coprecipitation (CP), and conventional hydrothermal (CH)] and to study their cluster coordination and optical properties. These microcrystals were structurally characterized by X-ray diffraction (XRD), Rietveld refinements, Fourier transform infrared (FT-IR), X-ray absorption near-edge structure (XANES), and extended X-ray absorption fine structure (EXAFS) spectroscopies. The shape and average size of these α-Ag(2)WO(4) microcrystals were observed by field-emission scanning electron microscopy (FE-SEM). The optical properties of these microcrystals were investigated by ultraviolet-visible (UV-vis) spectroscopy and photoluminescence (PL) measurements. XRD patterns and Rietveld refinement data confirmed that α-Ag(2)WO(4) microcrystals have an orthorhombic structure. FT-IR spectra exhibited four IR-active modes in a range from 250 to 1000 cm(-1). XANES spectra at the W L(3)-edge showed distorted octahedral [WO(6)] clusters in the lattice, while EXAFS analyses confirmed that W atoms are coordinated by six O atoms. FE-SEM images suggest that the α-Ag(2)WO(4) microcrystals grow by aggregation and the Ostwald ripening process. PL properties of α-Ag(2)WO(4) microcrystals decrease with an increase in the optical band-gap values (3.19-3.23 eV). Finally, we observed that large hexagonal rod-like α-Ag(2)WO(4) microcrystals prepared by the SC method exhibited a major PL emission intensity relative to α-Ag(2)WO(4) microcrystals prepared by the CP and CH methods.

Thumb basal joint arthritis: New classification, diagnostic and therapeutic algorithm.

The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.

Real-world data from the Portuguese Nivolumab Expanded Access Program (EAP) in previously treated Non Small Cell Lung Cancer (NSCLC).

OBJECTIVE: The main aim of the study was to evaluate the efficacy and safety profile of Nivolumab, an immune-checkpoint-inhibitor antibody, in advanced, previously treated, Non-Small Cell Lung Cancer (NSCLC) patients, in a real world setting. METHODS: We performed a retrospective, multicentre data analysis of patients who were included in the Portuguese Nivolumab Expanded Access Program (EAP). Eligibility criteria included histologically or citologically confirmed NSCLC, stage IIIB and IV, evaluable disease, sufficient organ function and at least one prior line of chemotherapy. The endpoints included Overall Response Rate (ORR), Disease Control Rate (DCR), Progression Free Survival (PFS) and Overall Survival (OS). Safety analysis was performed with the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 4.0, and immune-related Adverse Events (irAEs) were treated according to protocol treatment guidelines. Tumour response was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1. Data was analysed using SPSS, version 21.0 (IBM Statistics). RESULTS: From June 2015 to December 2016, a total of 229 patients with advanced NSCLC were enrolled at 30 Portuguese centres. Clinical data were collected up to the end of July 2018. The baseline median age was 64 years (range 37-83) and the majority of patients were males (70.3%) and former/current smokers (69.4%). Patients with non-squamous histology predominated (88.1%), and 67.6% of the patients had received 2 or more prior lines of chemotherapy. Out of 229 patients, data was available for 219 patients (3 patients did not start treatment, while data was unavailable in 7 patients); of the 219 patients, 15.5% were not evaluated for radiological tumour assessment, 1.4% had complete response (CR), 21% partial response (PR), 31% stable disease (SD) and 31.1% progressive disease (PD). Thus, the ORR was 22.4% and DCR was 53.4% in this population. At the time of survival analysis the median PFS was 4.91 months (95% CI, 3.89-6.11) and median OS was 13.21 months (95% CI, 9.89-16.53). The safety profile was in line with clinical trial data. CONCLUSIONS: Efficacy and safety results observed in this retrospective analysis were consistent with observations reported in clinical trials and from other centres.

Chickens (Gallus domesticus) are natural intermediate hosts of Neospora caninum.

Neospora caninum naturally infects many mammal species, but has not previously been demonstrated in birds. We examined sera for N. caninum antibodies from 200 outdoor chickens and from 200 chickens confined indoors in the state of Bahia, Brazil. Seroprevalence was greater in outdoor chickens (23.5% versus 1.5%, P<0.001). PCR testing for N. caninum was positive in six of 10 seropositive chickens. Amplicons from two of these were sequenced and had 97-98% nucleotide identity with N. caninum. This finding extends the list of intermediate hosts of N. caninum to include birds and may have important epidemiological consequences.

Effect of homeopathic medicines on helminth parasitism and resistance of Haemonchus contortus infected sheep.

This study evaluated the effects of homeopathic treatment on control of Haemonchus contortus infection in sheep. Twenty lambs were randomized to three treatments: treated with the homeopathic medicines, Ferrum phosphoricum, Arsenicum album and Calcarea carbonica; treated with a conventional antihelminthic, doramectin, and an untreated control group. Fecal and blood samples were taken from each animal on days 18, 38 and 68 after start of treatment. A significant reduction in number of H. contortus larvae (p<0.01) was observed for animals in the homeopathic treatment group compared to the control group. Fecal egg counts showed negative correlation between haematocrit and haemoglobin concentrations in the homeopathic treatment group (p<0.01); however, the biochemical and immunological parameters showed better correlation, indicating that the homeopathic medicine improved vital functions. Daily weight gain in the homeopathic treatment group was superior to the control and to the antihelminthic groups, 31 and 6.5%, respectively. The cost benefit analysis confirmed that homeopathy group increases economic trend when compared with the other groups.

Three-dimensional surface models of the facial soft tissues acquired with a low-cost scanner.

Although there has been an increase in three-dimensional (3D) scanning methods available on the market, they are generally expensive. The DI3D system is considered a good scanner for the acquisition of soft tissue surface images. The Microsoft Kinect scanner is a much more affordable alternative for acquiring 3D models. The aim of this study was to determine whether the precision and accuracy of Kinect are similar to those of DI3D. To verify the accuracy, 10 patients were scanned with both methods The models of each patient acquired from the two scanners were superimposed using a surface-to-surface registration technique, and the distances between the models were recorded for 10 different anatomical regions of interest. For the evaluation of precision, one patient was scanned 11 different times with the Kinect scanner, and these models were compared using the same superimposition method. It was found that the average difference between the two methods was 0.3±2.03mm. The assessment of reproducibility showed an average difference between the images taken with Kinect of 0.1±0.6mm (P<0.05, one-sample t-test). Thus, Kinect showed good precision and reasonable accuracy, and appears to be an interesting and promising resource for facial analysis.

Structural evolution, growth mechanism and photoluminescence properties of CuWO4 nanocrystals.

Copper tungstate (CuWO4) crystals were synthesized by the sonochemistry (SC) method, and then, heat treated in a conventional furnace at different temperatures for 1h. The structural evolution, growth mechanism and photoluminescence (PL) properties of these crystals were thoroughly investigated. X-ray diffraction patterns, micro-Raman spectra and Fourier transformed infrared spectra indicated that crystals heat treated and 100°C and 200°C have water molecules in their lattice (copper tungstate dihydrate (CuWO4·2H2O) with monoclinic structure), when the crystals are calcinated at 300°C have the presence of two phase (CuWO4·2H2O and CuWO4), while the others heat treated at 400°C and 500°C have a single CuWO4 triclinic structure. Field emission scanning electron microscopy revealed a change in the morphological features of these crystals with the increase of the heat treatment temperature. Transmission electron microscopy (TEM), high resolution-TEM images and selected area electron diffraction were employed to examine the shape, size and structure of these crystals. Ultraviolet-Visible spectra evidenced a decrease of band gap values with the increase of the temperature, which were correlated with the reduction of intermediary energy levels within the band gap. The intense photoluminescence (PL) emission was detected for the sample heat treat at 300°C for 1h, which have a mixture of CuWO4·2H2O and CuWO4 phases. Therefore, there is a synergic effect between the intermediary energy levels arising from these two phases during the electronic transitions responsible for PL emissions.

Astroglial cells in primary culture: a valid model to study Neospora caninum infection in the CNS.

The protozoan Neospora caninum has a veterinary importance because it causes abortion in cattle and neuromuscular alterations in dogs. We infected rat astrocytes, in vitro, with different concentrations of N. caninum. Astrocytes responded to infection by producing the pro-inflammatory cytokine TNF-alpha and the neurotoxic-free radical NO, 24 and 72 h post-infection. These data suggest that astrocytes, which are essential for brain function, are targets for the parasite and this represents a practical and valid model to study the effects of N. caninum on the CNS.

Diffusion Processes and Drug Release: Capsaicinoids - Loaded Poly (ε-caprolactone) Microparticles.

We present a generalmodel based on fractional diffusion equation coupled with a kinetic equation through the boundary condition. It covers several scenarios that may be characterized by usual or anomalous diffusion or present relaxation processes on the surface with non-Debye characteristics. A particular case of this model is used to investigate the experimental data obtained from the drug release of the capsaicinoids-loaded Poly (ε-caprolactone) microparticles. These considerations lead us to a good agreement with experimental data and to the conjecture that the burst effect, i.e., an initial large bolus of drug is released before the release rate reaches a stable profile, may be related to an anomalous diffusion manifested by the system.

Antileishmanial antibody profile in dogs naturally infected with Leishmania chagasi.

Visceral leishmaniasis (VL) presents vigorous Th2 immune response, which is mainly characterized in human by augmented expression of Il-4, polyclonal B cell activation, intense hypergammaglobulinemia and production of antileishmanial IgE antibodies. However, few aspects of this type of immune response have been demonstrated in studies of canine visceral leishmaniasis (CVL). This work investigated by ELISA and western immunoblotting the production of antileishmanial IgE antibodies (IgE Ab) in symptomatic and asymptomatic dogs naturally infected by Leishmania chagasi, and also compared this IgE immune response with those of IgG, IgG1 and IgG2 antibodies. Three groups of dogs were evaluated: 12 VL dogs with positive Leishmania biopsies (GI), 44 dogs with a positive leishmanial indirect fluorescent antibody test (IFAT), 30 of them presenting clinical signs of VL and 14 asymptomatic (GII) and 21 healthy dogs living in kennels located in leishmaniasis endemic areas (GIII), which were seronegative in the IFAT. Eighteen dogs from an area free of CVL were used as controls (GIV). Antileishmanial IgE antibodies were detected in 4 of 12 VL dogs from group I (33%) and 14 of 30 symptomatic dogs from group II (47%). While all asymptomatic dogs from group II (100%) were seronegative for antileishmanial IgE Ab, 7 of 21 healthy animals from group III (33%) had these immunoglobulins. A strong correlation was verified between antileishmanial IgG and IgG2 antibody titers in all symptomatic dogs, but only 15 of these 42 animals (36%) produced simultaneously IgE, IgG, IgG1 and IgG2 antibodies to Leishmania. IgE antibodies recognized leishmanial antigens of 12, 36, 61, 81 and 118 KDD, while a more complex pattern of immunoblotting was verified mainly for IgG and IgG2 antibodies from symptomatic animals. IgG1 and IgG2 antibodies shared the recognition of L. chagasi polypeptides of 118, 81, 61, 36, 18, 14 and 12 KDD, being more intense the immune reactions between IgG1 Ab and the leishmanial polypeptides of 61 and 36 KDD, and also between IgG2 antibodies and the antigens of 26, 21, 18, 14 and 12 KDD. Our results suggest that the polyclonal production of antileishmanial antibodies that includes IgE Ab could characterize a Th2 immune response in CVL and can help the laboratory diagnosis of this disease.

Serologic immunoreactivity to Neospora caninum antigens in dogs determined by indirect immunofluorescence, western blotting and dot-ELISA.

Neospora caninum, is a coccidian protozoan known as a major cause of bovine abortion and canine neuropathies. The aim of the present study was to develop a reliable and quick test to detect antibodies to N. caninum in dog sera. Sixty-five serum samples from dogs, including 35 positive and 30 negative for N. caninum antibodies were used for standardization of the test. In parallel, immunoreactivity of the sera to Toxoplasma gondii antigens was investigated using a passive agglutination test. A dot-ELISA test, using soluble extract of N. caninum tachyzoites on nitrocellulose ester membranes, was developed and standardized. SDS-PAGE and complementary analysis of reactivity by Western blotting were used for the characterization of the immunoreactive fractions of all tested sera. The sensitivity and specificity of the dot-ELISA were 94 and 73%, respectively, compared to IFAT at a cut-off of 1:50, and 87 and 100% compared to IFAT at a cut-off of 1:25. Among the sera that tested positively for both IFAT and dot-ELISA, only 8.6% were reactive to T. gondii. The most immunoreactive fractions in Western blots were the 14-, 33-, 42- and 55 kDa bands, with percentages of 42, 60, 42 and 37%, respectively. The 60 kDa band showed a non-specific reaction in 43% of neosporosis-negative animals by both dot-ELISA and IFAT. These results indicate that the dot-ELISA using N. caninum antigen present good sensitivity and specificity, and might be used as a screening test to detect antibodies to N. caninum in dogs.

Clinical and serological aspects of visceral leishmaniasis in northeast Brazilian dogs naturally infected with Leishmania chagasi.

Human visceral leishmaniasis is endemic in the northeast of Brazil, where the domestic dog is an important parasite reservoir in the infectious cycle of Leishmania chagasi. In this study, we evaluated the clinical signs of canine visceral leishmaniasis (CVL), serum protein profile and the antileishmanial IgG antibody production in 86 dogs living in northeast endemic areas of leishmaniasis. Thirty dogs from a leishmaniasis-free area were used as a control group. The major clinical signs of CVL seen were emaciation and skin ulcers (80%), followed by onychogryphosis and conjunctivitis (73%). Depilation was observed in 60% of animals while lymphadenomegaly, splenomegaly, liver enlargement or kidney involvement was less frequent (< or =20%). VL seropositive dogs presented with serum hyperproteinemia, hypoalbuminemia, hypergammaglobulinemia and decreased albumin/globulin ratio. A lower sensitivity and higher specificity was observed for promastigote indirect fluorescent antibody test (IFAT) (83 and 100%, respectively) compared with enzyme-linked immunosorbent assay (ELISA) (94 and 90%), which uses a crude extract of Leishmania. There was a positive correlation between IFAT and ELISA titers of antileishmanial IgG antibodies (Spearman test, P < 0.05), which was augmented in CVL dogs. This study found that the determination of serum protein, A/G ratio and the use of two different leishmanial serological tests like IFAT and ELISA are essential in CVL screening.

Relationship of bacterioplankton production with primary production and respiration in a shallow estuarine system (Ria de Aveiro, NW Portugal).

The response of bacterial growth to phytoplankton production and planktonic respiration (RESP) variation was examined over different stations and dates in the shallow estuarine system Ria de Aveiro. The temporal and spatial profiles of bacterial productivity (2.7-744.2mg Cm(-3)d(-1)) did not coincide with those of primary production (PP) (0.2-19.1 g Cm(-3)d(-1)) and RESP (0.1-8.2 g Cm(-3) d(-1)). The bacterioplankton production/PP ratio varied differently, depending on the season and location. The heterotrophic zones, with the lowest values of PP, exhibited the most intense bacterial secondary production. Moreover, the variation of PP in the system was rather small when compared with that of bacterial secondary production. These suggest that, in a large extension of the lagoon and throughout the year, bacterioplankton growth is largely dependent on non-phytoplanktonic carbon sources. Benthic PP and/or allochtonous organic matter from land have a fundamental role in the dynamics of the planktonic compartment of the estuarine system.

Activity and growth efficiency of heterotrophic bacteria in a salt marsh (Ria de Aveiro, Portugal).

Bacterial utilization of monomers is recognized as an important step in the biogeochemical cycling of organic matter. In this study we have compared the heterotrophic activity of bacterial communities from different micro-habitats within a salt marsh environment (Ria de Aveiro, Portugal) in order to establish spatial patterns of bacterial abundance, monomer turnover rates (Tr) and bacterial growth efficiency (BGE). Differences in bacterial abundance and activity could be found between distinct plant rhizospheres. BGE tended to be lower at Halimione portulacoides banks, when compared to Sarcocornia perennis subsp. perennis banks which, on the contrary, showed the highest bacterial densities. Experiments of amendment of natural samples with organic and inorganic supplements indicated that salt marsh bacteria are not strongly regulated by salinity but the increased availability of labile organic matter causes a significant metabolic shift towards mineralization.

Unlike beta-endorphin, dynorphin 1-13 does not cause retrograde amnesia for shuttle avoidance or inhibitory avoidance learning in rats.

Posttraining administration of the opioid peptides, beta-endorphin or the enkephalins, is known to cause retrograde amnesia for a variety of tasks in rats. The present paper studies the effect of the posttraining administration of dynorphin 1-13 on retention of a step-down inhibitory avoidance task and of a shuttle avoidance task. For the purpose of comparison, the effect of human beta-endorphin was also studied. In confirmation of previous results, beta-endorphin (1.0 or 10.0 micrograms/kg, IP) caused retrograde amnesia for the two tasks. Dynorphin 1-13 had no effect at doses between 0.008-125.0 micrograms/kg IP or 1.25-125.0 ng/rat ICV in the inhibitory avoidance task, or at doses of 5.0, 25.0, or 125.0 micrograms/kg in the shuttle avoidance paradigm. These findings suggest that, in contrast to beta-endorphin, dynorphin 1-13 may not be involved in memory regulation at the posttraining period in rats.

Effect of chemotherapy on experimental pulmonary schistosomiasis.

Mice with portal hypertension caused by portal vein ligation reproduced the model of severe pulmonary schistosomiasis when infected for 10 weeks with 30 cercariae of Schistosoma mansoni. Curative treatment promoted reversion, without fibrosis, of the periovular granulomatous lesions formed in the alveolar tissue. However, the arterial and arteriolar lesions were defectively repaired, with segmental vascular fibrosis, narrowing, and angiomatoid changes remaining for up to 120 days after treatment. There was also evidence that eggs are destroyed more rapidly and more completely in the lungs than in the liver.

Placental involvement in schistosomiasis mansoni. Report of four cases.

The histopathological features of four cases of placental involvement in schistosomiasis mansoni are described. One of the pregnancies resulted in a normal newborn, the other three in stillbirths. Adult worms were found in the intervillous space in one case and in the decidual vessels in another. Eggs were found in the placenta in all cases, in the intervillous space, within villi, or in the decidua. There was no evidence of fetal infection. The differential diagnosis with other forms of granulomatous placentitis is discussed.

Pre-training adrenaline recovers the amnestic effect of Met-enkephalin in demedullated rats.

The intracerebroventricular administration of 25 ng of Met-enkephalin causes retrograde amnesia for a shuttle avoidance task in intact rats. In demedullated rats, this effect of Met-enkephalin was lost. Intraperitoneal injection of 1.2 micrograms/kg adrenaline recovered the amnestic effect of Met-enkephalin. These results confirm the idea that the amnestic effect of Met-enkephalin is centrally mediated and that adrenal enkephalins do not seem to be important to the amnestic effect of Met-enkephalin since adrenaline recovers this effect in demedullated rats.

Pharmacokinetic studies of 131I-stevioside and its metabolites.

131I-STEVIOSIDE (1.10 MBq) was injected i.v in Wistar male rats, in distribution in the body and metabolism were studied. The highest concentration of radioactivity was observed in the liver and in the small intestine after 10 and 120 minutes, respectively. At 2 h after injection, the radioactivity eliminated in the bile was 52.0% of the original dose. The results of RP-HPLC analysis of the bile showed that stevioside was degraded in vivo and that steviol appeared as a major metabolite. However, in the urine; RP-HPLC analysis did not show the presence of steviol.