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1.
J Perinat Med ; 50(2): 185-191, 2022 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-34727592

RESUMEN

OBJECTIVES: Maternal and fetal complications can occur in pregnant kidney transplant recipients. Since these are high-risk pregnancies, they require a multidisciplinary follow-up to prematurely detect adverse events. Identifying factors that would affect fetal, maternal and graft outcomes is essential to further stratify the risk of pregnant kidney transplant recipients. METHODS: All pregnancies in kidney transplant recipients followed in a single center for 30 years were included. Data included previous transplant information and blood and urine tests performed before pregnancy. Impact of graft function on fetal, maternal and graft outcomes was evaluated. RESULTS: There were 41 pregnancies among 34 patients. Mean gestational age of 35 ± 3 weeks. Caesarean section was performed in 69.4% of patients. Five pregnancies were unsuccessful (12.2%). Four patients suffered an acute graft dysfunction (9.8%) and 12 (29.3%) had a serious maternal hypertensive disorder (preeclampsia, eclampsia or HELLP syndrome). Graft function before pregnancy showed significant correlation with adverse outcomes. CONCLUSIONS: A proteinuria >669 mg/g, serum creatinine >1.75 mg/dL and glomerular filtration rate <36.2 mL/min/1.73 m2 before pregnancy were correlated to graft dysfunction during pregnancy. Similar values of proteinuria were also associated with a risk of maternal hypertensive disorders and pregnancy failure. Therefore, in patients with proteinuria and graft dysfunction, follow-up should be stricter to quickly detect complications.


Asunto(s)
Trasplante de Riñón , Preeclampsia , Complicaciones del Embarazo , Cesárea/efectos adversos , Creatinina , Femenino , Humanos , Lactante , Riñón , Trasplante de Riñón/efectos adversos , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/etiología , Resultado del Embarazo/epidemiología
2.
Eur J Contracept Reprod Health Care ; 26(3): 240-245, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33615943

RESUMEN

OBJECTIVES: Menstrual symptoms are commonly cited barriers to physical activity in women. Delay or avoidance of menstruation through hormonal contraceptives may mitigate those barriers. Our purpose is to identify the uterine bleeding patterns of Portuguese athletes, their contraceptive choices and the impact of contraceptive methods in sports performance. We aim also to compare the outcomes between users and non-users of contraception. METHODS: Observational, descriptive and comparative study based on a customised self-assessment online survey aimed at Portuguese athletes. Athletes had to be at least 16 years old and competing at a national, international or professional level. RESULTS: A total of 256 athletes from 18 modalities were eligible. The mean age was 29 years and the mean age of menarche was 12.8 years. Monthly bleeding pattern was prevailing and 50% presented dysmenorrhoea. More than 85% experience fluctuations in sports performance throughout the month. The majority (71.5%) used contraceptive methods. Only 16% believed that contraception decreased sports performance. Contraceptive users exhibit a lower mean body mass index, blood loss and percentage of dysmenorrhoea than the non-users. CONCLUSION: Most athletes had the perception that performance varies throughout the month. The majority of participants do not report amenorrhoea and have monthly menses. The use of contraceptive methods is reportedly high, benefit cycle control and apparently without any physical inconvenience.


Asunto(s)
Atletas/psicología , Rendimiento Atlético , Conducta de Elección , Anticonceptivos/administración & dosificación , Menstruación/fisiología , Adolescente , Adulto , Anticoncepción , Femenino , Humanos , Ciclo Menstrual , Persona de Mediana Edad , Portugal , Adulto Joven
3.
Eur J Contracept Reprod Health Care ; 26(4): 272-278, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33719811

RESUMEN

INTRODUCTION: Contraceptive counselling is essential in women with chronic disease, though it is frequently overlooked. We aimed to assess practices and awareness in contraceptive counselling in hospital physicians caring for reproductive age women with chronic disease. METHODS: A questionnaire was distributed in April 2017 to physicians from 16 medical specialties in a tertiary care hospital in Portugal. Statistical analysis performed using Microsoft Office Excel® and IBM SPSS-Statistics®. RESULTS: Two-hundred physicians participated in the survey: 59.5% were female, 55% under 35 years-old and 48.5% were residents. Only 26.5% practiced in surgical specialties. Two-thirds consistently inquired about the use of contraception. Most referred patients to Family Planning services or performed contraceptive counselling when pregnancy posed significant health risks (89.0%), when prescribing teratogenic medication (79.5%) or drugs with potential interaction with contraceptives (75.0%). Lack of training in contraception was the main reason for not referring patients to Family Planning services. While 83% considered counselling very important, only 5% had recently undergone training and 12.5% felt knowledgeable enough to perform it. Only 12.5% were aware of the institution's Family Planning resources. Female gender, non-surgical specialty, age over 35 years-old and over 10 years since specialisation were positively associated with awareness. CONCLUSION: Most physicians addressed contraceptive management in women with comorbidities, but adequate training is lacking. Our results highlight the importance of communication between health care providers to achieve an adequate and multidisciplinary approach to reproductive and general health goals.


Asunto(s)
Enfermedad Crónica/epidemiología , Consejo , Servicios de Planificación Familiar , Conocimientos, Actitudes y Práctica en Salud , Médicos/psicología , Adulto , Anticoncepción , Conducta Anticonceptiva , Anticonceptivos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Embarazo
4.
Cell Tissue Res ; 373(2): 459-476, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29582167

RESUMEN

The discovery of the immunoregulatory potential of human amniotic membrane (hAM) propelled several studies focusing on its application for the treatment of immunological disorders. However, there is little information regarding the effects of hAM on distinct activation and differentiation stages of immune cells. Here, we aim to investigate the effect of human amniotic membrane extract (hAME) on the pattern of cytokine production by T cells, monocytes and myeloid dendritic cells (mDCs). For this purpose, peripheral blood mononuclear cells (PBMCs) from eight healthy individuals were stimulated in vitro in the presence or absence of hAME. Mitogen-induced proliferation of PBMCs and cytokine production among the distinct T cell functional compartments, monocyte subpopulations and mDCs were evaluated. hAME displayed an anti-proliferative effect and decreased the frequency of T cells producing tumor necrosis factor (TNF)α, interferon (IFN)γ and interleukin (IL)-2, for all T cell functional compartments. The frequency of IL-17 and IL-9-producing T cells was also reduced. The inhibition of mRNA expression of granzyme B, perforin and NKG2D by CD8+ T cells and γδ T cells and the augment of FoxP3 and IL-10 in CD4+ T cells and IL-10 in regulatory T cells were also observed. Furthermore, hAME inhibited IFNγ-induced protein (IP)-10 expression by classical and non-classical monocytes, without hampering the production of TNFα and IL-6 by monocytes and mDCs. These results suggest that hAME exerts an anti-inflammatory effect on T cells, still at a different extent for distinct T cell functional compartments.


Asunto(s)
Amnios/metabolismo , Células Dendríticas/citología , Monocitos/citología , Células Mieloides/citología , Subgrupos de Linfocitos T/citología , Adulto , Proliferación Celular/efectos de los fármacos , Células Dendríticas/efectos de los fármacos , Femenino , Humanos , Interferón gamma/metabolismo , Interleucina-17/metabolismo , Interleucina-2/metabolismo , Interleucina-9/metabolismo , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Mitógenos/farmacología , Monocitos/efectos de los fármacos , Células Mieloides/efectos de los fármacos , ARN Mensajero/genética , ARN Mensajero/metabolismo , Subgrupos de Linfocitos T/efectos de los fármacos , Transcripción Genética/efectos de los fármacos , Factor de Necrosis Tumoral alfa/metabolismo , Adulto Joven
5.
J Obstet Gynaecol ; 37(1): 29-32, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27925470

RESUMEN

Time for delivery and delivery pathway in twin pregnancies are still in great debate. Our study goal was to compare the characteristics of delivery and maternal-foetal outcome in uncomplicated near-term twin pregnancies undergoing labour induction and those with spontaneous labour. We found no statistical differences in patients with twin pregnancies who underwent labour induction and those with spontaneous labour regarding the history of previous caesarean delivery, parity, pregnancy achieved by assisted reproductive techniques (ART), chorionicity and cervical dilation at the admission as well as maternal and neonatal morbidity, and admission to the neonatal intensive care unit. There were significant differences in the caesarean section rate (60.6 vs. 33.3%, p < .05) and the time interval between delivery of the first and second foetus (9.8 vs. 11.7 min, p = .024). There was an increased incidence of caesarean section after the induction of labour. However, it appears to be a safe option.


Asunto(s)
Cesárea/estadística & datos numéricos , Trabajo de Parto Inducido/estadística & datos numéricos , Trabajo de Parto , Embarazo Gemelar/estadística & datos numéricos , Nacimiento a Término , Adulto , Intervalo entre Nacimientos , Femenino , Humanos , Paridad , Embarazo , Resultado del Embarazo
6.
Fetal Pediatr Pathol ; 36(2): 89-105, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27827548

RESUMEN

Preterm labor (PTL) accounts for almost 11% of deliveries, and is a major cause of neonatal morbidity and mortality. T regulatory (Treg) cells may prevent fetal rejection by the maternal immune system under the influence of progesterone. Case control study was conducted to determine Treg cells, IL-10, TGF-ß, and membrane progesterone receptorα (mPRα) in the maternal-fetal interface (placenta), including eight pregnant women with threatened PTL (study group) and 16 normal-delivery women (control group). Comparing study group versus control, mean gestational age of delivery differed significantly (p = 0.02), as did endothelial hyperplasia in the upper half (p = 0.035) and the lower half (p = 0.005) of the placenta. Besides, there was higher expression of mPRα and IL-10 in all layers, while Foxp3 expression occurred equally and only in the decidua. TGF-ß expression was similar in both groups. Preterm group placentas showed higher endothelial hyperplasia in both upper and lower halves of the placenta.


Asunto(s)
Desarrollo Fetal/fisiología , Feto , Trabajo de Parto Prematuro/fisiopatología , Placenta/fisiopatología , Nacimiento Prematuro/etiología , Adulto , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Recién Nacido , Relaciones Materno-Fetales , Embarazo , Factor de Crecimiento Transformador beta/metabolismo
7.
J Perinat Med ; 44(6): 605-11, 2016 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-26352073

RESUMEN

OBJECTIVES: The aim of this study was to determine if the actions of progesterone on preterm labor are accomplished through modulation of the percentage of regulatory T-cells (Treg). METHODS: The study was a cohort pilot study made in a single center tertiary obstetrical unit with women in preterm labor arrested with tocolytic treatment. Variation of the number and percentage of Treg cells obtained from peripheral blood samples of women with preterm labor were calculated by flow cytometry, before and after progesterone administration. RESULTS: In the paired samples for each patient, there was a significant difference in the Treg cell pool after progesterone treatment, with an increase in both their percentage (48.9 vs. 53; P=0.07) and absolute number (14.8 vs. 56.5 cells/µL; P=0.046). CONCLUSIONS: This research demonstrated a considerable increase in the Treg cell pool after progesterone treatment. This indicates a possible mechanism for progesterone treatment benefits in preterm labor, potentially increasing its more rational use.


Asunto(s)
Trabajo de Parto Prematuro/tratamiento farmacológico , Progesterona/farmacología , Linfocitos T Reguladores/efectos de los fármacos , Tocólisis/métodos , Tocolíticos/farmacología , Adulto , Biomarcadores/sangre , Femenino , Citometría de Flujo , Humanos , Trabajo de Parto Prematuro/inmunología , Proyectos Piloto , Embarazo , Progesterona/uso terapéutico , Linfocitos T Reguladores/metabolismo , Tocolíticos/uso terapéutico , Resultado del Tratamiento , Vasotocina/análogos & derivados , Vasotocina/uso terapéutico
8.
Arch Gynecol Obstet ; 293(1): 81-86, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26059084

RESUMEN

PURPOSE: To determine in women with hereditary thrombophilia whether the use of the combination of low-molecular-weight heparin (LMWH) and aspirin (ASA) is better than ASA alone. METHODS: Meta-analysis of randomized controlled trials evaluating LMWH + ASA compared to ASA in pregnant women with hereditary thrombophilia in order to improve live birth rate. A systematic literature search was conducted in 5 databases (PubMed, Cochrane Controlled Trials Register, EMBASE, Scopus and ISI Web of Knowledge). Trial selection, data extraction, and quality assessment were performed independently by two authors. The main outcome measure was live birth rate. Secondary outcomes included rates of first-trimester miscarriage, prematurity, pre-eclampsia, and low birth weight for gestational age babies. RESULTS: Four trials were included in the quantitative synthesis in a total of 222 randomized women. Effect of LMWH + ASA versus ASA with regard to live births was evaluable in all four randomized controlled trials with a similar overall treatment effect for the therapies OR 1.7 (95 % CI 0.72-4.0) and without heterogeneity (I (2) = 0 %). No significant differences or heterogeneity were observed between groups for secondary outcomes, namely first-trimester miscarriages OR 0.69 (0.22-2.16), prematurity OR 0.99 (0.4-2.08), pre-eclampsia OR 1.49 (0.63-3.5), and small for gestational age babies OR 2.08 (0.96-4.47). CONCLUSIONS: There were no significant differences in live birth weight and other pregnancy outcomes between LMWH + ASA versus ASA. However, these findings were based on few trials presenting methodological limitations. Therefore, there is no evidence to support any incremental benefit of adding LMWH to ASA alone in women with inherited thrombophilia.


Asunto(s)
Aborto Habitual/prevención & control , Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Nacimiento Vivo , Trombofilia/tratamiento farmacológico , Aborto Habitual/sangre , Aborto Habitual/etiología , Peso al Nacer , Femenino , Edad Gestacional , Humanos , Preeclampsia/tratamiento farmacológico , Embarazo , Complicaciones Hematológicas del Embarazo/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Trombofilia/complicaciones , Resultado del Tratamiento
9.
J Obstet Gynaecol ; 36(5): 598-601, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27013084

RESUMEN

This prospective cohort study compared obstetric, perinatal and postpartum outcomes of monochorionic diamniotic (n = 228) versus (vs.) dichorionic (n = 598) twin pregnancies. Statistical analysis was performed using software SPSS® v19.0.0.2. Chi square, Fischer's exact, Student's t and Mann-Withney tests were applied. Obstetrical complications rates were 85.5% vs. 75.1% (p < 0.01). Differences were found in preterm premature rupture of membranes (26.3% vs. 19.3%, p < 0.05) and intrauterine growth restriction (19.7% vs. 10.5%, p < 0.01). Twin-to-twin transfusion syndrome (TTTS) occurred in 7.9% of monochorionic pregnancies. Vaginal delivery occurred in 47.4% vs. 43.1%. Monochorionic pregnancies had earlier gestational ages at delivery and subsequently lower birthweights (p < 0.01). There was no difference in Apgar scores. Admission rate of at least one of the newborns in intensive care unit (NICU) was 50% vs. 38.9% (p < 0.05). Postpartum complications were similar. These results were the same excluding TTTS cases, except for admission in NICU (46.8% vs. 34.9%, p > 0.05). Analysing only the uncomplicated pregnancies (33 vs. 149), there were no differences in perinatal outcomes. We conclude that monochorionic pregnancies had higher rates of obstetrical complications, which were independent of TTTS occurrence in our sample. However, considering only the uncomplicated pregnancies till delivery, there were no significant differences in perinatal outcomes.


Asunto(s)
Complicaciones del Embarazo/epidemiología , Resultado del Embarazo , Embarazo Gemelar , Gemelos Dicigóticos/estadística & datos numéricos , Gemelos Monocigóticos/estadística & datos numéricos , Adulto , Parto Obstétrico/métodos , Parto Obstétrico/estadística & datos numéricos , Femenino , Transfusión Feto-Fetal/epidemiología , Transfusión Feto-Fetal/etiología , Edad Gestacional , Hospitalización/estadística & datos numéricos , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Embarazo , Complicaciones del Embarazo/etiología , Estudios Prospectivos
10.
Pediatr Pulmonol ; 2024 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-39282763

RESUMEN

This systematic review aimed to investigate the prevalence of symptoms of post-COVID-19 condition (long COVID), in children hospitalized with COVID-19. We searched PUBMED and EMBASE on 15 March, 2023, using search strategy: "long COVID" OR "post-COVID-19" OR "postacute COVID-19" OR "long-term COVID" OR "COVID-19 sequelae" OR "persistent COVID-19" OR "chronic COVID-19". We included observational studies (case-control, cross-sectional, cohort, or case series) that investigated symptoms of post-COVID-19 condition (long COVID) in children (<18 years) admitted with COVID-19. We used the WHO case definition of post-COVID-19 condition. Long COVID was defined as persistence of otherwise unexplained symptoms for at least three months after SARS-CoV-2 infection. We used the command "metaprop" to perform random-effects meta-analysis. Eleven studies involving 2279 patients were included. In the period between ≥3 months and <12 months after acute COVID-19, the most frequent symptom was exercise intolerance with a pooled prevalence of 29% (95% CI: 7%-57%, I2 = 95%), followed by nonspecific respiratory symptoms (12%, 95% CI: 0%-48%, I2 = 0%), psychological disorders (10%, 95% CI: 1%-25%, I2 = 97%), and nonspecific gastrointestinal symptoms (10%, 95% CI: 0%-37%, I2 = 99%). In the period ≥12 months after the initial infection, the pooled prevalence of post COVID symptoms was lower, with 6% (95% CI: 2%-10%, I2 = 83%) for exercise intolerance and 3% (95% CI: 0%-8%, I2 = 89%) for fatigue. In conclusion, symptoms of post-COVID condition (long COVID) in hospitalized children affect multiple organ systems, with higher prevalence in the period up to 12 months after the acute phase of COVID-19.

11.
Artículo en Inglés | MEDLINE | ID: mdl-39200604

RESUMEN

Variables such as body mass index (BMI), waist circumference (WC), and waist/height ratio (WHtR) are used to assess cardiovascular risks associated with abdominal obesity. The Timed Up and Go (TTUG) test assesses mobility and the risk of falls, especially in the elderly and individuals with physical limitations. The objective was to correlate anthropometric indicators of cardiovascular risk (BMI, WC, WHtR) with performance on the TTUG test in elderly people who practice physical activity. METHODS: Observational, cross-sectional study, CAAE: 27116319.1.0000.8044. Active elderly participants in a public physical exercise program "Project 60 Up", promoted by the Municipal Secretariat for the Elderly of the City of Niterói, RJ, Brazil, were evaluated. Elderly people of both sexes, with independent locomotion and preserved cognitive status, were included and those with visual, hearing, severe mobility difficulties or neurological sequelae and imbalances were excluded. Anthropometric data were collected: BMI, WC, WHtR, and the TTUG test was performed. RESULTS: In the sample composed of 55 elderly people of both sexes, with an average age of 68 years, the means of the variables were: body weight (67.8 ± 12.7 kg), height (157.2 ± 8.4 cm), TTUG (10.3 ± 2 s), WC (93.3 ± 10.9 cm), WHtR (0.59), and BMI (27.4 ± 4.4). The correlations were between TTUG and age (r = -0.24, p = 0.69), TTUG and BMI (r = 0.111, p = 0.426), and WC and WHtR (r = 0.885, p < 0.000). Weak correlations were observed between TTUG and BMI and WC and WHtR, indicating that factors other than BMI and abdominal fat accumulation may have a greater influence on performance on the TTUG test. In this specific context of elderly people participating in a physical activity program, the results found may have been shaped by the very nature of the interventions carried out in the program, with factors such as muscular strength, flexibility and balance preserved and acquired through the practice of regular physical exercise. Despite the benefits of physical activity, managing weight and abdominal fat remains challenging for elderly individuals with high anthropometric measurements. CONCLUSIONS: Although many elderly people have anthropometric measurements above average levels, the results indicate that no negative influence on their performance on the TTUG was observed. However, the limitation of the sample size and the underrepresentation of elderly people ≥ 80 years and of men highlight the need for future studies with larger and more balanced samples to confirm these results.


Asunto(s)
Índice de Masa Corporal , Ejercicio Físico , Factores de Riesgo de Enfermedad Cardiaca , Circunferencia de la Cintura , Humanos , Anciano , Masculino , Femenino , Estudios Transversales , Brasil , Persona de Mediana Edad , Anciano de 80 o más Años , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo
12.
J Inherit Metab Dis ; 36(5): 805-11, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23361304

RESUMEN

Mitochondrial respiratory chain diseases are a heterogeneous group of pathologies caused by genetic alterations affecting mitochondrial energy production. Theoretically, this deficiency may lead to any symptoms, in any organ or tissue, at any age even before birth. The aim of our study was to identify the frequency and characterize antenatal manifestations identifying possible associations between mitochondrial disease and more specific and earlier manifestation. We retrospectively review the files of 44 paediatric subjects with genetic and biochemical alterations of respiratory chain identified in the first decade of life and compare data with a control group (n = 88). Our results show that maternal age was similar in both groups. The female gender was predominant in patients group. Gestational age at delivery was similar in both groups. Concerning birth weight, it was significantly lower (p = 0.001) in patients (2899.9 ± 538.3 vs. 3246.6 ± 460.2 g). Fifteen pregnancies of the patients group were considered abnormal. Our findings show that intrauterine growth restriction was the most frequent antenatal feature observed. Neonatal morbidity was significantly higher (fivefold) in patients (p < 0.001). The clinical findings are independent of the molecular defect type. Our results are preliminary and more studies are needed, in order to learn more about mitochondrial physiology and activity in embryological development for the assessment of mitochondrial disease progress in fetal life. However, the present work is a significant contribution, given the scarcity of information in this field.


Asunto(s)
Enfermedades Mitocondriales/complicaciones , Adulto , Peso al Nacer , Femenino , Retardo del Crecimiento Fetal/etiología , Edad Gestacional , Humanos , Recién Nacido , Masculino , Estudios Retrospectivos
13.
BMC Fam Pract ; 14: 102, 2013 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-23865564

RESUMEN

BACKGROUND: In light of its epidemic proportions in developed and developing countries, obesity is considered a serious public health issue. In order to increase knowledge concerning the ability of health care professionals in caring for obese adolescents and adopt more efficient preventive and control measures, a questionnaire was developed and validated to assess non-dietitian health professionals regarding their Knowledge of Nutrition in Obese Adolescents (KNOA). METHODS: The development and evaluation of a questionnaire to assess the knowledge of primary care practitioners with respect to nutrition in obese adolescents was carried out in five phases, as follows: 1) definition of study dimensions 2) development of 42 questions and preliminary evaluation of the questionnaire by a panel of experts; 3) characterization and selection of primary care practitioners (35 dietitians and 265 non-dietitians) and measurement of questionnaire criteria by contrasting the responses of dietitians and non-dietitians; 4) reliability assessment by question exclusion based on item difficulty (too easy and too difficult for non-dietitian practitioners), item discrimination, internal consistency and reproducibility index determination; and 5) scoring the completed questionnaires. RESULTS: Dietitians obtained higher scores than non-dietitians (Mann-Whitney U test, P < 0.05), confirming the validity of the questionnaire criteria. Items were discriminated by correlating the score for each item with the total score, using a minimum of 0.2 as a correlation coefficient cutoff value. Item difficulty was controlled by excluding questions answered correctly by more than 90% of the non-dietitian subjects (too easy) or by less than 10% of them (too difficult). The final questionnaire contained 26 of the original 42 questions, increasing Cronbach's α value from 0.788 to 0.807. Test-retest agreement between respondents was classified as good to very good (Kappa test, >0.60). CONCLUSION: The KNOA questionnaire developed for primary care practitioners is a valid, consistent and suitable instrument that can be applied over time, making it a promising tool for developing and guiding public health policies.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Ciencias de la Nutrición/educación , Obesidad Infantil/diagnóstico , Médicos de Atención Primaria/psicología , Encuestas y Cuestionarios/normas , Adolescente , Adulto , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nutricionistas/psicología , Nutricionistas/estadística & datos numéricos , Cooperación del Paciente , Obesidad Infantil/terapia , Médicos de Atención Primaria/educación , Médicos de Atención Primaria/estadística & datos numéricos , Atención Primaria de Salud/normas , Análisis de Componente Principal , Reproducibilidad de los Resultados
14.
J Med Case Rep ; 16(1): 38, 2022 Jan 31.
Artículo en Inglés | MEDLINE | ID: mdl-35094699

RESUMEN

BACKGROUND: We present a case of primary biliary cholangitis diagnosed during pregnancy. Diagnosis of this entity in pregnancy is infrequent, and when everything seemed to point to a simple obstetric cholestasis, close attention to the details of the clinical history was required to raise suspicion of the true diagnosis. CASE PRESENTATION: We present a 37-year-old Portuguese Caucasian patient who complained of generalized pruritus and showed alteration in hepatic function tests with a cholestatic pattern. The first diagnostic hypothesis was intrahepatic cholestasis of pregnancy, and she began treatment with ursodeoxycholic acid, which resulted in slight improvement of cholestasis. Her pregnancy was also complicated with occlusive hemorrhagic placenta, and at 30 weeks she underwent emergency cesarean section due to heavy blood loss. However, careful observation of clinical and laboratory findings, postpartum evolution, and a multidisciplinary approach to the patient led to the probable diagnosis of primary biliary cholangitis. CONCLUSIONS: Physiological changes during pregnancy can mimic chronic liver disease that can only be revealed at this stage, having an impact not only on the pregnancy but on the entire future of the woman.


Asunto(s)
Colestasis Intrahepática , Colestasis , Cirrosis Hepática Biliar , Adulto , Cesárea , Femenino , Humanos , Cirrosis Hepática Biliar/complicaciones , Cirrosis Hepática Biliar/diagnóstico , Cirrosis Hepática Biliar/tratamiento farmacológico , Embarazo , Ácido Ursodesoxicólico/uso terapéutico
15.
Acta Med Port ; 34(1): 56-58, 2021 Jan 04.
Artículo en Portugués | MEDLINE | ID: mdl-33618795

RESUMEN

Pregnancy is a rare condition in women with chronic kidney disease on hemodialysis, but its incidence has increased in recent years. Despite being a high-risk condition for both mother and fetus, there has been an improvement in care due to the increased number of cases described and the experience gained in dialysis therapy. We report the case of a multiparous 32-years-old women with chronic hypertension and chronic kidney disease with 10 years of evolution and difficult control, with a diagnosis of dichorionic/diamniotic twin pregnancy, 4 months after beginning hemodialysis. Pregnancy was managed by a multidisciplinary team, hemodialysis sessions were clinically and hemodynamically well tolerated, with good blood pressure and analytical control, as well as adequate development of both fetuses. She went into labor at 34 weeks and 6 days, so a caesarean section was performed, with 2 boys born with adequate weight for gestational age.


A gravidez é uma situação rara em mulheres com doença renal crónica sob hemodiálise. Contudo, a sua incidência tem aumentado nos últimos anos. Apesar de ser uma situação de elevado risco materno e fetal, tem havido uma melhoria na assistência, devido ao aumento do número de casos descritos e da experiência adquirida na terapia dialítica. Relatamos o caso de uma multípara de 32 anos com hipertensão crónica e doença renal crónica com 10 anos de evolução e difícil controlo, com diagnóstico de gravidez gemelar bicoriónica/biamniótica, quatro meses após início da hemodiálise. A gestação foi vigiada por uma equipa multidisciplinar, as sessões de hemodiálise bem toleradas clínica e hemodinamicamente, com bom controlo tensional e analítico seriado, assim como adequado desenvolvimento de ambos os fetos. Foi submetida a cesariana às 34 semanas e seis dias por início de trabalho de parto, tendo nascido dois meninos com peso adequado para a idade gestacional.


Asunto(s)
Complicaciones del Embarazo/terapia , Embarazo Gemelar , Diálisis Renal/métodos , Insuficiencia Renal Crónica/terapia , Adulto , Cesárea , Femenino , Humanos , Masculino , Embarazo , Resultado del Embarazo
16.
Microorganisms ; 9(8)2021 Aug 10.
Artículo en Inglés | MEDLINE | ID: mdl-34442778

RESUMEN

In June 2019, a horse with neurological disorder was diagnosed with West Nile virus (WNV) in Boa Viagem, a municipality in the state of Ceará, northeast Brazil. A multi-institutional task force coordinated by the Brazilian Ministry of Health was deployed to the area for case investigation. A total of 513 biological samples from 78 humans, 157 domestic animals and 278 free-ranging wild birds, as well as 853 adult mosquitoes of 22 species were tested for WNV by highly specific serological and/or molecular tests. No active circulation of WNV was detected in vertebrates or mosquitoes by molecular methods. Previous exposure to WNV was confirmed by seroconversion in domestic birds and by the detection of specific neutralizing antibodies in 44% (11/25) of equids, 20.9% (14/67) of domestic birds, 4.7% (13/278) of free-ranging wild birds, 2.6% (2/78) of humans, and 1.5% (1/65) of small ruminants. Results indicate that not only equines but also humans and different species of domestic animals and wild birds were locally exposed to WNV. The detection of neutralizing antibodies for WNV in free-ranging individuals of abundant passerine species suggests that birds commonly found in the region may have been involved as amplifying hosts in local transmission cycles of WNV.

17.
J Reprod Immunol ; 136: 102616, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31581042

RESUMEN

BACKGROUND: Immunoinflammatory response by innate immunity components is a field with increasing interest in understanding the mechanisms behind preterm labor (PTL). OBJECTIVES: Systematic review of the role of innate immunity in spontaneous PTL. STUDY DESIGN: PubMed, Scopus, ClinicalTrials.gov and Web of Science were searched using pregnancy AND innate OR toll-like OR natural-killer OR dendritic AND delivery OR premature OR rupture of membranes. MAIN OUTCOME MEASURES: All article titles and abstracts were evaluated by two individuals, based in strict predefined inclusion criteria. For relevant studies, title, abstract, and full text were assessed to identify PTL and innate immunity studies, excluding multiple pregnancies, cervical insufficiency and indicated PTL. RESULTS: From 894 articles evaluated, 101 full texts articles were assessed independently. For this systematic review 44 studies were finally included. Toll-like receptors 2 and 4 mediated immune dysfunction and inflammation can result in PTL. Moreover, PTL is linked to high levels of CD14+ monocytes; neutrophils seem important in inflammation-associated PTL and in pathological preterm premature rupture of membranes. Besides, decidual natural-killer cells and premature activation of dendritic cells may also participate in the etiology of PTL. Finally, dysregulation of maternal complement might increase the risk of PTL, characterized by high levels of innate lymphoid cells 2 and 3. CONCLUSIONS: Further research is warranted to ascertain the precise role of innate immunity in PTL. Nonetheless, our results indicate that Toll-like receptors, monocytes, natural-killer cells, dendritic cells and complement have significant roles in PTL.


Asunto(s)
Decidua/inmunología , Rotura Prematura de Membranas Fetales/inmunología , Inmunidad Innata , Nacimiento Prematuro/inmunología , Decidua/patología , Femenino , Rotura Prematura de Membranas Fetales/patología , Humanos , Inflamación/inmunología , Inflamación/patología , Embarazo , Nacimiento Prematuro/patología
18.
Acta Med Port ; 31(7-8): 416-424, 2018 Aug 31.
Artículo en Portugués | MEDLINE | ID: mdl-30189170

RESUMEN

INTRODUCTION: There is no international consensus regarding gestational diabetes mellitus diagnostic criteria. In Portugal, the Carpenter and Coustan criteria were replaced by an adaptation of the International Association of Diabetes and Pregnancy Study Groups criteria. Our aim was to compare the incidence and outcomes of pregnancies complicated by gestational diabetes mellitus according to the current and previous criteria. MATERIAL AND METHODS: Retrospective analysis of 1218 singleton pregnancies complicated with gestational diabetes mellitus, with surveillance/delivery between 2008-2015. Two groups were considered: identification according to the Directorate-General of Health criteria - International Association of Diabetes and Pregnancy Study Groups (group 1); identification through Carpenter and Coustan criteria (group 2). A comparative analysis was performed. RESULTS: The incidence of gestational diabetes mellitus doubled (9.4% vs 4.6%), and the number of consultations/year increased (~3000 vs ~2000). In Group 1, in comparison with group 2, there was a lower risk of macrosomia in newborns [RR 0.44 (IC (95%):0.26 - 0.76)] and a higher risk of small for gestational age infants [RR 1.99 (IC (95%):1.19 - 3.31)]; a 6 - fold and 4 fold higher risk in neonatal hypoglycemia [RR 6.30 (IC (95%): 3.39 - 11.71)] and hyperbilirubinemia [RR 3.89 (IC (95%): 2.25 - 6.72)] were also observed, respectively. There were no differences regarding other outcomes. DISCUSSION: Outcomes related to the decrease in macrosomia did now show any improvement, with even an increase in Small for Gestational Age and neonatal complications. Given the increased incidence of gestational diabetes mellitus, Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria may be associated with greater healthcare-related costs due to more frequent consultations, with no apparent obstetrical/neonatal benefit. CONCLUSION: The Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria were associated with a decrease in macrosomia, not accompanied by an improvement of obstetrical/perinatal outcomes. The benefit of using these criteria is open to debate.


Introdução: Não existe consenso internacional quanto aos critérios de diagnóstico da diabetes gestacional. Em Portugal, os critérios de Carpenter e Coustan foram substituídos por uma adaptação dos critérios da International Association of Diabetes and Pregnancy Study Groups. O objetivo deste estudo foi comparar a incidência e outcomes obstétricos/perinatais das grávidas com diabetes gestacional segundo os critérios atuais e prévios. Material e Métodos: Estudo retrospetivo de 1218 gestações únicas complicadas com diabetes gestacional cuja vigilância/parto ocorreu entre 2008-2015. Consideraram-se dois grupos: diagnóstico pelos critérios da Direção Geral da Saúde ­ International Association of Diabetes and Pregnancy Study Groups (grupo 1); diagnóstico segundo Carpenter e Coustan (grupo 2), tendo sido feita análise estatística comparativa. Resultados: A incidência da diabetes gestacional duplicou (9,4% vs 4,6%) e o número de consultas/ano aumentou consideravelmente (~ 3 000 vs ~ 2 000). No grupo 1 verificou-se um risco inferior de recém-nascidos macrossómicos em relação ao grupo 2 [RR 0,44 (IC (95%): 0,26 ­ 0,76)], e um risco mais elevado de recém-nascidos leves para a idade gestacional (LIG) [RR 1,99 (IC (95%):1,19 ­ 3,31)]; um risco cerca de seis e quatro vezes superior de hipoglicémia [RR 6,30 (IC (95%): 3,39 ­ 11,71)] e hiperbilirrubinémia [RR 3,89 (IC (95%): 2,25 ­ 6,72)] neonatais, respetivamente. Não houve diferenças em relação a outros outcomes. Discussão: A redução dos recém-nascidos macrossómicos não resultou em melhoria dos outcomes, havendo um aumento dos recém-nascidos leves para a idade gestacional bem como de complicações neonatais. Os critérios atuais poderão associar-se a maiores gastos em saúde, devido ao aumento considerável da incidência de diabetes gestacional e maior vigilância em consultas, sem benefícios obstétricos/perinatais. Conclusão: A aplicação dos critérios da Direção Geral da Saúde ­ International Association of Diabetes and Pregnancy Study Groups associou-se a redução da macrossomia, não acompanhada de uma melhoria dos outcomes. É discutível o benefício destes critérios em relação aos anteriormente preconizados.


Asunto(s)
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Adulto , Técnicas de Diagnóstico Obstétrico y Ginecológico/normas , Femenino , Humanos , Incidencia , Portugal/epidemiología , Embarazo , Resultado del Embarazo , Estudios Retrospectivos
19.
Rev Bras Ginecol Obstet ; 39(10): 560-568, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28651292

RESUMEN

Objectives To characterize the most common peripheral and central neurological disorders during pregnancy. Methods Original research and review of the literature on neurological complications during pregnancy. We searched for keywords related to the topic on different databases. Results Pregnancy involves physiological changes that can trigger peripheral neurological and/or central nervous system pathologies, which can sometimes be associated with hypertensive disorders. A definitive diagnosis of neurological disorders can be made according to the trimester of pregnancy and the clinical findings. Carpal tunnel syndrome and peripheral facial palsy are common peripheral neurological disorders, more frequent in the second half of pregnancy. Central nervous disorders are more complex and a precise diagnosis must be made in order to improve perinatal outcomes, provide correct management and treatment and to prevent acute and long-term complications. Conclusions It is possible to achieve a precise diagnosis, management and treatment of neurological disorders during pregnancy, but these require a multidisciplinary approach, crucial to improve perinatal outcomes.


Objetivos Caracterizar as alterações neurológicas centrais e periféricas mais comuns durante a gravidez. Métodos Foi efetuada uma revisão da literatura acerca de complicações neurológicas durante a gravidez. Foram utilizadas diversas bases de dados usando palavras-chave relacionadas com o tema. Resultados A gravidez envolve alterações fisiológicas que podem desencadear alterações neurológicas periféricas e/ou do sistema nervoso central, por vezes associadas a distúrbios hipertensivos. Um diagnóstico definitivo pode ser feito tendo em conta o trimestre de gravidez e os achados clínicos encontrados. A síndrome do túnel carpal e a paralisia facial periférica são alterações neurológicas periféricas comuns que ocorrem mais frequentemente na segunda metade da gravidez. As alterações em termos do sistema nervoso central são mais complexas. Um diagnóstico preciso é fulcral, não só para melhorar os desfechos perinatais, mas também para efetuar uma vigilância e tratamento adequados e para prevenir complicações agudas e a longo prazo. Conclusões Um diagnóstico preciso e um acompanhamento e tratamento apropriados dos distúrbios neurológicos durante a gravidez são ações exequíveis. Contudo, requerem uma abordagem multidisciplinar, crucial para melhorar os desfechos perinatais.


Asunto(s)
Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/terapia , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/terapia , Enfermedad Aguda , Femenino , Humanos , Embarazo
20.
Rev Bras Ginecol Obstet ; 39(6): 265-272, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28609805

RESUMEN

Purpose To evaluate maternal-fetal surveillance and follow-up of infants at risk for congenital syphilis (CS). Methods Retrospective cohort study in a Portuguese Tertiary Referral Hospital. The main inclusion criterion was a positive syphilis serology. The study included all pregnant women that delivered in our hospital between January 2004 and December 2013. The neonates were classified according to their probability of infection based on the Centers for Disease Control and Prevention guidelines. Results Among the 27 pregnancies at risk for CS, 48.2% (n = 13) of the women had a diagnosis during the 1st trimester, and the median gestational age at the end of the treatment was 28 weeks. Inadequate treatment was noted in 44.4% (n = 12) of the women. Adverse pregnancy outcomes were observed in 30.8% of the cases (n = 8), 5 of which had been adequately treated. We found 2 (7.7%) cases with "proven or highly probable CS," 10 (38.5%) with "possible CS," 12 (46.1%) with "less likely CS," and 2 (7.7%) with "unlikely CS." Among the infants, the treatment was successful, except for 1 neurosyphilis case. Conclusion This study highlights many of the difficulties/concerns encountered in the maternal-neonatal management of syphilis. We highlight the importance of assuring the early detection of the infection as a way of guaranteeing the timely treatment, as well as a good compliance to the treatment and follow-up through a more efficient pregnant women surveillance network.


Objetivo Avaliar a vigilância materno-fetal e o acompanhamento de crianças em risco de sífilis congênita (SC). Métodos Estudo de coorte retrospetivo desenvolvido num hospital terciário de referência, cujo principal critério de inclusão foi a presença de serologia positiva para sífilis. O estudo incluiu todas as grávidas admitidas no nosso Hospital entre janeiro de 2004 e dezembro de 2013. Os recém-nascidos foram classificados de acordo com a probabilidade de infeção, com base nas recomendações do Centers for Disease Control and Prevention. Resultados Entre as 27 gravidezes em risco de SC, 48,2% (n = 13) tiveram diagnóstico durante o 1° trimestre; a idade gestacional média no final do tratamento foi de 28 semanas. Em 44,4% (n = 12) das mulheres, o tratamento foi considerado inadequado. Em 30,8% dos casos (n = 8) houve algum evento adverso da gravidez, dos quais 5 foram adequadamente tratados. Em dois dos casos (7,7%) a SC foi provada ou considerada como altamente provável, 10 (38,5%) com SC provável, 12 (46,1%) com SC pouco provável, e 2 (7,7%) com SC improvável. Nos lactentes, o tratamento foi bem sucedido, com exceção de um caso de neurossífilis. Conclusão Este estudo visa realçar muitas das dificuldades/preocupações encontradas na vigilância materno-neonatal dos casos com diagnóstico de sífilis. ublinhamos, não só, a importância de se assegurar a deteção precoce de infeção como forma de se garantir o tratamento atempado, mas também, uma adequada adesão à vigilância/tratamento, através de uma rede mais eficiente entre as diferentes instituições envolvidas no acompanhamento das grávidas.


Asunto(s)
Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis Congénita/epidemiología , Sífilis/epidemiología , Adolescente , Adulto , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Recién Nacido , Masculino , Vigilancia de la Población , Portugal , Embarazo , Estudios Retrospectivos , Medición de Riesgo , Adulto Joven
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