Pregnancy and fetal outcomes of symptoms of sleep-disordered breathing.

The physiological changes of pregnancy may predispose females to develop sleep-disordered breathing (SDB) or protect against it. Studies evaluating outcomes of SDB symptoms in pregnancy are scarce. The goal of this study was to evaluate the prevalence of SDB symptoms in pregnancy and their relationship with pregnancy and neonatal outcomes. A cross-sectional survey of randomly selected immediate postpartum females was performed using the multivariable apnoea prediction index. Record review, including demographics and medical history, was performed. Main outcome measures included pregnancy and neonatal outcomes. 1,000 subjects were recruited. Mean±sd age was 29.1±6.1 yrs. Factors used in the regression analysis included age, body mass index, diabetes, chronic hypertension, multifetal gestations, smoking and renal disease. Snoring was present in 35.1% of subjects. Symptoms of SDB were associated with a higher likelihood of pregnancy-induced hypertension and pre-eclampsia (adjusted OR 2.3, 95% CI 1.4-4.0), gestational diabetes (adjusted OR 2.1, 95% CI 1.3-3.4) and unplanned Caesarean deliveries (adjusted OR 2.1, 95% CI 1.4-3.2) after multivariable regression analysis. Gasping may have been associated with a higher likelihood of preterm delivery, after adjusting for age and multifetal pregnancies (adjusted OR 1.8, 95% CI 1.1-3.2) but this association appeared to be mediated by pre-eclampsia. Symptoms of SDB are common in pregnancy and associated with a higher likelihood of gestational hypertensive disorders, gestational diabetes and unplanned Caesarean deliveries.

Relaçäo entre comprimento craniocaudal e diâmetro da vesícula embrionária/fetal com idade de gestaçäo por meio de avaliaçäo ultra-sonográfica em ovino da raça Bergamácia / Relationship between crown-rump length and embryonic/fetal vesicle diameter with gestational age in ovine of Bergamácia breed by ultrasonography

Este trabalho objetivou relacionar o diâmetro da vesícula embrionária/fetal (DVE) e comprimento craniocaudal do embriäo/feto (CCC) do 15§ ao 45§ dia de gestaçäo com a idade de gestaçäo em ovelhas. Utilizaram-se 19 ovelhas adultas da raça Bergamácia, com cio sincronizado e cobertas por um mesmo reprodutor. A avaliaçäo ultra-sonográfica foi realizada diariamente do 15§ ao 30§ dia após a cobriçäo e a cada cinco dias do 30§ ao 45§ dia, utilizando-se aparelho com transdutor linear de 5,0 e 7,5MHZ. O crescimento diário médio do DVE e CCC foi de 1,40mm e 1,33mm, respectivamente. A calibragem inversa obtida para DVE foi: Dias = -11 + 50(0,1 + 0,04log DVE sobrescrito) 1/2(sobrescrito), com R2(sobrescrito) = 0,85 e para CCC foi: Dias = 13,63 + 12,5(-0,71 + 0,l6CCC)1/2(sobrescrito), com R 2 sobrescrito = 0,93. Tanto o DVE como o CCC obtidos por ultra-sonografia säo medidas pelas quais se pode prever a idade de gestaçäo em ovelhas da raça Bergamácia

Perfil dos constituintes do sangue do puerpério imediato de ovelhas submetidas a cesariana eletiva e de ovelhas com parto normal / Profile of blood components at immediate puerperium of ewes submitted to cesarean section and of those which had normal parturition

Compararam-se os perfis dos constituintes do sangue de ovelhas submetidas a cesariana eletiva (n=21; GI) ou com partos normais (n= 11; GII). Obtiveram-se amostras de sangue em cinco momentos: no dia do parto, antes de sua ocorrência (M1), um (M2), dois (M3), três (M4) e sete (M5) dias pós-parto. Os valores do eritrograma em todos os animais apresentaram-se normais, näo se constituindo em guia para o prognóstico da ocorrência pós-parto. No leucograma do GI observou-se presença de neutrófilos imaturos nos animais que morreram após a cirurgia. Apesar de a contagem de neutrófilos imaturos ter sido sugestiva do efeito da cesariana, nenhuma variável hematológica mensurada constituiu-se em acurado guia para o prognóstico da cesariana

The use of snake venom derived fibrin glue in hysterorrhaphy of ovine caesarean surgery

Fibrin glue has been used on its own or in conjunction with suturing materials to promote hemostasis, reduce adherence, strengthen the wound site, and improve healing. Snake venom derived fibrin glue was evaluated as an alternative to conventional uterine suturing after ovine caesarean surgey. Twenty-eight pregnant ewes of known mating date were used. The animals submitted to conventional caesaream sections showed a better wound healing process. As expected, all the operated animals had retained placenta, compromissing coaptation of wound edges. This had a strong influence in the results observed with the animals in which fibrin glue was used. The animals were divided into four groups GI, GII, GIII, and GIV and sacrificed, respectively, 3, 7, 15, and 30 days after surgery for macro and microscopic examination of the uterus. From each group, six animals underwent surgery using fibrin glue and four animals were submitted to comparative conventional hysterorrhaphy using catgut.

Cell-mediated immune responses and cytotoxicity to mycobacterial antigens in patients with tuberculous pleurisy in Brazil.

Evaluating human immune response to defined Mycobacterium tuberculosis antigens in patients with different clinical forms of tuberculosis may help in elucidating pathogenesis and in vaccine development. In the present report we evaluated the lymphocyte proliferation, cytokine production and natural killer cell cytotoxicity as parameters to screen four mycobacterial recombinant antigens. Pleural fluid mononuclear cells (PFMC) and peripheral blood mononuclear cells (PBMC) from 13 HIV-negative patients with tuberculous pleurisy, living in a tropical region of Brazil were used in these assays. Crude M. tuberculosis antigen and recombinant 70-, 65- and 38-kDa mycobacterial antigens, induced greater proliferation in PFMC than in PBMC. IFN-gamma, TNF-alpha, IL-4 and IL-10 were evaluated in the PFMC supernatants stimulated by these antigens. Both crude and 70-kDa antigens induced higher levels of IFN-gamma, TNF-alpha and IL-10. There was a significant positive correlation between IFN-gamma and the proliferative response induced by crude M. tuberculosis antigen, and an inverse correlation was identified between IL-10 and cell proliferation. IL-4 was not detected in the supernatants of pleural fluid mononuclear cell cultures stimulated by either crude, or recombinant antigens. TNF-alpha was detected in variable amounts in supernatants of PFMC stimulated by all antigens tested. Natural killer cytotoxicity was induced by both crude and 70-kDa antigen. Our results demonstrate that cells present at the site of disease recognized three of the antigens screened, as shown by lymphocyte proliferation and production of regulatory and inflammatory cytokines, and the results obtained with PFMC were consistently higher than those obtained with homologous PBMC.

Valor da determinaçäo da atividade de adenosina desaminase (ADA) no diagnóstico diferencial dos derrames pleurais / Value of determining the activity of adenosine deaminase (ADA) in the differenrial diagnosis of pleural effusions

Justificativa. Derrame pleural é um problema freqüentemente encontrado na prática clínica. Enquanto o derrame pleural transudativo, geralmente, nao apresenta dificuldade no diagnóstico, as efusoes exsudativas necessitam de um diagnóstico diferencial cuidadoso que inclui, necessariamente, tuberculose e neoplasia metastática para a pleura. Métodos. Num estudo transversal, foram estudados 221 pacientes consecutivos, com derrame pleural persistente e/ou nao eslarecido, em um hospital de refência para doenças respiratórias na rede pública estadual, com o objetivo de avaliar a acurácia da determinaçao da atividade da adenosina desaminase (ADA) no líquido pleural para o diagnóstico de tuberculose. Esses pacientes foram enquadrados nos seguintes grupos: a) tuberculose (confirmada, n=150; provável, n=9); b) neoplasia (confirmada, n=21; provável, n=16; linfoma, n=3); e c) miscelânea (n=22). Os pacientes foram submetidos a exame clínico, radiografias de tórax, testes sanguíneos e toracocenteses com biópsias pleurais. No líquido pleural foram realizados os exames de rotina com adicional determinaçao da atividade da ADA pelo método de Giusti. Resultados. Estudando a inter-relaçao entre sensibilidade e especificidade da atividade da ADA em diferentes níveis de corte, foi determinado que o melhor nível seria o de 40U/L. assim, observou-se sensibilidade de 93,3 por cento, especificidade de 93,5 por cento, valor preditivo positivo de 97,2 por cento e valor preditivo negativo de 85,3 por cento, quando analisados apenas os pacientes com tuberculose confirmada e os nao-tuberculosos. Três dos quatro pacientes com elevada atividade da ADA, sem tuberculose, tinham linfoma. Conclusao. A determinaçao da atividade da ADA no líquido pleural é um exame de baixo custo, de técnica simples e rápida, tem alta sensibilidade e especificidade para identificar pacientes com pleurite tuberculosa. Os achados do presente estudo sao comparáveis a outras observaçoes publicadas, demonstrando a utilidade da incorporaçao deste teste na avaliaçao rotineira dos derrames pleurais em áreas com alta prevalência de tuberculose.

[Value of determining the activity of adenosine deaminase (ADA) in the differential diagnosis of pleural effusions]. / Valor da determinação da atividade de adenosina desaminase (ADA) no diagnóstico diferencial dos derrames pleurais.

BACKGROUND: Pleural effusion (PE) is a common problem in medical practice. Transudative effusions usually do not present difficulty in diagnosis, in most populations. Exudative PE however, require careful differential diagnosis that include necessarily tuberculosis and metastatic cancer. METHODS: We have conducted a cross-sectional study of 221 patients with persistent PE, in order to evaluate accuracy of determining adenosine deaminase activity (ADA) for diagnosis of tuberculosis pleuritis. This group of patients, taken mostly from the State Hospital for pulmonary diseases, consecutively, was constituted as follows: 1) Tuberculosis (confirmed, n = 150; likely, n = 9); 2) Cancer (confirmed, n = 21; likely, n = 16; Lymphoma = 3); and 3) Miscellaneous (n = 22). All individuals were submitted to clinical examination, chest X-ray, blood tests, and underwent thoracocentesis with pleural biopsy. Pleural fluids were analyzed by routine tests plus determination of ADA activity using Giusti's Method. RESULTS: In agreement with previous reports we have found 40 U/L to be the best cutoff point according to a Receiver Operating Curve (ROC) analysis of our data. Sensitivity of ADA activity < or = 40 U/L was 93.3% and specificity 93.5%, resulting in a positive predictive value of 97.2% and a negative predictive value of 85.3%, in this specific population of patients, when taking into account only the individuals with confirmed tuberculosis by histopathology or culture. Three out of the 4 patients with elevated ADA without tuberculosis had lymphoma. CONCLUSION: ADA determination in pleural fluids, a quick and inexpensive technique, is shown to be an accurate method for identifying tuberculosis pleuritis. Our findings are comparable to reports from other series, and stress how useful it is to incorporate this test to the routine evaluation of pleural effusions in areas of high incidence of tuberculosis.