RESUMO
Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)
This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)
Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)
Assuntos
Humanos , Masculino , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Serviços de Saúde da Criança , Saúde Mental , Humanização da Assistência , Morte Fetal , Dor , Pais , Pediatria , Perinatologia , Doenças Placentárias , Preconceito , Cuidado Pré-Natal , Psicologia , Psicologia Médica , Política Pública , Qualidade da Assistência à Saúde , Reprodução , Síndrome , Anormalidades Congênitas , Tortura , Contração Uterina , Traumatismos do Nascimento , Auxílio-Maternidade , Trabalho de Parto , Prova de Trabalho de Parto , Adaptação Psicológica , Aborto Espontâneo , Cuidado da Criança , Enfermagem Materno-Infantil , Recusa em Tratar , Saúde da Mulher , Satisfação do Paciente , Poder Familiar , Licença Parental , Qualidade, Acesso e Avaliação da Assistência à Saúde , Privacidade , Depressão Pós-Parto , Credenciamento , Afeto , Choro , Curetagem , Técnicas de Reprodução Assistida , Acesso à Informação , Ética Clínica , Parto Humanizado , Ameaça de Aborto , Negação em Psicologia , Fenômenos Fisiológicos da Nutrição Pré-Natal , Parto , Dor do Parto , Nascimento Prematuro , Lesões Pré-Natais , Mortalidade Fetal , Descolamento Prematuro da Placenta , Violência contra a Mulher , Aborto , Acolhimento , Ética Profissional , Natimorto , Estudos de Avaliação como Assunto , Cordão Nucal , Resiliência Psicológica , Fenômenos Reprodutivos Fisiológicos , Medo , Doenças Urogenitais Femininas e Complicações na Gravidez , Fertilidade , Doenças Fetais , Uso Indevido de Medicamentos sob Prescrição , Esperança , Educação Pré-Natal , Coragem , Trauma Psicológico , Profissionalismo , Sistemas de Apoio Psicossocial , Frustração , Tristeza , Respeito , Angústia Psicológica , Violência Obstétrica , Apoio Familiar , Obstetra , Culpa , Acessibilidade aos Serviços de Saúde , Maternidades , Complicações do Trabalho de Parto , Trabalho de Parto Induzido , Ira , Solidão , Amor , Tocologia , Mães , Cuidados de EnfermagemRESUMO
This study was designed to evaluate umbilical cord ischaemia-modified albumin (IMA) levels and the cord blood gas parameters of foetuses with or without nuchal cords, at the time of elective C-section. The cross-sectional study population consisted of the patients who were admitted to the Tertiary Care Center between February and June 2015. Women with uncomplicated single term gestations between 37 and 40 completed weeks and scheduled for elective C-sections were included in the study. Fifty cases with a nuchal cord and 50 cases without a nuchal cord were recruited. Nuchal cord blood gas analysis and the IMA levels were evaluated. The IMA levels in umbilical artery of foetuses both in the study and control groups were similar (0.714 ± 0.150 vs. 0.689 ± 0.107 ABSU, p = .340, respectively). The umbilical artery pH values of the study group were significantly lower than that in the control group (7.31 ± 0.04 vs. 7.32 ± 0.03, p = .042; respectively). The results of the current study indicate that the nuchal cord has an impact on the foetal cord blood gas parameters to some extent before the initiation of labour. Fortunately, this impact does not end up with foetal tissue ischaemia, as confirmed by the IMA levels. Impact statement What is already known on this subject? The impact of nuchal cord on perinatal outcomes has been the subject of research for many years. Although the accumulated data has pointed out some unfavourable perinatal effects, the heterogeneity of the study groups both including a vaginal delivery and C-section and the inability to adjust the interfering factors ended up with some controversies. This is why there is not much known about the effects of the nuchal cord in women who are not in the labour process. What do the results of this study add? The current study aimed to exclude the interfering effects such as the active stage of labour. In this study, elective caesarean sections were selected as the study population to evaluate the effects of the nuchal cord on cord blood gas parameters and the IMA values. pH analysis in cord blood is used to detect hypoxia and the IMA is a new ischaemia marker. The results revealed that the in utero nuchal cord is associated with a significantly higher pCO2 and lower pH values and similar IMA values. What are the implications of these findings for clinical practice and/or further research? The final outcome supports that the nuchal cord causes alterations in cord blood gas analysis but this does not reach critical levels. Therefore, the results show that there is no need to change clinical practice when the nuchal cord is detected by ultrasound in a term gestation.
Assuntos
Cordão Nucal/sangue , Adulto , Biomarcadores/sangue , Gasometria , Cesárea , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Sangue Fetal/química , Humanos , Gravidez , Albumina Sérica Humana , Adulto JovemRESUMO
Introducción: La cesárea tiene por objetivo la extracción del feto a través de la incisión de las paredes del abdomen y del útero. La tasa ideal de cesárea debe oscilar entre el 10% y el 15% según la Organización Mundial de la Salud. Las complicaciones en las pacientes que habían tenido más cesáreas demostraron una morbilidad mucho mayor que las que habían tenido menos cirugías. Gran parte de esta morbilidad se concentró con placenta previa o acreta y las múltiples adherencias. Objetivos: Determinar las características clínicas en gestantes cesareadas y hallazgos transoperatorios más frecuentes en el servicio de ginecología y obstetricia, del Hospital Regional de Coronel Oviedo, 2017. Materiales y método: Estudio observacional descriptivo, con muestreo no probabilístico de casos consecutivos. La población de estudio estuvo constituida por gestantes cesareadas de distintas edades del servicio de ginecología y obstetricia del Hospital Regional de Coronel Oviedo. Resultados: La población base estuvo conformado por 224 cesareadas, de los cuales, la mediana de edad fue de 26 años, el rango etario más frecuente fue entre 20 a 24 años; de unión libre, de procedencia urbana, con estudios primarios, edad gestacional de termino, nulíparas , que presentaron controles prenatales la mayoría, con diagnóstico preoperatorio ecográfico más frecuentes de desproporción cefalopélvica, con antecedente quirúrgico obstétrico de cesárea por primera vez, y con hallazgos transoperatorios más frecuentes de circular ceñido de cordón, líquido meconial y múltiples adherencias en orden de frecuencia. Conclusión: Como antecedentes quirúrgicos obstétricos se encontró la cesárea por primera vez con mayor frecuencia en el rango de edad de 20-24 años, con hallazgos transoperatorios más frecuentes, de circular ceñido de cordón, liquido meconial y múltiples adherencias en orden de frecuencia
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Adulto Jovem , Cesárea , Complicações Intraoperatórias/epidemiologia , Paraguai/epidemiologia , Paridade , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Fatores Socioeconômicos , Testes Sorológicos , Aderências Teciduais , Estudos Transversais , Fatores de Risco , Idade Gestacional , Estado Civil , Distribuição por Idade , Escolaridade , Cordão Nucal , MecônioRESUMO
BACKGROUND: In human fetuses with cardiac defects and increased nuchal translucency, abnormal ductus venosus flow velocity waveforms are observed. It is unknown whether abnormal ductus venosus flow velocity waveforms in fetuses with increased nuchal translucency are a reflection of altered cardiac function or are caused by local morphological alterations in the ductus venosus. AIM: The aim of this study was to investigate if the observed increased nuchal translucency, cardiac defects and abnormal lymphatic development in the examined mouse models are associated with local changes in ductus venosus morphology. STUDY DESIGN: Mouse embryos with anomalous lymphatic development and nuchal edema (Ccbe1(-/-) embryos), mouse embryos with cardiac defects and nuchal edema (Fkbp12(-/-), Tbx1(-/-), Chd7(fl/fl);Mesp1Cre, Jarid2(-/-NE+) embryos) and mouse embryos with cardiac defects without nuchal edema (Tbx2(-/-), Fgf10(-/-), Jarid2(-/-NE-) embryos) were examined. Embryos were analyzed from embryonic day (E) 11.5 to 15.5 using markers for endothelium, smooth muscle actin, nerve tissue and elastic fibers. RESULTS: All mutant and wild-type mouse embryos showed similar, positive endothelial and smooth muscle cell expression in the ductus venosus at E11.5-15.5. Nerve marker and elastic fiber expression were not identified in the ductus venosus in all investigated mutant and wild-type embryos. Local morphology and expression of the used markers were similar in the ductus venosus in all examined mutant and wild-type embryos. CONCLUSIONS: Cardiac defects, nuchal edema and abnormal lymphatic development are not associated with morphological changes in the ductus venosus. Ductus venosus flow velocity waveforms most probably reflect intracardiac pressure.
Assuntos
Edema/patologia , Cardiopatias Congênitas/patologia , Sistema Linfático/anormalidades , Cordão Nucal/patologia , Veias Umbilicais/patologia , Actinas/genética , Actinas/metabolismo , Animais , Velocidade do Fluxo Sanguíneo , Proteínas de Ligação ao Cálcio/genética , Feminino , Fator 10 de Crescimento de Fibroblastos/genética , Cardiopatias Congênitas/genética , Sistema Linfático/patologia , Camundongos , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Cordão Nucal/genética , Medição da Translucência Nucal , Complexo Repressor Polycomb 2/genética , Proteínas com Domínio T/genética , Proteína 1A de Ligação a Tacrolimo/genética , Proteínas Supressoras de Tumor/genéticaRESUMO
Mannose-binding lectin, together with mannose-associated serine proteases, activates the lectin pathway of the complement system and subsequent inflammatory mechanisms. An association between mannose-binding lectin deficiency and anti-Saccharomyces cerevisiae antibody levels is observed in Crohn's disease and this deficiency is frequently associated with a severe Crohn's disease phenotype. In the present study, we assessed the relationship between serum concentrations of mannose-binding lectin, mannose-binding lectin functional activity, MBL2 and NOD2 polymorphisms, anti-S. cerevisiae antibody levels and clinical Crohn's disease phenotype in 69 Crohn's disease patients and 30 age- and sex-matched healthy controls. The results show that the MBL2 variant rs5030737 at codon 52 was associated with a low level of mannose-binding lectin and impaired mannose-binding lectin-mannose-associated serine protease (MBL-MASP) functional activity in Crohn's disease patients. This MBL2 variant was also associated with a higher level of anti-S. cerevisiae antibodies. In addition, the NOD2 variant rs2066844, which is associated with susceptibility to Crohn's disease, was significantly correlated with an impairment in MBL-MASP functional activity. These results provide evidence that Crohn's disease patients have an impairment in MBL-MASP functional activity and that this defect is associated with MBL2 and NOD2 variants.
Assuntos
Doença de Crohn/genética , Lectina de Ligação a Manose/genética , Serina Proteases Associadas a Proteína de Ligação a Manose/genética , Proteína Adaptadora de Sinalização NOD2/genética , Doença de Crohn/sangue , Feminino , Genótipo , Humanos , Masculino , Lectina de Ligação a Manose/sangue , Cordão Nucal , Fenótipo , Polimorfismo de Nucleotídeo Único , Saccharomyces cerevisiae/imunologiaRESUMO
Genome-wide association studies have reported 11 regions conferring risk of high-grade serous epithelial ovarian cancer (HGSOC). Expression quantitative trait locus (eQTL) analyses can identify candidate susceptibility genes at risk loci. Here we evaluate cis-eQTL associations at 47 regions associated with HGSOC risk (P≤10(-5)). For three cis-eQTL associations (P<1.4 × 10(-3), FDR<0.05) at 1p36 (CDC42), 1p34 (CDCA8) and 2q31 (HOXD9), we evaluate the functional role of each candidate by perturbing expression of each gene in HGSOC precursor cells. Overexpression of HOXD9 increases anchorage-independent growth, shortens population-doubling time and reduces contact inhibition. Chromosome conformation capture identifies an interaction between rs2857532 and the HOXD9 promoter, suggesting this SNP is a leading causal variant. Transcriptomic profiling after HOXD9 overexpression reveals enrichment of HGSOC risk variants within HOXD9 target genes (P=6 × 10(-10) for risk variants (P<10(-4)) within 10 kb of a HOXD9 target gene in ovarian cells), suggesting a broader role for this network in genetic susceptibility to HGSOC.
Assuntos
Estudos de Associação Genética , Proteínas de Neoplasias/genética , Neoplasias Epiteliais e Glandulares/genética , Neoplasias Ovarianas/genética , Locos de Características Quantitativas , Carcinoma Epitelial do Ovário , Linhagem Celular Tumoral , Feminino , Regulação Neoplásica da Expressão Gênica , Predisposição Genética para Doença , Proteínas de Homeodomínio/genética , Proteínas de Homeodomínio/metabolismo , Humanos , Proteínas de Neoplasias/metabolismo , Neoplasias Epiteliais e Glandulares/metabolismo , Cordão Nucal , Neoplasias Ovarianas/metabolismo , Ligação ProteicaRESUMO
El objetivo del estudio fue comparar los resultados perinatales en las gestaciones con doble circular de cordón al cuello fetal según la vía del parto en el Instituto Nacional Materno Perinatal de Lima - Perú durante los años 2011-2012. Se realizó un estudio retrospectivo transversal, observacional analítico de tipo casos y controles. Se compararon los resultados perinatales de 101 mujeres con gestaciones con circular de cordón doble al cuello que tuvieron parto vaginal (casos) con los de 101 gestantes con circular de cordón doble al cuello a quienes se les realizó cesárea (controles). El análisis estadístico se realizó con el programa IBM Statistics SPSS 19. La edad de las gestantes varió entre los 12 y 46 años, con una media de 27,2 +/- 7,0 años. El análisis de regresión logística no demostró asociación entre las variables muerte fetal intraútero y muerte neonatal con la vía del parto (vaginal o cesárea) en las gestaciones con circular de cordón doble al cuello. Se concluyó que la vía del parto vaginal en las gestaciones con circular de cordón doble al cuello incrementó el riesgo asfixia perinatal, líquido amniótico meconial, sufrimiento fetal agudo, monitoreo electrónico fetal patológico, necesidad de reanimación neonatal e ingreso a la Unidad de Cuidados Intensivos Neonatal.
The objective of the study was to compare perinatal outcomes in pregnancies with double nuchal cord by the route of delivery in the National Maternal and Perinatal Institute in Lima - Peru during 2011-2012. An observational cross-sectional, retrospective case-control study was performed. Perinatal outcomes of 101 pregnant women with double nuchal cord delivered vaginally (cases) were compared with those of 101 pregnant women with double nuchal cord who underwent cesarean section (controls). Statistical analysis was performed with the IBM SPSS Statistics 19 program. The age of the pregnant women ranged between 12 and 46 years with a mean of 27.2 +/- 7.0. The logistic regression analysis showed no association between the variables intrauterine fetal death and neonatal death with the route of delivery (vaginal or cesarean) in pregnancies with circular double neck cord. It was concluded that the path of vaginal delivery in pregnancies with circular double neck cord increased the risk perinatal asphyxia, meconium, fetal distress, pathological EFM, need for neonatal resuscitation and admission lo Neonatal Intensive Care Unit.
Assuntos
Feminino , Humanos , Gravidez , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cordão Nucal , Monitorização Fetal , Terapia Intensiva Neonatal , Estudos Observacionais como Assunto , Estudos Retrospectivos , Estudos Transversais , Estudos de Casos e ControlesRESUMO
A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making.
Assuntos
Cordão Nucal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Cordão Umbilical/anormalidades , Cordão Umbilical/diagnóstico por imagem , Cisto do Úraco/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Gravidez , Cordão Umbilical/irrigação sanguíneaRESUMO
With the advent of ultrasound as a means of providing quality antenatal care, there is an increase in the diagnosis of nuchal cord in fetuses. The major cause of foetal or neonatal death during labor and in postpartum period is birth asphyxia and tight nuchal cord is a cause of birth asphyxia. Whilst there are instances in which fetuses with 3 to 4 loops of cord around the neck have been delivered by normal vaginal delivery, some cases have to be delivered by caesarean section due to foetal distress caused by a single loop of cord around the neck. The reason for conducting this study was also to analyze the incidence and other aspects of nuchal cord. Dhulikhel Hospital labour registry was reviewed between Jan 2010 and Dec 2011. A total of 289 cases with at least one loop of nuchal cord were recorded as study case. For comparison, 965 controls were randomly selected from the 4219 unaffected singleton births delivered during the same time period. Of 1254 neonates, nuchal cord was present at 6.85% of deliveries (n = 289). Of these the incidence was 6.57% at preterm, 49.13% at term, 39.79% at postdated and 4.50% at postterm. A total of 151 had one loop and 138 had two or more loops. There was significant difference in the maternal age and birth weight of among three groups (control, with one loop and with two or more loops) in this study (p = 0.002) and (p = 0.000) respectively. However, the incidence was not affected by caste, parity, gestational age, antenatal site, neonatal intensive care unit admission and other perinatal complications. Most were primigravida (62.98%) and about 85.12% were delivered vaginally but caesarean section had to be done in 30 cases. And 2.8% cases required neonatal intensive care unit admission for prematurity. Obstetrician working in the periphery should refer the clients to a tertiary care center to confirm a suspicion of nuchal cord (non-engaged foetal head, decreased foetal movements, meconium stained liquor, foetal distress or malpresentation etc.) and also as a routine basis for ultrasound. Clients with confirmed complication should be managed in tertiary hospitals or institutions with the facility of ultrasound, cardiotocography and emergency surgery. This would improve the health of both the mother and fetus.
Assuntos
Parto Obstétrico/métodos , Cordão Nucal/epidemiologia , Resultado da Gravidez , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Recém-Nascido , Nepal/epidemiologia , Gravidez , Adulto JovemAssuntos
Erros de Diagnóstico , Imperícia/legislação & jurisprudência , Acetaminofen/efeitos adversos , Acetilcisteína/administração & dosagem , Acetilcisteína/intoxicação , Adolescente , Adulto , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/etiologia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/etiologia , Apendicite/diagnóstico por imagem , Asma/diagnóstico , Criança , Pré-Escolar , Fibrose Cística/diagnóstico , Rotulagem de Medicamentos/legislação & jurisprudência , Overdose de Drogas , Emergências , Reações Falso-Negativas , Evolução Fatal , Feminino , Frequência Cardíaca Fetal , Humanos , Ibuprofeno/efeitos adversos , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/diagnóstico , Masculino , Síndrome de Marfan/complicações , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/diagnóstico , Erros de Medicação/legislação & jurisprudência , Cordão Nucal/diagnóstico , Cordão Nucal/enfermagem , Segurança do Paciente/legislação & jurisprudência , Estado Vegetativo Persistente/induzido quimicamente , Pleurisia/diagnóstico , Gravidez , Sons Respiratórios/etiologia , Mídias Sociais/legislação & jurisprudência , Síndrome de Stevens-Johnson/etiologia , Suicídio , Tomografia Computadorizada por Raios X , Transporte de Pacientes/legislação & jurisprudência , Procedimentos Desnecessários , Adulto JovemRESUMO
The potential interaction of growth-promoting implants and genetic markers previously reported to be associated with growth, carcass traits, and tenderness was evaluated. Two implant protocols were applied to subsets of steers (n = 383) and heifers (n = 65) that were also genotyped for 47 SNP reported to be associated with variation in growth, fat thickness, LM area, marbling, or tenderness. The "mild" protocol consisted of a single terminal implant [16 mg estradiol benzoate (EB), 80 mg trenbalone acetate (TBA) or 8 mg EB, 80 mg TBA given to steers and heifers, respectively]. The "aggressive" protocol consisted of both a growing implant (8 mg EB, 40 mg TBA) for the lightest half of the animals on the aggressive protocol and 2 successive implants (28 mg EB, 200 mg TBA) given to all animals assigned to the aggressive treatment. Implant protocol had measurable impact on BW and ADG (P < 0.05), with the aggressive protocol increasing these traits before the terminal implant (relative to the mild protocol), whereas the mild protocol increased ADG after the terminal implant so that the final BW and ADG over the experimental period were similar between protocols. Animals on the aggressive protocol had significantly increased (P < 0.05) LM area (1.9 cm(2)), slice shear force (1.4 kg), and intact desmin (0.05 units), but decreased (P < 0.05) marbling score (49 units) and adjusted fat thickness (0.1 cm), and yield grade (0.15 units). Among both treatments, 8 of 9 growth-related SNP were associated with BW or ADG, and 6 of 17 tenderness-related SNP were associated with slice shear force or intact desmin. Favorable growth alleles generally were associated with increased carcass yield traits but decreased tenderness. Similarly, favorable tenderness genotypes for some markers were associated with decreased BW and ADG. Some interactions of implant protocol and genotype were noted, with some growth SNP alleles increasing the effect of the aggressive protocol. In contrast, putative beneficial effects of favorable tenderness SNP alleles were mitigated by the effects of aggressive implant. These type of antagonisms of management variables and genotypes must be accounted for in marker assisted selection (MAS) programs, and our results suggest that MAS could be used to manage, but likely will not eliminate negative impact of implants on quality.
Assuntos
Bovinos/genética , Estradiol/análogos & derivados , Acetato de Trembolona/farmacologia , Aumento de Peso/efeitos dos fármacos , Aumento de Peso/genética , Animais , Relação Dose-Resposta a Droga , Implantes de Medicamento/administração & dosagem , Implantes de Medicamento/farmacologia , Estradiol/administração & dosagem , Estradiol/farmacologia , Feminino , Marcadores Genéticos , Genótipo , Masculino , Carne/normas , Cordão Nucal , Acetato de Trembolona/administração & dosagemAssuntos
Doença de Hirschsprung/diagnóstico , Hipoventilação/congênito , Neoplasias Renais/diagnóstico , Neuroblastoma/diagnóstico , Apneia do Sono Tipo Central/diagnóstico , Apneia/etiologia , Cianose/etiologia , Doença de Hirschsprung/genética , Doença de Hirschsprung/cirurgia , Proteínas de Homeodomínio/genética , Humanos , Hipoventilação/diagnóstico , Hipoventilação/genética , Lactente , Recém-Nascido , Intubação Intratraqueal , Neoplasias Renais/genética , Masculino , Mutação , Neuroblastoma/genética , Cordão Nucal , Apneia do Sono Tipo Central/genética , Fatores de Transcrição/genéticaRESUMO
BACKGROUND: The human multi-drug resistance gene (MDR1), which encodes the major trans-membrane transporter P-glycoprotein (P-gp), was found to be associated with susceptibility to cancer and response to chemotherapy. The C3435T Polymorphism of MDR1 gene was correlated with expression levels and functions of P-gp. Here, we studied the association between MDR1 C3435T polymorphism and susceptibility to Hodgkin lymphoma (HL) and patient's response to ABVD chemotherapy regimen. METHODS: a total of 130 paraffin embedded tissue samples collected from HL patients were analyzed to identify the C3435T polymorphism. As a control group, 120 healthy subjects were enrolled in the study. The C3435T Polymorphism was genotyped by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. Data analysis was carried out using the statistical package SPSS version 17 to compute all descriptive statistics. Chi-square and Fisher exact tests were used to evaluate the genotype distribution and allele frequencies of the studied polymorphism. RESULTS: these studies revealed that the frequency of T allele was significantly higher in HL patients compared to the controls (P < 0.05). In addition, the frequency of CT and TT genotypes were also significantly higher in HL patients compared to the controls (P < 0.05). No association between C3435T polymorphism and response to ABVD was detected among HL patients (P > 0.05). CONCLUSIONS: these results suggest that MDR1 C3435T polymorphism might play a role in HL occurrence; however this polymorphism is not correlated with the clinical response to ABVD.
Assuntos
Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/genética , Subfamília B de Transportador de Cassetes de Ligação de ATP , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/biossíntese , Adolescente , Adulto , Estudos de Casos e Controles , Resistência a Múltiplos Medicamentos , Resistencia a Medicamentos Antineoplásicos , Feminino , Genótipo , Doença de Hodgkin/metabolismo , Humanos , Masculino , Cordão Nucal , Valor Preditivo dos Testes , Fatores de Risco , Adulto JovemRESUMO
O prolapso de cordão umbilical é uma intercorrência obstétrica que, embora pouco frequente,uma vez diagnosticada, necessita de rápida intervenção, devido ao grande riscode morbimortalidade fetal. A conduta mais recomendada ,nesse caso, é a interrupçãoda gestação por meio de cesariana. Algumas medidas pré e per-operatórias podemser utilizadas a fim de reduzir a compressão do cordão e manter adequado fluxo sanguíneopara o feto até a intervenção obstétrica definitiva. O intervalo de tempo entre oprolapso do cordão e a interrupção da gravidez, assim como o grau de compressão docordão são fatores determinantes para o prognóstico neonatal. Apresenta-se, neste relato,o caso de uma paciente primigesta de 21 anos, com 40 semanas de gestação, quefoi internada para indução do trabalho de parto e investigação de suspeita de síndromeHELLP. O quadro evoluiu com rotura da bolsa e prolapso de cordão umbilical. Foi realizadacesariana de urgência para resolução do caso.
Umbilical cord prolapse is an obstetric complication that, although uncommon, once diagnosed needs prompt intervention, due to high risk of fetal morbimortality. The widely recommended management in this set is the interruption of the pregnancy by means of cesarean. Some pre and peroperative techniques may be used in order to reduce funic compression and maintain appropriate blood flow to the fetus to definitive obstetric intervention. Time interval between cord prolapse and pregnancy interruption, as well as cord compression degree are crucial for neonatal prognosis. This report presents the case of a 21 year primigravida patient, with a 40 weeks pregnancy, who was admitted to the Hospital das Clínicas da UFMG for induction of labor and investigation of suspected HELLP syndrome. The patient developed rupture of mem-branes and umbilical cord prolapse. An urgency cesarean was performed to solve the case.
Assuntos
Humanos , Feminino , Recém-Nascido , Adulto , Cordão Nucal , Cordão Umbilical , ProlapsoRESUMO
We conducted a case-control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted analyses identified seven prenatal and seven perinatal risk factors significantly associated with autism. In the adjusted analysis, nine risk factors showed significant association with autism: maternal second-hand smoke exposure, maternal chronic or acute medical conditions unrelated to pregnancy, maternal unhappy emotional state, gestational complications, edema, abnormal gestational age (<35 or >42 weeks), nuchal cord, gravidity >1, and advanced paternal age at delivery (>30 year-old).
Assuntos
Transtorno Autístico/epidemiologia , Transtorno Autístico/etiologia , Emoções , Mães/psicologia , Complicações na Gravidez/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Transtorno Autístico/diagnóstico , Transtorno Autístico/psicologia , Estudos de Casos e Controles , Criança , China/epidemiologia , Edema/epidemiologia , Feminino , Idade Gestacional , Número de Gestações , Humanos , Masculino , Exposição Materna/efeitos adversos , Exposição Materna/estatística & dados numéricos , Anamnese , Mães/estatística & dados numéricos , Cordão Nucal , Idade Paterna , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Fatores de Risco , Poluição por Fumaça de Tabaco/estatística & dados numéricosRESUMO
OBJECTIVE: We have determined venous and arterial cord blood levels for IL-6 and TNFalpha at the time of delivery to assess gestational tissue versus fetal sources in labouring and non-labouring patients at term, and the relationship to labour events. METHODS: Fifty-five patients were studied (elective cesarean section n=24, and labouring n=31) with blood sampling from a clamped segment of cord after delivery of the fetus and from the cord at its insertion into the placenta after delivery of the placenta, with subsequent measurement of blood gases, pH, IL-6 and TNFalpha. RESULTS: Umbilical cord levels for IL-6 were increased by 4 fold in low risk labouring patients, and a further 6 fold when showing histologic chorioamnionitis, but with no evident effect of nuchal cord with 'variable' fetal heart rate decelerations, fetal acidemia, nor of labour duration. IL-6 levels from the cord at its insertion into the placenta were generally higher than those from the respective umbilical levels indicating that placental release of IL-6 into cord blood must be occurring. However, a consistent venoarterial difference for IL-6 and thereby a net flux from the placenta could not be demonstrated. TNFalpha levels for both patient groups were uniformly low for all of the cord measurements with no significant differences noted. CONCLUSION: Umbilical cord levels for IL-6 are increased in low risk labouring patients at term in the absence of evident infection which likely involves both gestational tissue and fetal contributions. Cord levels for IL-6 are further increased in low risk labouring patients showing histologic chorioamnionitis which might then contribute to newborn morbidity in these pregnancies.
Assuntos
Sangue Fetal/metabolismo , Interleucina-6/sangue , Início do Trabalho de Parto/sangue , Placenta/metabolismo , Nascimento a Termo/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto , Peso ao Nascer , Cesárea , Corioamnionite/sangue , Corioamnionite/diagnóstico , Feminino , Idade Gestacional , Humanos , Cordão Nucal/sangue , Tamanho do Órgão , Placenta/irrigação sanguínea , GravidezRESUMO
OBJECTIVES: To assess the prevalence of cord entanglement and perinatal outcome in a large series of monoamniotic twin pregnancies and to review the recent literature on similar published large series. METHODS: Prospective observational study of all prenatally detected cases of monoamniotic twin pregnancies during an 8-year period in a tertiary fetal medicine unit. A Medline database review for publications since 2000 containing five or more cases of monoamniotic pregnancies that showed data on cord entanglement and perinatal outcome was also undertaken. RESULTS: A total of 32 monoamniotic pregnancies were diagnosed during the study period, including three conjoined twins, seven pregnancies with twin reversed arterial perfusion (TRAP) syndrome, three surgical pregnancy interruptions for discordant fetal abnormality and one miscarriage before 16 weeks' gestation. The remaining 18 monoamniotic pregnancies were included in the study analysis. All monoamniotic pregnancies were complicated with antenatal cord entanglement diagnosed by B-mode and color Doppler ultrasound. There were 34 live births and a double intrauterine death diagnosed at 19 + 2 weeks' gestation. There were two late neonatal deaths, one from congenital complete heart block and the other after surgery for transposition of the great arteries. The overall perinatal loss rate was 11.1% after 16 weeks and 5.9% after 20 weeks' gestation. The cumulative rates of cord entanglement and perinatal mortality in the reviewed literature were 74% and 21%, respectively. CONCLUSIONS: Umbilical cord entanglement is present in all monoamniotic twins when it is systematically evaluated by ultrasound and color Doppler. Perinatal mortality in monoamniotic twins is mainly a consequence of conjoined twins, TRAP, discordant anomaly and spontaneous miscarriage before 20 weeks' gestation. Expectantly managed monoamniotic twins after 20 weeks have a very good prognosis despite the finding of cord entanglement. The practice of elective very preterm delivery or other interventions to prevent cord accidents in monoamniotic twins should be re-evaluated.
Assuntos
Doenças em Gêmeos/diagnóstico por imagem , Cordão Nucal/diagnóstico por imagem , Placenta/diagnóstico por imagem , Gêmeos Monozigóticos , Doenças em Gêmeos/embriologia , Doenças em Gêmeos/mortalidade , Feminino , Morte Fetal/diagnóstico por imagem , Idade Gestacional , Humanos , Cordão Nucal/embriologia , Cordão Nucal/mortalidade , Placenta/irrigação sanguínea , Placenta/embriologia , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-NatalAssuntos
Síndrome de Bandas Amnióticas/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Cordão Nucal/diagnóstico por imagem , Deglutição , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Septo Nasal/anormalidades , Gravidez , Resultado da Gravidez , Ultrassonografia , Adulto JovemRESUMO
Tumor necrosis factor-alpha (TNF-alpha) is a major proinflammatory cytokine and involved in the etiology of psoriasis. The -238G>A and -308G>A polymorphisms influence the transcription of the TNF-alpha gene and have been implicated in psoriasis risk. However, the results from the published studies on the association between TNF-alpha polymorphisms and psoriasis risk are conflicting. Our meta-analysis of a total of 997 psoriasis cases and 943 control subjects from eight published case-control studies for the -238G>A polymorphism and of 1,156 psoriasis cases and 1,083 control subjects from 10 published case-control studies for the -308G>A polymorphism showed that a significantly increased risk was associated with the variant GA+AA genotypes of -238G>A, compared with the GG genotype (odds ratio (OR) 2.60, 95% confidence interval (95% CI) 1.48-4.56), whereas a significantly reduced psoriasis risk was associated with the variant GA+AA genotypes of the -308G>A compared with the GG genotype (OR 0.57, 95% CI 0.45-0.71). Our findings suggest that TNF-alpha -238G>A and -308G>A polymorphisms might be used as biomarkers for psoriasis risk prediction. A single larger study with thousands of subjects and biochemical and biological characterization is warranted to evaluate further the role of -238G>A and -308G>A polymorphisms and psoriasis risk in a population of various ethnicities.
Assuntos
Cordão Nucal , Regiões Promotoras Genéticas , Psoríase/genética , Fator de Necrose Tumoral alfa/genética , Estudos de Casos e Controles , Predisposição Genética para Doença , Genótipo , Psoríase/etiologia , Fatores de RiscoRESUMO
A systematic search of studies of intrapartum management of the nuchal umbilical cord at term found no published controlled studies in this area. A postal survey containing both structured and open questions and a request for local protocols and guidelines was sent to all 637 midwives in 7 maternity units in England. There were 401 (63%) responses. There appeared to be no unit guidelines for this area of practice. Midwife approaches to nuchal cord during birth varied, and included clamping and cutting of loose nuchal cords and a hands-off approach to tight nuchal cords. Reasons for specific actions included doing what had been taught during midwifery training and learning from previous personal experiences. Theories of diffusion of innovation and of planned behaviour may provide a conceptual basis for understanding the adoption of specific practices. Future qualitative and controlled studies are needed to explore the nature and consequences of varying approaches to intrapartum nuchal cord management.