A Study on the Influence of Sensors in Frequency and Time Domains on Context Recognition.

Adaptive AI for context and activity recognition remains a relatively unexplored field due to difficulty in collecting sufficient information to develop supervised models. Additionally, building a dataset for human context activities "in the wild" demands time and human resources, which explains the lack of public datasets available. Some of the available datasets for activity recognition were collected using wearable sensors, since they are less invasive than images and precisely capture a user's movements in time series. However, frequency series contain more information about sensors' signals. In this paper, we investigate the use of feature engineering to improve the performance of a Deep Learning model. Thus, we propose using Fast Fourier Transform algorithms to extract features from frequency series instead of time series. We evaluated our approach on the ExtraSensory and WISDM datasets. The results show that using Fast Fourier Transform algorithms to extract features performed better than using statistics measures to extract features from temporal series. Additionally, we examined the impact of individual sensors on identifying specific labels and proved that incorporating more sensors enhances the model's effectiveness. On the ExtraSensory dataset, the use of frequency features outperformed that of time-domain features by 8.9 p.p., 0.2 p.p., 39.5 p.p., and 0.4 p.p. in Standing, Sitting, Lying Down, and Walking activities, respectively, and on the WISDM dataset, the model performance improved by 1.7 p.p., just by using feature engineering.

Blocking the HGF-MET pathway induces resolution of neutrophilic inflammation by promoting neutrophil apoptosis and efferocytosis.

Inflammation resolution is an active process that involves cellular events such as apoptosis and efferocytosis, which are key steps in the restoration of tissue homeostasis. Hepatocyte growth factor (HGF) is a growth factor mostly produced by mesenchymal-origin cells and has been described to act via MET receptor tyrosine kinase. The HGF/MET axis is essential for determining the progression and severity of inflammatory and immune-mediated disorders. Here, we investigated the effect of blocking the HGF/MET signalling pathway by PF-04217903 on the resolution of established models of neutrophilic inflammation. In a self-resolving model of gout induced by MSU crystals, HGF expression on periarticular tissue peaked at 12 h, the same time point that neutrophils reach their maximal accumulation in the joints. The HGF/MET axis was activated in this model, as demonstrated by increased levels of MET phosphorylation in neutrophils (Ly6G+ cells). In addition, the number of neutrophils was reduced in the knee exudate after PF-04217903 treatment, an effect accompanied by increased neutrophil apoptosis and efferocytosis and enhanced expression of Annexin A1, a key molecule for inflammation resolution. Reduced MPO activity, IL-1ß and CXCL1 levels were also observed in periarticular tissue. Importantly, PF-04217903 reduced the histopathological score and hypernociceptive response. Similar findings were obtained in LPS-induced neutrophilic pleurisy. In human neutrophils, the combined use of LPS and HGF increased MET phosphorylation and provided a prosurvival signal, whereas blocking MET with PF-04217903 induced caspase-dependent neutrophil apoptosis. Taken together, these data demonstrate that blocking HGF/MET signalling may be a potential therapeutic strategy for inducing the resolution of neutrophilic inflammatory responses.

Escala Interativa de Amamentação: avaliação da confiabilidade / Escala Interactiva de la Lactancia Materna: evaluación de la confiabilidade / Interactive Breastfeeding Scale: reliability assessment

Resumo Objetivo avaliar a confiabilidade da Escala Interativa de Amamentação. Método estudo metodológico, que seguiu a terceira etapa do método de Pasquali para elaboração de escalas, desenvolvido com 216 puérperas, em hospital universitário da região Sudeste do Brasil. Para avaliação da confiabilidade, foram utilizados o percentual de concordância (pa) acima de 80%, o Kappa ponderado (Kp), a second-order agreement coefficient (AC2) de Gwet e o alfa de Cronbach. Resultados o percentual de concordância dos itens foi de 83,33%; o valor global do alfa de Cronbach foi de 0,67; o coeficiente AC2 com ponderações quadrática e linear obteve a confiabilidade quase perfeita. Conclusão e implicação para a prática a avaliação da confiabilidade da Escala Interativa de Amamentação foi alta, e foi confirmada pelos resultados que asseguram a qualidade do instrumento na população estudada, mostrando-se um instrumento confiável e válido para avaliar os fatores que interferem na interação mãe-filho durante a amamentação.

Resumen Objetivo evaluar la confiabilidad de la Escala Interactiva de Lactancia Materna. Método estudio metodológico, que siguió el tercer paso del método Pasquali para la elaboración de escalas, desarrollado con 216 puérperas, en un hospital universitario de la región Sureste de Brasil. Para evaluar la confiabilidad, se utilizaron el porcentaje de concordancia (pa) por encima del 80%, el Kappa ponderado (Kp), el coeficiente de concordancia de segundo orden (AC2) de Gwet y el alfa de Cronbach. Resultados el porcentaje de concordancia fue del 83,33%; el valor global del alfa de Cronbach fue de 0,67; el coeficiente AC2 con pesos cuadráticos y lineales obtuvo una confiabilidad casi perfecta. Conclusión e implicación para la práctica la evaluación de la confiabilidad de la Escala Interactiva de Lactancia Materna fue alta, y fue confirmada por los resultados que aseguran la calidad del instrumento en la población estudiada, demostrando ser un instrumento confiable y válido para evaluar los factores que interfieren en la interacción madre-hijo durante la lactancia.

Abstract Objective to assess the Interactive Breastfeeding Scale reliability. Method a methodological study that followed the third stage of Pasquali's method for the elaboration of scales, carried out with 216 postpartum women at a university hospital in southeastern Brazil. To assess reliability, percentage of agreement (pa) above 80%, the weighted Kappa (Kp), Gwet's second-order agreement coefficient (AC2) and Cronbach's alpha were used. Results the percentage of agreement was 83.33%; the overall Cronbach's alpha value was 0.67; the AC2 coefficient with quadratic and linear weights obtained near-perfect reliability. Conclusion and implication for practice the Interactive Breastfeeding Scale reliability assessment was high, and it was confirmed by the results that ensure instrument quality in the population studied, proving to be a reliable and valid instrument to assess factors that interfere in the mother-child interaction while breastfeeding.

Artificial Intelligence in Dermatology: Challenges and Perspectives.

Artificial intelligence (AI) based on machine learning and convolutional neuron networks (CNN) is rapidly becoming a realistic prospect in dermatology. Non-melanoma skin cancer is the most common cancer worldwide and melanoma is one of the deadliest forms of cancer. Dermoscopy has improved physicians' diagnostic accuracy for skin cancer recognition but unfortunately it remains comparatively low. AI could provide invaluable aid in the early evaluation and diagnosis of skin cancer. In the last decade, there has been a breakthrough in new research and publications in the field of AI. Studies have shown that CNN algorithms can classify skin lesions from dermoscopic images with superior or at least equivalent performance compared to clinicians. Even though AI algorithms have shown very promising results for the diagnosis of skin cancer in reader studies, their generalizability and applicability in everyday clinical practice remain elusive. Herein we attempted to summarize the potential pitfalls and challenges of AI that were underlined in reader studies and pinpoint strategies to overcome limitations in future studies. Finally, we tried to analyze the advantages and opportunities that lay ahead for a better future for dermatology and patients, with the potential use of AI in our practices.

Artificial intelligence (AI) is the development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, and translation between languages. The research on the use of AI in dermatology includes the ability of a machine to correctly classify a skin lesion. Skin cancer is the most common cancer worldwide and melanoma is the deadliest form of skin cancer. All skin cancers have a better prognosis when detected early in their development, hence their early detection is of paramount importance. Dermatologists use a dermatoscope­a specialized magnifying lens to improve their diagnostic capacity. However, even with the use of the dermatoscope, their ability to recognize skin cancer is far from perfect. AI has the ability to learn from dermoscopic images and subsequently provide an image-based diagnosis. Several studies compared the performance of machines and humans in classifying skin lesions from these images and showed that machines can classify skin lesions as good (and sometimes better) than humans. However, the application of AI in everyday clinical practice remains a challenge. In this article, we attempt to summarize the limitations and challenges that researchers found in their studies, and we provide strategies to improve the design of future studies. Finally, we describe the advantages and opportunities that could lay ahead for a better future for dermatology and patients.

Influence of drug-related problems on length of hospital stay of women with a history of preeclampsia: A multicenter study.

BACKGROUND: Approximately 5-7 % of pregnant women have hypertension during pregnancy, requiring antihypertensive drug treatment. There have been a lack of studies evaluating how drug-related problems (DRPs) affect morbidity or mortality in the postpartum period among women with a history of preeclampsia. OBJECTIVE: To determine the influence of drug-related problems on length of hospital stay of postpartum women with a history of preeclampsia. METHODS: This cross-sectional study included postpartum women diagnosed with preeclampsia, from June to November 2016, in two teaching maternity hospitals in Brazil. The outcomes assessed were, length of hospital stay of postpartum women. The DRPs were classified through the Pharmaceutical Care Network Europe Foundation (PCNE) v 8.01. RESULTS: 600 women were included, and 354 (59%) were exposed to at least one DRP. The most frequent DRPs were no administration of the prescribed medication, lack of prescription of a medication, although the indication was clear, and ineffectiveness (unknown reason). In patients exposed to DRP, the average length of hospital stay after labour was 5.4 (S.D. 3.6) days versus 4.4 (S.D. 3.3) days in patients non-exposed to DRP (p = 0.0001). The period (in days) to achieve blood pressure control after labour was 4.5 (S.D. 3.5) 3.5 (S.D. 3.2), respectively (p = 0.0001). There were no deaths during the study. CONCLUSION AND RELEVANCE: Drug-related problems significantly increased the length of hospital stay in postpartum women with a history of preeclampsia.

Medication use during pregnancy in patients attended at public and private prenatal care in Aracaju, Sergipe / Uso de medicamentos na gestação em pacientes atendidas no pré-natal público e privado de Aracaju, Sergipe / Uso de medicación durante el embarazo por pacientes atendidas en servicios prenatales públicos y privados en Aracaju, Sergipe

This study aimed to analyze the medications used by pregnant women in public and private prenatal care in Aracaju, Sergipe. We conducted a cross-sectional study at three public health care services and two private services that offered prenatal appointments. This study was based on interview, drugs classification and statistical analysis. At the public service, 15.49% (33) of pregnant women declared self-medication; 52.58% (112) used just one class; 42.25% (90) used class B. At the private service, 19.38% (25) declared self-medication; 44.19% (57) used three classes; 36.43% (47) used class C. Among pregnant women at the public service, we noticed statistical significance between self-medication/gestational age during interview, self-medication/number of prenatal appointments, self-medication/professional performer, information about medications/number of pregnancies, number of used drugs/professional performer. At the private service, between self-medication/occupation, number of used drugs/gestational age during interview. Thus, self-medication was not prevalent in this study. Moreover, the highest drugs use occurred in the first trimester of pregnancy, and the predominant outcome was relief of symptoms. Pregnant women at the private service showed more self-medication than those at the public service.

Este estudo teve como objetivo analisar os medicamentos utilizados por gestantes nos serviços de pré-natal público e privado em Aracaju, Sergipe. Trata-se de um estudo transversal, conduzido em três serviços públicos de saúde e em dois privados, que ofereciam consultas de pré-natal. Este trabalho foi baseado em entrevistas, classificação de medicamentos e análise estatística. No serviço público, 15,49% (33) das gestantes declararam automedicação; 52,58% (112) utilizaram apenas uma classe; 42,25% (90) utilizavam classe B. No serviço privado, 19,38% (25) declararam automedicação; 44,19% (57) usaram três classes; 36,43% (47) usavam a classe C. Na entrevista realizada com as gestantes do serviço público, notou-se significância estatística entre automedicação/idade gestacional, automedicação/número de consultas de pré-natal, automedicação/profissional executante, informações sobre medicamentos/número de gestações e número de medicamentos utilizados/profissional executante. No serviço privado, a significância foi entre automedicação/ocupação e número de medicamentos utilizados/idade gestacional durante a entrevista. Assim, a automedicação não era prevalente. Além disso, o maior uso de drogas ocorreu no primeiro trimestre da gravidez e o desfecho predominante foi o alívio dos sintomas. As gestantes do serviço privado apresentaram maior prevalência de automedicação do que as usuárias do serviço público.

Este estudio tuvo como objetivo analizar los fármacos utilizados por las embarazadas en los servicios de atención prenatal públicos y privados de Aracaju, en Sergipe (Brasil). Se trata de un estudio transversal, realizado en tres servicios de salud pública y dos privados, que ofrecieron consultas prenatales. Este trabajo se basó en entrevistas, la clasificación de fármacos y el análisis estadístico. En el servicio público, el 15,49% (33) de las embarazadas declaró automedicarse; el 52,58% (112) utilizó una sola clase; y el 42,25% (90) utilizó la clase B. En el servicio privado, el 19,38% (25) declaró automedicarse; el 44,19% (57) utilizó tres clases; y el 36,43% (47) utilizó la clase C. Los resultados de las entrevistas con las gestantes del servicio público mostraron que hubo significación estadística entre automedicación/edad gestacional, automedicación/número de consultas prenatales, automedicación/profesional ejecutante, información sobre medicamentos/número de embarazos, y número de medicamentos utilizados/profesional ejecutante. En el servicio privado, se encontró significancia entre automedicación/ocupación, y número de fármacos consumidos/edad gestacional durante la entrevista. Por lo tanto, la automedicación no era frecuente. Además, el mayor uso de fármacos ocurrió en el primer trimestre del embarazo; y el resultado principal fue el alivio de los síntomas. Las mujeres embarazadas del servicio privado se automedicaban más que las usuarias del servicio público.

Cuidados cirúrgicos durante a pandemia mundial do COVID-19: rotinas alternativas para minimizar os riscos / Surgical care during worldwide COVID-19 pandemic: alternative routines aimed at minimizing the risks

A pandemia do COVID-19, causada por um novo coronavírus, tem preocupado autoridades e profissionais da saúde. Pouco se sabe ainda sobre a doença ou seu agente etiológico, motivo pelo qual muitas das condutas tomadas são empíricas. Os profissionais de saúde envolvidos no cuidado cirúrgico estão sujeitos a um grande risco, devido à exposição a diversos tipos de secreção. Os pacientes cirúrgicos também estão expostos a um risco elevado de contraírem a doença no pós-operatório, com repercussão na morbi-mortalidade. Portanto, alguns cuidados são fundamentais na prevenção, tanto para profissionais quanto para pacientes. Muitos serviços estão desenvolvendo seus próprios protocolos, com algumas diferenças, tendo em vista o baixo nível de evidência para as recomendações. Neste artigo apresentaremos algumas condutas sugeridas para o cuidado no pré, per e pós-operatório, de forma a minimizar os riscos envolvidos.

The increasing pandemic of COVID-19, caused by a new coronavirus, has challenged authorities and health care professionals. Most preventive measures are empirical, due to the small amount of information on the disease and etiological agent so far. Surgical care professionals are exposed to a greater risk, owing to manipulation of all kind of discharge. Surgical patients are also at risk of developing this condition post-operatively, increasing their morbi-mortality. Hence, preventive care is vital both for professionals and patients. Each surgical team is developing its own protocol, with some differences between them, due to the low level of evidence for the recommendation. In this article we will present some suggested measures for the pre, per and post-operative care, in order to minimize the risks involved.

COVID-19 information exposure in digital media and implications for employees in the health care sector: findings from an online survey.

OBJECTIVE: To estimate coronavirus disease 2019-related information consumption and related implications for health care professionals (medical and nonmedical personnel) during the pandemic. METHODS: A cross-sectional on-line survey was distributed to employees of a major health care institution located in São Paulo, Brazil between April 3 and April 10, 2020. Data were analyzed using descriptive statistics. RESULTS: The sample comprised 2,646 respondents. Most participants (44.4%) reported excessive or almost excessive access to information about the novel coronavirus and 67.6% reported having increased their average time spent on social media. When asked how frequently they consider it was easy to determine the reliability of information, "sometimes" corresponded to 43.2% of the answers in contrast to 14.6% responding "always". Answers related to potential signs of information overload associated with the pandemic indicated that 31% of respondents felt stressed by the amount of information they had to keep up with almost every day or always. Overall, 80.0% of respondents reported having experienced at least one of the following symptoms: headache, eye twitching, restlessness or sleeping difficulty. The frequency of symptoms was higher among participants with a more negative information processing style regarding when dealing with large volumes of information relative to those with a positive information processing style. Likewise, symptoms were more frequently reported by participants who had increased their social media access relative to those reporting reduced access during the pandemic. CONCLUSION: Our survey provides a description of how health professionals consume COVID-19 related information during the pandemic, and suggests that excessive information exposure and high processing demands may impose psychological distress and affect mental health.

Cap-assisted endoscopy increases ampulla of Vater visualization in high-risk patients.

BACKGROUND: Periampullary adenocarcinoma is a major clinical problem in high-risk patients including FAP population. A recent modification for visualizing the ampulla of Vater (AV) involves attaching a cap to the tip of the forward-viewing endoscope. Our aim was to compare the rates of complete visualization of AV using this cap-assisted endoscopy (CAE) approach to standard forward-viewing endoscopy (FVE). We also determined: (i) the rates of complications and additional sedation; (ii) the mean time required for duodenal examination; and (iii) the reproducibility among endoscopists performing this procedure. METHODS: We performed esophagogastroduodenoscopy for AV visualization in 102 > 18 years old using FVE followed by CAE. Video recordings were blinded and randomly selected for independent expert endoscopic evaluation. RESULTS: The complete visualization rate for AV was higher in CAE (97.0%) compared to FVE (51.0%) (p <  0.001). The additional doses of fentanyl, midazolam, and propofol required for CAE were 0.05, 1.9 and 36.3 mg. in 0.9, 24.5, and 77.5% patients, respectively. The mean time of duodenal examination for AV visualization was lower on CAE compared to FVE (1.41 vs. 1.95 min, p <  0.001). Scopolamine was used in 34 FVE and 24 CAE, with no association to AV complete visualization rates (p = 0.30 and p = 0.14). Three more ampullary adenomas were detected using CAE compared to FVE. Cap displacement occurred in one patient, and there was no observed adverse effect of the additional sedatives used. Kappa values for agreement between endoscopists ranged from 0.60 to 0.85. CONCLUSIONS: CAE is feasible, reproducible and safe, with a higher success rate for complete visualization compared to FVE. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02867826 , 16 August 2016.

Synthesis, crystal structure and leishmanicidal activity of new trimethoprim Ru(III), Cu(II) and Pt(II) metal complexes.

Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania, which has very limited treatment options and affects poor and underdeveloped populations. The current treatment is plagued by many complications, such as high toxicity, high cost and resistance to parasites; therefore, novel therapeutic agents are urgently needed. Herein, the synthesis, characterization and in vitro leishmanicidal potential of new complexes with the general formula [RuCl3(TMP)(dppb)] (1), [PtCl(TMP)(PPh3)2]PF6 (2) and [Cu(CH3COO)2(TMP)2]·DMF (3) (dppb = 1,4-bis(diphenylphosphino)butane, PPH3 = triphenylphosphine and TMP = trimethoprim) were evaluated. The complexes were characterized by infrared, UV-vis, cyclic voltammetry, molar conductance measurements, elemental analysis and NMR experiments. Also, the geometry of (2) and (3) were determined by single crystal X-ray diffraction. Despite being less potent against promastigote L. amazonensis proliferation than amphotericin B reference drug (IC50 = 0.09 ± 0.02 µM), complex (2) (IC50 = 3.6 ± 1.5 µM) was several times less cytotoxic (CC50 = 17.8 µM, SI = 4.9) in comparison with amphotericin B (CC50 = 3.3 µM, SI = 36.6) and gentian violet control (CC50 = 0.8 µM). Additionally, complex (2) inhibited J774 macrophage infection and amastigote number by macrophages (IC50 = 6.6 and SI = 2.7). Outstandingly, complex (2) was shown to be a promising candidate for a new leishmanicidal therapeutic agent, considering its biological power combined with low toxicity.

COVID-19 information exposure in digital media and implications for employees in the health care sector: findings from an online survey / Exposição às informações sobre COVID-19 em mídias digitais e suas implicações para funcionários do setor de saúde: resultados de uma pesquisa on-line

ABSTRACT Objective: To estimate coronavirus disease 2019-related information consumption and related implications for health care professionals (medical and nonmedical personnel) during the pandemic. Methods: A cross-sectional on-line survey was distributed to employees of a major health care institution located in São Paulo, Brazil between April 3 and April 10, 2020. Data were analyzed using descriptive statistics. Results: The sample comprised 2,646 respondents. Most participants (44.4%) reported excessive or almost excessive access to information about the novel coronavirus and 67.6% reported having increased their average time spent on social media. When asked how frequently they consider it was easy to determine the reliability of information, "sometimes" corresponded to 43.2% of the answers in contrast to 14.6% responding "always". Answers related to potential signs of information overload associated with the pandemic indicated that 31% of respondents felt stressed by the amount of information they had to keep up with almost every day or always. Overall, 80.0% of respondents reported having experienced at least one of the following symptoms: headache, eye twitching, restlessness or sleeping difficulty. The frequency of symptoms was higher among participants with a more negative information processing style regarding when dealing with large volumes of information relative to those with a positive information processing style. Likewise, symptoms were more frequently reported by participants who had increased their social media access relative to those reporting reduced access during the pandemic. Conclusion: Our survey provides a description of how health professionals consume COVID-19 related information during the pandemic, and suggests that excessive information exposure and high processing demands may impose psychological distress and affect mental health.

RESUMO Objetivo: Estimar o consumo de informações relacionadas com doença do novo coronavírus e seus efeitos em profissionais do setor da saúde durante a pandemia. Métodos: Um questionário on-line foi distribuído para funcionários de uma instituição de saúde em São Paulo, Brasil, entre 3 e 10 de abril de 2020. Os dados foram analisados com estatísticas descritivas. Resultados: Foram incluídos nas análises 2.646 participantes. A maioria (44,4%) reportou ter acessado uma quantidade excessiva ou próxima de excessiva sobre o novo coronavírus, e 67,6% reportaram ter aumentado seu tempo médio em mídias sociais. Quando perguntados se era fácil determinar o que era informação confiável, 43,2% responderam "às vezes", comparados com 14,6% que responderam "sempre". Sobre os possíveis sinais de sobrecarga de informação associada com a pandemia, 31% sempre ou quase todos os dias se sentiram estressados com a quantidade de informações que tinham que acompanhar. Entre os respondentes, 80,0% reportaram sentir pelo menos um sintoma como dor de cabeça, espasmos oculares, inquietação ou dificuldade para dormir. Participantes com um estilo mais negativo de lidar com muitas informações também reportaram maior proporção de sintomas que os participantes com estilo positivo. De forma semelhante, participantes que aumentaram seu acesso a mídias sociais reportaram maior proporção de sintomas do que os que diminuíram seu acesso durante a pandemia. Conclusão: Nossa pesquisa fornece uma descrição de como os indivíduos consomem informações relacionadas com a doença do novo coronavirus durante a pandemia e sugere que a exposição a uma quantidade excessiva de informações e as elevadas demandas podem impor sofrimento psicológico e afetar a saúde mental.

Grau de conhecimento das gestantes do serviço público sobre parto humanizado / Level of knowledge of pregnant women in the public service about humanized birth

INTRODUÇÃO: A conscientização das gestantes é fundamental para experiências positivas de parto. OBJETIVO: Avaliar o grau de conhecimento das gestantes em dois serviços públicos sobre parto humanizado. Caracterizar epidemiologicamente a população estudada. MÉTODOS: Estudo descritivo realizado entre julho e agosto de 2017. Amostra com 297 gestantes foram selecionadas 200 após aplicação dos critérios de exclusão. Utilizados testes estatísticos de associações de variáveis (Qui-quadrado e Exato de Fisher). RESULTADOS: A média de idade das gestantes foi 26,6 anos. A maioria era procedente do interior do estado (72,5%), com renda até um salário mínimo (90,5%), e com mais de oito anos de estudo (62,5%). 71% iniciaram pré-natal até o primeiro trimestre e o pré-natal foi conduzido por médico em 72% dos casos. 71% preferiam parto normal e 44% tinha medo de cesárea. Profissional pré-natalista não ofereceu informações para 66,5%. 30,5% conhecia parto humanizado, destas 83,6% apresentaram conceito adequado. Houve associação entre conhecimento sobre parto humanizado e procedência (Aracaju) (p=0,03), maior renda (p=0,02), menor ocorrência de aborto (p=0,04), médico pré-natalista (p=0,04) preferência pelo parto vaginal (p=0,04). Dentre as que não conheciam o parto humanizado houve associação de respostas corretas com a maior renda (p=0,03) e anos estudados (p=0,02) e médico pré-natalista (p=0,01). CONCLUSÃO: A maioria desconhecia o parto humanizado, era procedente do interior com menor renda, preferência por parto normal, sem informações quanto aos tipos de parto pelo profissional executante (na maioria médicos), quem conhecia adequadamente. Conceitos adequados sobre parto humanizado mesmo na ausência de informação prévia associaram-se às variáveis socioeconômico e pré-natal.

INTRODUCTION: The awareness of pregnant women is fundamental to positive birth experiences. OBJECTIVE: To analyze the level of knowledge on humanized birth of pregnant women from two public services and characterize the sample epidemiologically. METHODS: Descriptive study using questionnaire between June and August 2017. Sample with 297 pregnant women being selected 200 after applying the exclusion criteria. Association test of variables were used (Chi-square and Fisher's exact test). RRESULTS: Mean age was 26.6 years. Majority were from countryside (72.5%), income up to a minimum wage (90.5%) and more of eight years of education (62.5%). 71% started prenatal care in the first trimester and it was conducted by physician in 71% of cases. 71% preferred vaginal delivery and 44% related fear of cesarean. Prenatal professional in charge did not provide information for 66.5%. 30.5% have heard about humanized childbirth, among these, 83.6% showed adequate concepts. Associations were observed between prior knowledge of humanized childbirth and origin (Aracaju) (p=0.03), higher income (p=0.02), lower abortion incidence (p=0.04), prenatal physician (p=0.04) and preference for normal childbirth (p=0.04). Among women without previous knowledge on humanized childbirth there association of correct concept with higher income (p=0.03), schooling (p=0.02) and prenatal physician (p=0.01). CONCLUSION: The majority did not know about humanized delivery, were from the countryside with lower income, preference for normal birth, were not informed on the types of delivery by the professional practitioner (in majority doctors), whom knew properly. Adequate concepts about humanized childbirth, even in the absence of prior information, were associated to socio-economic and prenatal variables.

Lactation performance of dairy cows fed rehydrated and ensiled corn grain differing in particle size and proportion in the diet.

Rehydrated and ensiled mature ground corn has high ruminal starch digestibility, but particle size (PS) and dietary starch proportion (ST) can affect starch digestion and lactating cow performance. We evaluated the effect of rehydrated and ensiled corn (REC), PS, and ST on intake, lactation performance, nutrient digestibility, ruminal fermentation profile, and chewing behavior of dairy cows. Kernels from an 84% vitreousness hybrid were finely (FN) or coarsely (CS) ground, yielding geometric mean particle sizes of 1,591 and 2,185 µm, respectively. Ground kernels were rehydrated [60% dry matter (DM)] and ensiled in 200-L buckets for ≥205 d. The grinding rate (t/h) was 3.9 for FN and 11.7 for CS. The PS did not affect DM loss (11.3% of ensiled) or silage pH (3.8). Samples of each bucket (n = 15/PS) before and after silage fermentation were incubated in situ for 0, 3, 6, 18, and 48 h in 4 rumen-cannulated lactating cows. Ensiling increased the effective ruminal in situ DM degradation (63.7 vs. 34.1%), regardless of PS. Sixteen Holstein cows (152 ± 96 d in milk) in 4 × 4 Latin squares (21-d periods) were individually fed a 2 × 2 factorial combination of low (LO) or high (HI) starch diets with FN or CS. Cows were fed the same REC incubated in situ. Varied concentration of starch in the diet (29.2 vs. 23.5% of DM) was achieved by partial replacement of REC (22.0 vs. 14.2% of DM) with citrus pulp (0 vs. 8.2% of DM). Milk, protein, fat, and lactose yields did not differ. Milk fat percentage was reduced and protein percentage was increased by HI. Treatment FN increased feed efficiency (energy-corrected milk/digestible organic matter intake) when fed with HI. Total-tract starch digestibility tended to be reduced by CS (96.4 vs. 97.2% of starch intake). Serum ß-hydroxybutyrate was increased by LO. High-starch diet reduced the molar proportions of acetate and butyrate in ruminal fluid and increased propionate and isoacids. Particle size did not affect ruminal fermentation profile. Coarse grinding reduced plasma d-lactate concentration with HI. Diet HI reduced the proportion of daily intake from 1900 to 0700 h and induced preferential intake of feed particles <8 mm and greater refusal of particles >19 mm in the morning. Fine REC reduced rumination time per day and increased eating time per DM intake. Milk and plasma urea-N did not differ. Ensiling of mature flint corn for >200 d largely eliminated the effect of the PS of REC on the studied outcomes. The proportion of REC in the diet affected ruminal fermentation profile and milk solids concentration, but did not affect short-term performance and digestibility. Coarse grinding of REC may allow increasing the grinding rate and thus save labor and energy during ensiling.

Uterine alterations in women undergoing routine hysteroscopy before in vitro fertilization: high prevalence of unsuspected lesions.

OBJECTIVE: The aim of this study was to verify the prevalence of uterine cavity abnormalities diagnosed by routine office hysteroscopy in women preparing to IVF. METHODS: We carried out a retrospective cross-sectional study of 1141 consecutive women who underwent outpatient hysteroscopy before IVF at a tertiary academic center. Of these, 961 participants had a normal transvaginal sonography (TVS) of the uterine cavity. The prevalence of hysteroscopic alterations in successive age strata was submitted to Mantel-Haenzsel Chi-square test for linear trend. The diagnostic accuracy of TVS using hysteroscopy as reference was assessed by calculating the sensitivity, specificity, positive and negative likelihood ratios. RESULTS: Hysteroscopic alterations were present in 265/961 of patients with a negative TVS (prevalence 27.6%, 95% confidence interval [CI] 24.8%-30.5%). The prevalence of unsuspected submucous leiomyoma was higher among older women (p=0.005, chi-square test for linear trend) and reached 7.2% (95% CI 3.5%-14.1%) after 40 years. The sensitivity of TVS ranged from 8% (95% CI 2%-20%) for uterine synechiae to 41% (95% CI 28%-56%) for submucous leiomyoma, resulting in low likelihood ratios for negative TVS results. CONCLUSIONS: These findings suggest a high prevalence of unsuspected alterations found by routine hysteroscopy before IVF, an age-dependent increase in the frequency of submucous leiomyoma and a low diagnostic sensitivity of TVS to detect intracavitary lesions.

C-type natriuretic peptide signaling in human follicular environment and its relation with oocyte maturation.

Studies in mice have shown that C-type natriuretic peptide (CNP) is produced by granulosa cells and contributes to ovarian follicle growth and oocyte meiotic arrest until the preovulatory LH surge. In humans, the relationship between intraovarian CNP levels and oocyte meiotic resumption is unknown. The aim of this study was to investigate whether CNP and its receptor NPR2 are expressed in human ovarian follicles and if their levels change according to the meiotic phase of oocytes. We collected follicular fluid (FF) and luteinized granulosa cells (LGC) from follicle pools (n = 47), and FF, LGC and cumulus cells (CC) from individual follicles (n = 96) during oocyte pickup for in vitro fertilization. There was a positive linear correlation between CNP levels in FF pools and basal antral follicle counting (rs = 0.458; p = 0.002), number of preovulatory follicles >16 mm (rs = 0.361; p = 0.016) and number of oocytes retrieved (rs = 0,378; p = 0.011) and a negative correlation between CNP levels in FF pools and the percentage of mature (MII) oocytes retrieved (rs = -0.39; p = 0.033). FF CNP levels in follicles containing MII oocytes were significantly lower than in follicles containing immature (MI) oocytes (median = 0.44 vs. 0.57 ng/mL, p < 0.05). Accordingly, the CNP precursor gene NPPC was 50% less expressed in LGC from follicles containing MII oocytes than in follicles containing MI oocytes (p < 0.01). In addition, NPR2 mRNA was down-regulated in CC surrounding MII oocytes (60% reduction, p < 0.01). CNP signaling is downregulated in human ovarian follicles containing mature oocytes. Further studies should clarify whether CNP signaling is essential to keep oocyte meiotic arrest in humans.

Pro-apoptotic activity of ruthenium 1-methylimidazole complex on non-small cell lung cancer.

Herein, novel ruthenium(II) complexes containing 1-methylimidazole as a ligand were obtained with the following formulas: [RuCl(1Meim)(dppb)(bpy)]Cl (1), [RuCl(1Meim)(dppb)(4,4'-DMbpy)]Cl (2), [RuCl(1Meim)(dppb)(5,5'-DMbpy)]Cl (3) and [RuCl(1Meim)(dppb)(phen)]Cl (4) where, 1Meim = 1-methylimidazole, dppb = 1,4-Bis(diphenylphosphino)butane, bpy = 2,2'-bipyridine, 4,4'-DMbpy = 4,4'-dimethyl-2,2'-bipyridine, 5,5'-DMbpy = 5,5'-dimethyl-2,2'-bipyridine and phen = 1,10-phenanthroline. Additionally, crystal structures containing the cations of (1) and (3) were obtained when the counter ion was exchanged, leading to the formation of [RuCl(1Meim)(dppb)(bpy)]PF6 (5) and [RuCl(1Meim)(dppb)(5,5'-DMbpy)]PF6 methanol solvate (6) where PF6 = hexafluorophosphate, showing one 1-methylimidazole molecule coordinated through the imidazole nitrogen, as expected. The complexes were characterized by elemental analysis, molar conductivity, infrared and UV-Vis spectroscopy, 1H, 13C{1H} and 31P{1H} NMR, mass spectrometry and cyclic voltammetry. The interactions of complexes 1-4 with DNA and human serum albumin (HSA) were evaluated, and the cytotoxicity profiles of compounds 1-4 were determined using four different tumor cell lines derived from human cancers (melanoma: HT-144, colon: HCT-8, breast: MDA-MB-231 and lung: A549). A higher cytotoxic activity was observed for compound (3) against non-small cell lung cancer (A549). Complex (3) inhibited the clonogenic capacity and cell cycle progression of A549 cells and induced apoptosis involving mitochondrial pathway activation. Therefore, the data obtained in the present study support further investigations concerning molecular targets of complex (3) in non-small cell lung cancer.

Analysis of database about vaccination against Human Papillomavirus in Sergipe in 2014 / Análise do banco de dados referente à vacinação contra papilomavírus humano no estado de Sergipe no ano de 2014

Introduction: The development of the Human papillomavirus vaccine has created the possibility of action at the primary level for the prevention of cervical cancer and precancerous lesions. Objective: To analyze the data obtained by the introduction of the vaccine against papillomavirus in the state of Sergipe, quantifying the sampling population of girls met in 2014 and quantify the hit target by each micro-region of the state. Methods: Cross-sectional analysis, descriptive with retrospective component, using only secondary data from the Health State Department - Sergipe, concerning the vaccination coverage of vaccine against human papillomavirus from March 2014 to December 2014 in 11 to 13-year-old girls. Wilcoxon test was used for mean differences in the paired regions, ages and both. Results: In the analysis of the study period, a total population of 11 to 13-year-old girls, 61785 received the first dose of the vaccine (D1), reaching a 103.25% coverage and, 30,561 of these received the second dose of vaccine, resulting in a 56.26% coverage. In all analyzed regions decreasing doses applied between the first (D1) and the second dose (D2) were found. In this analysis, the confidence interval to 95% were all small and all data were analyzed statistically significant at p<0.001. Conclusion: All micro-regions reached the vaccination goal of the State Departament of Health in the application of the first doses and two of them were above the national average. However, none reached the target in the second dose, four micro-regions were below the national average and tree above. The age group of 12 years was the only one to not reach the goal neither in the first nor in the second dose.

Introdução: O desenvolvimento da vacina contra o Papilomavírus humano criou a possibilidade de agir a nível primário na prevenção de câncer cervical e lesões pré-cancerosas. Objetivo: Analisar os dados obtidos através da instituição da vacina contra o Papilomavirus no estado de Sergipe, quantificando amostralmente a população de meninas atendidas no ano de 2014 e quantificar a meta atingida por cada microrregião do estado. Métodos: Análise de corte transversal, descritiva, com componente retrospectivo, utilizando-se exclusivamente dados secundários provenientes da Secretaria Estadual de Saúde - Sergipe, referentes à cobertura vacinal contra o papilomavirus humano no ano de 2014 em meninas de 11 a 13 anos de idade. Foi utilizado o teste de Wilcoxon para diferenças de médias pareadas nas regiões, nas idades e em ambos. Resultados: No período de análise do estudo, de uma população total de meninas na faixa etária de 11 a 13 anos, 61.785 receberam a primeira dose da vacina (D1), atingindo uma cobertura de 103,25% e destas, 30.561 receberam a segunda dose da vacina gerando uma cobertura de 56,26%. Em todas as regiões analisadas foram encontradas diminuição de doses aplicada entre a primeira (D1) e a segunda dose (D2). Nesta análise, o intervalo de confiança para 95% foram todos pequenos e todos os dados analisados foram estatisticamente significantes com p<0,001. Conclusão: Todas as microrregiões atingiram a meta de vacinação da Secretaria Estadual de Saúde na aplicação das primeiras doses, duas delas ficaram acima da média nacional. No entanto, nenhuma atingiu a meta na segunda dose, quatro microrregiões ficaram abaixo da média nacional e três acima. A faixa etária de de 12 anos foi a única que não alcançou a meta vacinal nem na primeira, nem na segunda dose.

Yeast culture increased plasma niacin concentration, evaporative heat loss, and feed efficiency of dairy cows in a hot environment.

The supplementation of dairy cows with yeast culture may increase diet digestibility, plasma niacin concentration, heat dissipation, and lactation performance. Our objective was to evaluate the response of Holstein cows in late lactation (234 ± 131 d in milk) to dead yeast culture (YC, 15 g/d, Factor SC, GRASP, Saccharomyces cerevisiae) during Brazilian summer (temperature-humidity index >68 for 92.2% of the time). Thirty-two cows were individually fed a standard total mixed ration for 14 d and control (CTL) or YC treatments for 35 d, in a covariate adjusted complete randomized block design. Response was evaluated in wk 5 or as repeated measures over time. Cows were milked 3 times per day and treatments (YC or placebo) were orally dosed to each cow before each milking. Plasma niacin was 1.50 for CTL and 1.66 µg/mL for YC. The YC reduced rectal temperature, respiration rate, and skin temperature, whereas it tended to increase sweating rate. The proportion of cows with rectal temperature ≥39.2°C on CTL and YC was, respectively, 8 and 0% at 0730 h, 52 and 25% at 1500 h, and 35 and 26% at 2200 h. Plasma glucose was increased by YC. The total-tract apparent digestibility of nutrients, plasma urea N concentration, molar proportion of ruminal VFA, and urinary allantoin excretion were not affected by YC. Cows fed YC were less selective against feed particles >19 mm in the morning, in the afternoon were more selective against long feed particles and in favor of particles <8 mm, and refused short particles at night. Milk yield was not different (30.5 kg/d for CTL and 30.2 kg/d for YC). Feeding YC reduced dry matter intake (20.3 vs. 19.4 kg/d) and the digestible organic matter intake (15.6 vs. 13.9 kg/d). The inclusion of YC increased the ratios of milk to dry matter intake (1.50 vs. 1.64) and energy-corrected milk to dry matter intake (1.81 vs. 1.98). The covariate adjusted body weight (648 kg) and body condition score (3.0) did not differ. Milk solids yields and concentrations, linear somatic cell count, and milk urea N were also similar. The supplementation of YC increased plasma niacin concentration, body heat loss, and feed efficiency of late lactation dairy cows by reducing intake at similar milk yield.

Vacinação pública contra o papilomavirus humano no Brasil / Vaccination public against human papillomavirus in Brazil

A infecção pelo papilomavirus humano (HPV) está associada a diversas lesões cutaneomucosas, como câncer de colo de útero, vagina, vulva, ânus, laringe, orofaringe e verrugas genitais, sendo o carcinoma invasivo do colo uterino o seu principal desfecho. Estratégias de prevenção da infecção pelo HPV configuram metodologias importantes para reduzir os índices de morbimortalidade associados ao HPV. Desde 2014, o Brasil incorporou a vacinação contra o vírus em seu programa nacional de imunizações, sendo um avanço relevante em políticas públicas. Existem três tipos de vacinas aprovadas pelo FDA (Food and Drug Administration) - bivalente, quadrivalente e nonavalente. A vacina quadrivalente mostrou-se segura e apresentou resultados favoráveis na prevenção de lesões associadas aos sorotipos presentes em sua composição, que são os HPVs 6, 11, 16 e 18. Os tipos 16 e 18 são os mais frequentes em lesões pela infecção por HPV, sendo detectados na maioria dos casos de câncer do colo do útero. O Brasil utiliza a vacina quadrivalente para meninas de 09 a 14 anos de idade e, incorporados em 2017 à população alvo da cobertura vacinal, meninos de 12 a 13 anos de idade também devem ser vacinados. A inserção da vacina quadrivalente no calendário nacional de vacinação marca uma estratégia de prevenção importante contra a infecção persistente e doenças causadas pelos tipos virais específicos da vacina, porém, isso reforça a necessidade de estudos de seguimento populacional para possibilitar o conhecimento do seu verdadeiro impacto para a saúde pública nacional. (AU)

Human papillomavirus (HPV) infection is associated with several cutaneomucous lesions, such as cervical cancer, vagina, vulva, anus, larynx, oropharynx and genital warts, and invasive cervical carcinoma is its main outcome. Strategies for the prevention of HPV infection configure important methodologies to reduce the morbidity and mortality rates associated with HPV. Since 2014, Brazil has incorporated vaccination against the virus into its national immunization program, being a relevant advance in public policies. There are three types of FDA (Food and Drug Administration)-approved vaccines - bivalent, quadrivalent, and nonvalent. The quadrivalent vaccine was safe and presented favorable results in the prevention of lesions associated with the serotypes present in its composition, which are HPVs 6, 11, 16 and 18. Types 16 and 18 are the most frequent in lesions due to HPV infection, being detected in the majority of cases of cancer of the cervix. Brazil uses the quadrivalent vaccine for girls from 9 to 14 years of age and, in 2017, the target population of the vaccination coverage, boys from 12 to 13 years of age should also be vaccinated. Insertion of the quadrivalent vaccine into the national vaccination schedule marks a major prevention strategy against persistent infection and diseases caused by the specific vaccine types, but this reinforces the need for population-based followup studies to national public health. (AU)

Adverse drug reactions in high-risk pregnant women: A prospective study.

BACKGROUND: Because pregnant women are often excluded from clinical trials, there is still very limited information about the risk and safety of prescription drugs during pregnancy. OBJECTIVE: We aimed to determine the prevalence of Adverse Drug Reactions (ADRs) in high-risk pregnant women after hospital admission. A prospective study was carried out in a teaching maternity hospital in Brazil during six months. Causality of ADRs was assessed through the Naranjo Algorithm and Korean Algorithm for ADR Causality Assessment. Severity of ADRs was assessed using Hartwig's Severity Assessment Scale. RESULTS: The prevalence of ADRs among the 294 inpatients studied was 8.8%. The mean age was 27.14 (±7.5) y.o. Patient's age was related to the presence of ADRs, while the manifestation of these events was not associated with any adverse pregnancy outcome. 75.9% of the ADRs reported in the study were of mild severity and 24.1% were of moderate severity. No ADR was caused by drug-drug interaction; however, a significant increase in blood pressure was observed in all patients using concurrent methyldopa and ferrous sulfate. CONCLUSION: Overall, ADRs were not common events among high-risk pregnant women and no adverse pregnancy outcomes following these events were observed.