PROGINS Polymorphism of the Progesterone Receptor Gene and the Susceptibility to Uterine Leiomyomas: A Systematic Review and Meta-Analysis.

AIMS: Steroid hormones play a central role in modulating the growth of uterine leiomyoma, and several studies have suggested that polymorphisms in genes encoding these hormones and their receptors may be risk factors for developing the disease. Progesterone is a potent antagonist of estrogen-induced proliferation in the endometrium, and the PROGINS polymorphisms have been associated with leiomyoma, but the results are inconsistent. In this study, we aimed to investigate the possible associations between the PROGINS polymorphisms and uterine leiomyoma. MATERIALS AND METHODS: MEDLINE using PubMed, Science Direct, and Google Scholar databases was searched using the terms "PROGINS," "progesterone receptor," "polymorphism," and "leiomyoma." We estimated risk with odds ratios [ORs] and 95% confidence intervals using standard genetic models (homozygous, recessive, dominant, and codominant). RESULTS: Six studies were included in this meta-analysis based on 837 cases and 1011 controls. Subjects in three studies were Asian (365 cases/391 controls), and five were non-Asian (472 cases/620 controls). Our findings showed no association between PROGINS and leiomyoma in the overall analysis (OR 0.91-1.07, p = 0.15-0.57) nor in either of the subgroups (Asian: OR 0.84-1.04, p = 0.68-0.98; or non-Asian: OR 0.77-1.34, p = 0.33-0.93), in all genetic models. CONCLUSION: The PROGINS polymorphisms cannot be considered a risk factor for developing uterine leiomyoma.

The training and professional expectations of medical students in Angola, Guinea-Bissau and Mozambique.

BACKGROUND: The purpose of this paper is to describe and analyze the professional expectations of medical students during the 2007-2008 academic year at the public medical schools of Angola, Guinea-Bissau and Mozambique, and to identify their social and geographical origins, their professional expectations and difficulties relating to their education and professional future. METHODS: Data were collected through a standardised questionnaire applied to all medical students registered during the 2007-2008 academic year. RESULTS: Students decide to study medicine at an early age. Relatives and friends seem to have an especially important influence in encouraging, reinforcing and promoting the desire to be a doctor.The degree of feminization of the student population differs among the different countries.Although most medical students are from outside the capital cities, expectations of getting into medical school are already associated with migration from the periphery to the capital city, even before entering medical education.Academic performance is poor. This seems to be related to difficulties in accessing materials, finances and insufficient high school preparation.Medical students recognize the public sector demand but their expectations are to combine public sector practice with private work, in order to improve their earnings. Salary expectations of students vary between the three countries.Approximately 75% want to train as hospital specialists and to follow a hospital-based career. A significant proportion is unsure about their future area of specialization, which for many students is equated with migration to study abroad. CONCLUSIONS: Medical education is an important national investment, but the returns obtained are not as efficient as expected. Investments in high-school preparation, tutoring, and infrastructure are likely to have a significant impact on the success rate of medical schools. Special attention should be given to the socialization of students and the role model status of their teachers.In countries with scarce medical resources, the hospital orientation of students' expectations is understandable, although it should be associated with the development of skills to coordinate hospital work with the network of peripheral facilities. Developing a local postgraduate training capacity for doctors might be an important strategy to help retain medical doctors in the home country.

Postpartum hemorrhage: a prospective, comparative study in Angola using a new disposable device for oxytocin administration.

BACKGROUND: Postpartum hemorrhage (PPH) is the single most common cause of maternal death in the world, and oxytocin is known to be effective for its prevention and treatment. The use of syringes can be problematic in areas affected by HIV. The aim of this study was to introduce Uniject (a new disposable device for administration of 10 IU oxytocin) as part of active management of the third stage of labor (AMTL) and try to reduce PPH. METHODS: A prospective, comparative study was performed between March 1998 and May 2000 in Luanda. Seven hundred and eighty-two parturient women with physiological management were compared to 814 with AMTL. Postpartum lost blood was collected using a plastic sheet during labor and a bucket placed under a cholera bed for 2 h postpartum. Student's t-test and chi(2) test were used. RESULT: PPH was reduced from 40.4 to 8.2% and severe PPH (> or =1000 ml) from 7.5 to 1% in the AMTL group (P < 0.001). CONCLUSIONS: Uniject was well tolerated and offers an alternative for oxytocin administration. AMTL should be implemented also in resource-poor settings as a routine management to reduce PPH.

Use of cholera beds in the delivery room: a simple and appropriate method for direct measurement of postpartum bleeding.

Abundant obstetric bleeding is a predominant cause of maternal death, with the immediate postpartum period being the most critical time. Visual estimation of postpartum haemorrhage (PPH) often leads to severe underestimation and delay in treatment. Various methods have been developed in order to measure blood loss accurately, but none has proved appropriate in poor settings. The aim of this study was to present a method which is appropriate for measuring postpartum blood loss in a setting with limited resources. Parturient women (n = 814) with active management of third stage of labour in Luanda, Angola were studied. Vaginal bleeding immediately after birth and during the first 2 hours postpartum was collected using a combination of a plastic sheet and a bucket belowa cholera bed, in which the women rested during postpartum observation. Monitoring postpartum blood loss in the same way as cholera patients are monitored for loss of stool fluid was found to be a useful and practical way of measuring haemorrhage of parturient women after childbirth. The method described here is simple and appropriate, which makes it a good alternative to more costly methods in detecting and quantifying PPH.

Perfil de morbidade hospitalar no RGS no Sistema Único de Saúde em 1995 / Hospital sickness profile in Rio Grande do Sul in the Ntional Health Insurance in 1995

Este trabalho tem por objetivo traçar o perfil da morbidade hospitalar da rede conveniada e prórpia do Sistema Único de Saúde (SUS) no estado do Rio Grande do Sul, no ano de 1995.