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BACKGROUND: Cesarean section rates are increasing and surpassing WHO guidelines. While sometimes necessary, excessive use poses risks and additional costs to pregnant women and healthcare systems. AIM: To evaluate the prevalence of cesarean section according to healthcare professionals, facility location, and the wealth index of pregnant women in each Peruvian healthcare system. METHODS: A cross-sectional study analyzed 20,870 records of women aged 12 to 49 from the Demographic and Family Health Survey (ENDES). The evaluated healthcare systems were the Ministry of Health, Social Health Insurance, Armed Forces and National Police, and private institutions. FINDINGS: The highest cesarean section prevalence was observed in women receiving prenatal care in private hospitals or clinics (69.13%) and Social Health Insurance hospitals (51.54%). Urban settings, "richest" wealth index, and medical professional involvement increased the probability of cesarean sections. Conversely, the probability of cesarean section was reduced in Ministry of Health facilities when pregnant women belonged to the "poorest" or "poorer" wealth index category and when prenatal care was provided by a midwife in a private facility. CONCLUSION: The prevalence of cesarean sections in Peru during 2021 is 33.75%, warranting evaluation of strategies to regulate their indiscriminate use in each system.
Assuntos
Cesárea , Cuidado Pré-Natal , Gravidez , Feminino , Humanos , Prevalência , Estudos Transversais , Peru , Hospitais Privados , Atenção à SaúdeRESUMO
RESUMEN Introducción. El uso de Artemisia absinthium (ajenjo) en el trabajo de parto es ampliamente empleado en países de la región; sin embargo, no hay evidencia científica suficiente de su eficacia y seguridad, lo que representa un alto riesgo maternofetal. Objetivo. El propósito fue evaluar el efecto contractil de la Artemisia absinthium (ajenjo) en comparación a la oxitocina en útero aislado de ratas. Métodos. Se separaron 8 ratas Holtzman en i) Grupo experimental: Artemisia dosis 5, 10, 20, 30, 40 y 50 mg y ii) Grupo control: oxitocina 10-6 M. Se montaron los úteros en un baño de órganos aislados y se registraron contracciones por 5 minutos. Resultados. La frecuencia de contracciones con ajenjo 40 y 50 mg fueron comparables con oxitocina (p>0,05). Asimismo, dosis de 20 y 30 mg de Artemisia provocaron contracciones significativamente más duraderas que la oxitocina. La intensidad resultó ser comparable con oxitocina con dosis de 20, 40 y 50 mg de Artemisia. Conclusión. El extracto acuoso de Artemisia absinthium presentó efecto contráctil similar a la oxitocina y dependiente de la dosis en útero aislado de ratas.
ABSTRACT Introduction. The use of Artemisia absinthium (wormwood) in labour is widely used in countries in the region; however, there is no enough scientific evidence of its efficacy and safety, which represents a high maternalfetal risk. Objective. The purpose was to assess the contractile effect of Artemisia absinthium (wormwood) compared to oxytocin in utero isolated from rats. Methods. Eight Holtzman rats were separated into i) Experimental group: Artemisia dose 5, 10, 20, 30, 40, and 50 mg and ii) Control group: oxytocin 10-6 M. The uteruses were mounted in an isolated organ bath, and contractions were recorded for 5 minutes. Results. The frequency of contractions with wormwood 40 and 50 mg were comparable with oxytocin (p>0.05). Likewise, doses of 20 and 30 mg of Artemisia caused significantly longer-lasting contractions than oxytocin. The intensity was found to be comparable with oxytocin at doses of 20, 40, and 50 mg of Artemisia. Conclusion. The aqueous extract of Artemisia absinthium has a contractile effect similar to oxytocin and is dose dependent in utero isolated from rats.
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BACKGROUND: Sickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed. METHODS: This nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups. RESULTS: Fifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%; n = 9), 53% (n = 8) were female, and mean age was 30 ± 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1-19.6; P = 0.04 and HR = 7.7; 95%CI 1.5-40.2; P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92-13.4; P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV. CONCLUSIONS: In summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.
