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1.
Sci Rep ; 10(1): 1738, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32015460

RESUMO

Clinical practice guides recommend delayed clamping of the umbilical cord. If this is not possible, some authors suggest milking as an alternative. The objective of this study was to determine the variability in professional practice in the management of umbilical cord clamping and milking and to identify factors or circumstances associated with the different methods. An observational cross-sectional study done on 1,045 obstetrics professionals in Spain in 2018. A self-designed questionnaire was administered online. The main variables studied were type of clamping and use of milking. Crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. 92.2% (964) performed delayed clamping. 69.3% (724) clamped the cord when it stopped beating. 83.8% (876) had heard of milking, and 55.9% (584) had never performed it. Professionals over 50 were less likely to perform delayed clamping, with an ORa of 0.24 (95% CI: 0.11-0.52), while midwives were more likely to perform delayed clamping than obstetricians, with an ORa of 14.05 (95% CI: 8.41-23.49). There is clinical variability in the management of umbilical cord clamping and the use of milking in normal births. Part of this variability can be attributed to professional and work environment factors.

2.
J Clin Immunol ; 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32008135

RESUMO

In 2014, a child with broad combined immunodeficiency (CID) who was homozygous for a private BCL10 allele was reported to have complete inherited human BCL10 deficiency. In the present study, we report a new BCL10 mutation in another child with CID who was homozygous for a BCL10 variant (R88X), previously reported as a rare allele in heterozygosis (minor allele frequency, 0.000003986). The mutant allele was a loss-of-expression and loss-of-function allele. As with the previously reported patient, this patient had complete BCL10 deficiency. The clinical phenotype shared features, such as respiratory infections, but differed from that of the previous patient that he did not develop significant gastroenteritis episodes or chronic colitis. Cellular and immunological phenotypes were similar to those of the previous patient. TLR4, TLR2/6, and Dectin-1 responses were found to depend on BCL10 in fibroblasts, and final maturation of T cell and B cell maturation into memory cells was affected. Autosomal-recessive BCL10 deficiency should therefore be considered in children with CID.

3.
J Am Coll Cardiol ; 75(5): 482-494, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32029130

RESUMO

BACKGROUND: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.

5.
BMJ Open ; 10(1): e029642, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31919123

RESUMO

INTRODUCTION: Acute myeloblastic leukaemia (AML) constitutes the second most common haematological malignancy in the paediatric population. Current treatment regimens are based on the administration of polychemotherapy, combining high doses of cytarabine with anthracyclines and topoisomerase inhibitors. Allogeneic haematopoietic stem cell transplantation (HSCT) is an option for high-risk patients with AML (and for intermediate-risk patients if a sibling donor is available). With this strategy, AML survival has increased substantially; however, it has remained stagnant at approximately 60%, with relapse being the principal culprit. The predominant role of the immune system and natural killer (NK) cells in controlling paediatric AML has gained importance within the context of HSCT. In this protocol, we propose incorporating this cell therapy as an adjuvant treatment through the infusion of activated and expanded haploidentical NK (NKAE) cells in paediatric patients with AML who are in cytological remission after completing consolidation therapy, and with no indication for HSCT. METHODS AND ANALYSIS: Patients up to 30 years of age, diagnosed with AML, in their first cytological remission, who have completed both the induction and the consolidation phases of chemotherapy and do not meet the criteria for allogeneic HSCT are eligible. The patients will receive two doses of NKAE cells once a week, using a GMP K562-mbIL15-41BBL stimulus from a haploidentical donor and interleukin 2 subcutaneously. The patients will then be followed up for 36 months to assess the primary endpoint, which is the probability of relapse after NK cell infusion. ETHICS AND DISSEMINATION: This clinical trial was approved by the Clinical Research Ethics Committee of La Paz University Hospital and The Spanish Agency of Medicines and Medical Devices. Findings will be disseminated through peer-reviewed publications, conference presentations and community reporting. TRIAL REGISTRATION NUMBER: EudraCT code: 2015-001901-15, ClinicalTrials.gov Identifier: NCT02763475.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31943626

RESUMO

The synthesis, and x-ray structure, of a cobalt  s -alkane complex, [Co(Cy 2 P(CH 2 ) 4 PCy 2 )( norbornane )][BAr F 4 ], is achieved by a single-crystal to single-crystal solid/gas hydrogenation from a norbornadiene precursor. Magnetic data show this complex to be a triplet. Periodic DFT and electronic structure analyses identify weak C-H ··· Co  σ -interactions, augmented by dispersive stabilisation between the alkane ligand and the anion-microenvironment. The calculations are most consistent with a  η 1 : η 1 -alkane binding mode.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31936751

RESUMO

Communicating bad news (CBN) is a fundamental skill in nursing; nevertheless, few instruments exist for its evaluation. This study presents a questionnaire designed to measure nurses' knowledge and ability of CBN, as well as the analysis of its psychometric properties. Based on a literature search, the initial dimensions of CBN were identified to construct the questionnaires' items, which were evaluated by experts for the validity of the items' contents. Construct validity and reliability of the resulting questionnaire was carried out in a sample of 71 nurses of an Andalusian university hospital. A questionnaire with 25 items was constructed with a high internal consistency (Cronbach's alpha 0.816). The content validity was evaluated via a literature review and additionally by the assessment of seven experts. The Kaiser-Meyer-Olkin test (KMO) obtained a score of 0.683, and the Bartlett test of sphericity a value of p < 0.001. The principal component analysis supported a construct of four dimensions. This questionnaire was found to be a valid and reliable instrument with a high internal consistency for the evaluation of CBN knowledge and skills of nursing professionals.

8.
Clin Trials ; 17(1): 39-51, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31690107

RESUMO

BACKGROUND/AIMS: Efficient recruitment of eligible participants, optimizing time and sample size, is a crucial component in conducting a successful clinical trial. Inefficient participant recruitment can impede study progress, consume staff time and resources, and limit quality and generalizability or the power to assess outcomes. Recruitment for disease prevention trials poses additional challenges because patients are asymptomatic. We evaluated candidates for a disease prevention trial to determine reasons for nonparticipation and to identify factors that can be addressed to improve recruitment efficiency. METHODS: During 2001-2009, the Tuberculosis Trials Consortium conducted Study 26 (PREVENT TB), a randomized clinical trial at 26 sites in four countries, among persons with latent tuberculosis infection at high risk for tuberculosis disease progression, comparing 3 months of directly observed once-weekly rifapentine plus isoniazid with 9 months of self-administered daily isoniazid. During March 2005-February 2008, non-identifying demographic information, risk factors for experiencing active tuberculosis disease, and reasons for not enrolling were collected from screened patients to facilitate interpretation of trial data, to meet Consolidated Standards of Reporting Trials standards, and to evaluate reasons for nonparticipation. RESULTS: Of the 7452 candidates screened in Brazil, Canada, Spain, and the United States, 3584 (48%) were not enrolled, because of ineligibility (41%), site decision (10%), or patient choice (49%). Among those who did not enroll by own choice, and for whom responses were recorded on whether they would accept treatment outside of the study (n = 1430), 68% reported that they planned to accept non-study latent tuberculosis infection treatment. Among 1305 patients with one or more reported reasons for nonparticipation, study staff recorded a total of 1886 individual reasons (reason count: median = 1/patient; range = 1-9) for why patients chose not to enroll, including grouped concerns about research (24% of 1886), work or school conflicts (20%), medication or health beliefs (16%), latent tuberculosis infection beliefs (11%), and patient lifestyle and family concerns (10%). CONCLUSION: Educational efforts addressing clinical research concerns and beliefs about medication and health, as well as study protocols that accommodate patient-related concerns (e.g. work, school, and lifestyle) might increase willingness to enter clinical trials. Findings from this evaluation can support development of communication and education materials for clinical trial sites at the beginning of a trial to allow study staff to address potential participant concerns during study screening.

9.
Surg Oncol ; 32: 41-45, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31733585

RESUMO

Endoscopic procedures have not become the gold standard in breast surgery. In order to improve today's outcomes we have developed a pilot study in the Breast Pathology Unit of Hospital Germans Trias i Pujol. A surgical procedure was performed creating a pneumoendoscopic cavity by using a Single Incision Laparoscopic Surgery (Single port) approach with a follow up of four years. Four patients underwent pneumoendoscopic single-port breast surgery receiving skin-sparing quadrantectomy and axillary surgery requiring lymphadenectomy in all of them. All patients had immediate reconstruction with a Latisimus Dorsi flap. No perioperative complications appeared. Mean operative time was 290 min (range 240-315 min) and mean hospital stay was 3,2 days. Surgical margins of all cases were pathologically negative and all patients were disease free after four years of monitoring. All patients were satisfied with the cosmetic outcome in the immediate postoperative and during the follow up. Although all innovative techniques generate hesitation on their beginnings and are liable to improve, we believe that pneumoendoscopic single-port breast surgery can be suitable for breast cancer, offering better cosmetic outcomes with oncological safety.

10.
Fetal Diagn Ther ; 47(1): 34-44, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31137027

RESUMO

OBJECTIVE: To evaluate whether the addition of the mean uterine arteries pulsatility index (mUtA PI) to the cerebroplacental ratio (CPR) improves its ability to predict adverse perinatal outcome (APO) at the end of pregnancy. METHODS: This was a prospective study of 891 fetuses that underwent an ultrasound examination at 34-41 weeks. The CPR and the mUtA PI were converted into multiples of the median (MoM) and the estimated fetal weight (EFW) into centiles according to local references. APO was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean section, 5' Apgar score <7, neonatal pH <7.10 and admission to pediatric care units. The accuracies of the different parameters were evaluated alone and in combination with gestational characteristics using univariate and multivariate analyses by means of the Akaike Information Criteria (AIC) and the area under the curve (AUC). Finally, a comparison was similarly performed between the CPR and the cerebro-placental-uterine ratio (CPUR; CPR/mUtA PI) for the prediction of APO. RESULTS: The univariate analysis showed that CPR MoM was the best parameter predicting APO (AIC 615.71, AUC 0.675). The multivariate analysis including clinical data showed that the best prediction was also achieved with the CPR MoM (AIC 599.39, AUC 0.718). Moreover, when EFW centiles were considered, the addition of UtA PI MoM did not improve the prediction already obtained with CPR MoM (AIC 591.36, AUC 0.729 vs. AIC 589.86, AUC 0.731). Finally, the prediction by means of CPUR did not improve that of CPR alone (AIC 623.38, AUC 0.674 vs. AIC 623.27, AUC 0.66). CONCLUSION: The best prediction of APO at the end of pregnancy is obtained with CPR whatever is the combination of parameters. The addition of uterine Doppler to the information yielded by CPR does not result in any prediction improvement.

11.
Methods Mol Biol ; 2083: 103-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31745916

RESUMO

The color of the food can be evaluated visually or instrumentally. The instrumental measurement allows to measure the color objectively and can be carried out by different techniques, most of them fast, cheap, and simple. Carotenoids are responsible for the color of many plants and foods. The measurement of color can be an effective tool to determine indirectly the concentration of carotenoids in plants and foods. In this chapter, we describe both traditional and recent methodologies for color measurement.

12.
Am J Hematol ; 95(1): 28-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31625177

RESUMO

A total of 192 pediatric patients, median age 8.6 years, with high-risk hematological malignancies, underwent haploidentical stem cell transplantation (haplo-HSCT) using post-transplantation cyclophosphamide (PT-Cy), or ex vivo T cell-depleted (TCD) graft platforms, from January 1999 to December 2016 in 10 centers in Spain. Some 41 patients received an unmanipulated graft followed by PT-Cy for graft-vs-host disease (GvHD) prophylaxis. A total of 151 patients were transplanted with CD3-depleted peripheral blood stem cells (PBSCs) by either CD34+ selection, CD3+ CD19+ depletion, TCRαß+ CD19+ depletion or CD45RA+ depletion, added to CD34+ selection for GvHD prophylaxis. The PBSCs were the only source in patients following ex vivo TCD haplo-HSCT; bone marrow was the source in 9 of 41 patients following PT-CY haplo-HSCT. Engraftment was achieved in 91.3% of cases. A donor younger than 30 years, and the development of chronic GvHD were positive factors influencing survival, whereas positive minimal residual disease (MRD) before transplant and lymphoid disease were negative factors. The probability of relapse increased with lymphoid malignancies, a donor killer-cell immunoglobulin-like receptor (KIR) haplotype A and positive MRD pretransplant. No difference was found in overall survival, disease-free survival or relapse incidence between the two platforms. Relapse is still of concern in both platforms, and it should be the focus of future efforts. In conclusion, both platforms for haplo-HSCT were effective and could be utilized depending on the comfort level of the center.

13.
Sci Rep ; 9(1): 18792, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31827202

RESUMO

Infection is the leading cause of non-relapse-related mortality after allogeneic haematopoietic stem cell transplantation (HSCT). Altered functions of immune cells in nasal secretions may influence post HSCT susceptibility to viral respiratory infections. In this prospective study, we determined T and NK cell numbers together with NK activation status in nasopharyngeal aspirates (NPA) in HSCT recipients and healthy controls using multiparametric flow cytometry. We also determined by polymerase chain reaction (PCR) the presence of 16 respiratory viruses. Samples were collected pre-HSCT, at day 0, +10, +20 and +30 after HSCT. Peripheral blood (PB) was also analyzed to determine T and NK cell numbers. A total of 27 pediatric HSCT recipients were enrolled and 16 of them had at least one viral detection (60%). Rhinovirus was the most frequent pathogen (84% of positive NPAs). NPAs of patients contained fewer T and NK cells compared to healthy controls (p = 0.0132 and p = 0.120, respectively). Viral PCR + patients showed higher NK cell number in their NPAs. The activating receptors repertoire expressed by NK cells was also higher in NPA samples, especially NKp44 and NKp46. Our study supports NK cells relevance for the immune defense against respiratory viruses in HSCT recipients.

14.
Artigo em Inglês | MEDLINE | ID: mdl-31816966

RESUMO

Mental health problems have been identified by the World Health Organization as a global development priority. Negative attitudes toward mental health patients have been documented in multiple health professionals. The aim of this study was to determine the level of stigma and associated factors toward people with mental health problems among students doing their degree in nursing. An explanatory sequential mixed-methods approach. A cross-sectional descriptive observational study was carried out on a sample of 359 students doing their degree in nursing. Students had to be enrolled in any of the four years of study of the degree at the time the questionnaire was done. We explored the perception and experience of students doing their degree in nursing regarding the level of stigma, through in-depth interviews (n = 30). The mean overall Mental Health Stigma Scale (MHSS) score was 30.7 points (SD = 4.52); 29.5% (n = 106) scored low for stigma, 49.9% (n = 179) showed moderate stigma, and 20.6% (n = 74) scored high. The multivariate analysis showed that 4th-year students had an OR of 0.41 (CI95%: 0.20-0.84) for high/moderate stigma and that 3rd-year students had an OR of 0.49 for high/moderate stigma compared with 1st-year students. We also observed that students with family members with mental health problems had an OR of 2.05 (CI95%: 1.19-3.56) for high/moderate stigma compared with students who did not have family members with mental health problems. The following categories emerged: fear and lack of knowledge, breaking the silence, and integration into society. The levels of mental health stigma in our sample of nursing students were moderate. Stigma levels were lower in 3rd- and 4th-year students (i.e., after having received training in mental health), and in students with family members with mental health problems.

15.
Med Clin (Barc) ; 2019 Nov 23.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31771858

RESUMO

Children and adolescents suffering from refractory leukaemia, relapse after stem cell transplantation, solid metastatic tumour or refractory to conventional treatments still condition a dismal prognosis. The critical role of the immune system in the immunosurveillance of cancer is becoming relevant with the development of new treatments such as the checkpoint inhibitor drugs and genetic modified T lymphocytes, tisagenlecleucel or axicabtagene ciloleucel. In addition, other immunotherapies are being developed such as cell therapy with natural killer (NK) lymphocytes. The rapid and potent cytotoxic activity of NK cells respecting healthy cells and the possibility of expansion, manipulating them and combining them with other treatments, make these cells a powerful therapeutic tool to be developed, with a very high safety profile. Furthermore, new strategies are being developed to increase the therapeutic benefit of NK cells such as genetic manipulation for the expression of chimeric antigen receptors.

16.
Arch Bronconeumol ; 2019 Nov 23.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31771919

RESUMO

BACKGROUND: Tuberculosis (TB) represents a diagnostic and therapeutic challenge for solid organ transplant recipients, particularly after lung transplant (LT). Our aim was to determine the impact of TB in LT patients in Spain, considering prevalence, clinical presentation, prevention and therapeutic management. In addition, differences in outcome between rifampicin (RIF) versus non-RIF containing regimens were analyzed. METHODS: Multicenter, observational retrospective study, including all cases of TB diagnosed in recipients after LT, in five pulmonary transplant units in Spain, between January 1990 and December 2017. RESULTS: Among 2962 LT recipients, 45 cases of TB were diagnosed, resulting in a prevalence of 1.52%. Most of them (88.89%) were diagnosed during the first year posttransplantation, 86.67% with pulmonary presentation. Screening for latent TB infection (LTBI) was done in 36 of the 45 patients and LTBI was detected pretransplant in 12 (33.33%). Less than half of the patients with disease (42.22%) received rifampicin (RIF). Lower probability of TB worsening was found in RIF-containing regimens (p=0.049), as well as longer survival (p=0.001). RIF use was not associated with an increased risk in rejection (p=0.99), but doses of calcineurin inhibitors (CNI) had to be raised an average of 215%. CONCLUSIONS: Risk of TB after LT was lower in our series than previously reported. TB should be searched during the first year posttransplant in patients with TB risk factors. Pulmonary presentation was predominant. More sensitive algorithms for detecting LTBI before LT are crucial. It is reasonable to use RIF-containing regimens over non-RIF regimens based on the tendency toward better outcome in our series. RIF regimen requires close monitoring of CNI trough level for 2-3 weeks, until stability is achieved.

17.
Artigo em Inglês | MEDLINE | ID: mdl-31752197

RESUMO

Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort or problems during the postpartum period and their relationship with the mode of delivery. This cross-sectional study, carried out with 3324 participants in Spain in 2017, aimed to investigate the association between the mode of delivery and self-reported postpartum symptoms of discomfort and maternal problems during the puerperium. An ad hoc online questionnaire was used to collect data on socio-demographic and obstetric variables, symptoms of discomfort, and maternal problems during the puerperium. The crude odds ratios (OR) and adjusted OR (aOR) and their 95% confidence intervals (95%CI) were calculated using binary logistic regression. In total, 3324 women participated. Compared to a normal vaginal delivery, having a cesarean section was associated with increased odds of an infected surgical wound (aOR: 11.62, 95%CI: 6.77-19.95), feeling sad (aOR: 1.31, 23 95%CI: 1.03-1.68), and symptoms of post-traumatic stress (aOR: 4.64, 95%CI: 2.94-7.32). Instrumental delivery vs. normal vaginal delivery was a risk factor for constipation (aOR: 1.35 95%CI: 25 1.10-1.66), hemorrhoids (aOR: 1.28, 95%CI: 1.04-1.57), urinary incontinence (aOR: 1.30, 95%CI: 26 1.05-1.61), and fecal incontinence (aOR: 1.94, 95%CI: 1.29-2.92) during the puerperium. Women who gave delivery via cesarean section or instrumental delivery had higher incidences of infection and psychological alterations than those who had a normal vaginal delivery. Identifying women at risk of giving birth by cesarean section and informing them about subsequent symptoms of discomfort and maternal problems during the puerperium must be included in pregnancy health program policies and protocols to allow women to make informed decisions regarding their birthing plan.

18.
J Biomed Opt ; 24(10): 1-6, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31668028

RESUMO

Near-infrared spectroscopy (NIRS) is widely used in biomedical optics with applications ranging from basic science, such as in functional neuroimaging, to clinical, as in pulse oximetry. Despite the relatively low absorption of tissue in the near-infrared, there is still a significant amount of optical attenuation produced by the highly scattering nature of tissue. Because of this, designers of NIRS systems have to balance source optical power and source­detector separation to maximize the signal-to-noise ratio (SNR). However, theoretical estimations of SNR neglect the effects of speckle. Speckle manifests as fluctuations of the optical power received at the detector. These fluctuations are caused by interference of the multiple random paths taken by photons in tissue. We present a model for the NIRS SNR that includes the effects of speckle. We performed experimental validations with a NIRS system to show that it agrees with our model. Additionally, we performed computer simulations based on the model to estimate the contribution of speckle noise for different collection areas and source­detector separations. We show that at short source­detector separation, speckle contributes most of the noise when using long coherence length sources. Considering this additional noise is especially important for hybrid applications that use NIRS and speckle contrast simultaneously, such as in diffuse correlation spectroscopy.

19.
J Assist Reprod Genet ; 36(12): 2435-2445, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31741255

RESUMO

BACKGROUND: Although most newborns conceived through assisted reproductive treatments are healthy, there are concerns about the safety of reproductive techniques and their effect on foetal/maternal well-being. OBJECTIVE: This study aims to describe the incidence of obstetric and perinatal complications in women undergoing assisted reproductive treatments in the Spanish Health System. METHOD: This is a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain. The data was collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated, through a multivariate analysis with binary logistic regression and multinomial logistic regression. RESULTS: Five thousand nine hundred forty-two women participated, 2.3% (139) through artificial insemination and 8.2% (486) through in vitro fertilisation (IVF) techniques. Women who underwent IVF had a higher likelihood of suffering problems during pregnancy (OR = 1.71; 95% confidence intervals (95% CI), 1.37-2.13), delivery (OR = 1.43; 95% CI, 1.01-2.02), and postpartum (OR = 1.94; 95% CI, 1.40-2.69) than women with spontaneous pregnancy. No increased likelihood of neonatal problems was observed in this group except for twin pregnancy (OR = 9.17; 95% CI, 6.02-13.96) and prematurity (OR = 1.43; 95% CI, 1.01-2.02). No differences were observed between spontaneous pregnancies and those achieved by artificial insemination. CONCLUSIONS: Pregnancies achieved through IVF present a higher risk of complications before, during and after delivery. However, there is no increased risk of neonatal problems except for a higher likelihood of twin pregnancy and prematurity.

20.
J Nat Prod ; 82(10): 2886-2896, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31617361

RESUMO

Pentacyclic triterpenes, such as oleanolic acid (I), are promising scaffolds for diversification through the use of combinatorial methods to obtain derivatives that improve their biological properties, increasing their bioavailability and enhancing their therapeutic efficacy. The purpose of this study was to evaluate the influence that derivatives of oleanolic acid, conjugated with one or two amino acids and an acyl group, might exert on HIV-1 protease inhibition. The in vitro studies conducted suggested that the presence of a carboxyacyl group generally improves the inhibition of HIV-1 protease, especially when a phthaloyl group is present, with IC50 concentration values below 5 µM. The gain in activity of three 3-phthaloyl derivatives, with sub-micromolar IC50 values, was between 60- and 100-fold more active than oleanolic acid. A molecular docking study has also been performed to elucidate the mode of binding to the protease by these oleanolic acid derivatives. In general, the derivatives that exhibited the highest inhibitory activity of HIV-1 protease also showed the highest binding energies in docking simulations. The overall results suggest that the coupling of one or two amino acids and a phthaloyl group to oleanolic acid improves HIV-1 protease inhibition, implying that these triterpene derivatives may be promising antiviral agents against HIV.

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