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1.
Kardiologiia ; 60(6): 984, 2020 Jul 07.
Artigo em Russo | MEDLINE | ID: mdl-32720617

RESUMO

Aim      To evaluate the effect of bromocriptine on clinical hemodynamic and functional indexes and to analyze life prognosis for patients with periportal cardiomyopathy divided into two groups: group 1, bromocriptine treatment (n=21) and group 2, standard treatment without bromocriptine (n=22). History was taken, examination and standard clinical evaluation were performed, the Clinical Condition Scale (CCS with V.Yu. Mareev, 2000, modification) was administered, and 6-min walk test (6MWT) was performed. Quality of life was determined with the Minnesota questionnaire. Standard 12-lead electrocardiography, echocardiography, and blood biochemistry with measuring C-reactive protein (CRP) and prolactin, were performed. Follow-up duration was one year.Results Heart rate was significantly decreased in group 1 (22.7%) compared to group 2 (18%); the 6-min distance was increased (61 and 50 %, respectively), the total CCS score was decreased (66 and 55 %, respectively, and the quality of life Minnesota questionnaire score was improved (from 68.4±12.4 to 26.4±12.4 and from 63.4±10.9 to 36.4±15.1, respectively). Also, left ventricular (LV) end-diastolic dimension was reduced from 66.82±7.07 to 60.67±3.79 mm (9.2 %) in group 1 and from 61.92±4.41 to 58.91±4.68 mm (5 %) in group 2, which was associated with increases in LV ejection fraction by 18.3 and 14.5 %, respectively. In both groups, CRP concentration was decreased from 8.3±4.1 to 4.3±1.2 mg/l and from 8.5±3.5 to 6.3±1.5 mg/l, respectively. The bromocriptine treatment was associated with a significant decrease in prolactin level (62 %). The LV function completely recovered in 66.6% of patients in group 1 and in 27% of patients in group 2.Conclusion      The bromocriptine treatment of periportal cardiomyopathy in combination with an optimal drug therapy was associated with an additional beneficial effect on the clinical functional status, intracardiac hemodynamics, blood concentration of CRP, and a potentiality for complete recovery of the LV function.


Assuntos
Bromocriptina/uso terapêutico , Cardiomiopatias , Cardiomiopatias/tratamento farmacológico , Humanos , Período Periparto , Qualidade de Vida , Resultado do Tratamento
3.
Lancet Gastroenterol Hepatol ; 5(10): 927-939, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32730786

RESUMO

WHO has set global targets for the elimination of hepatitis B and hepatitis C as a public health threat by 2030. However, investment in elimination programmes remains low. To help drive political commitment and catalyse domestic and international financing, we have developed a global investment framework for the elimination of hepatitis B and hepatitis C. The global investment framework presented in this Health Policy paper outlines national and international activities that will enable reductions in hepatitis C incidence and mortality, and identifies potential sources of funding and tools to help countries build the economic case for investing in national elimination activities. The goal of this framework is to provide a way for countries, particularly those with minimal resources, to gain the substantial economic benefit and cost savings that come from investing in hepatitis C elimination.


Assuntos
Erradicação de Doenças/métodos , Saúde Global/economia , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Redução de Custos/economia , Erradicação de Doenças/economia , Feminino , Saúde Global/normas , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Período Periparto , Gravidez , Saúde Pública/economia , Saúde Pública/normas , Vacinação/normas , Organização Mundial da Saúde/organização & administração
4.
Ceska Gynekol ; 85(2): 120-123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527106

RESUMO

OBJECTIVE: Author demonstrates case of enteral cystic duplicature located between coccyx and rectum in peripartal period. DESIGN: Case report. SETTING: Masarykova městská nemocnice, Jilemnice. SUBJECT AND METHOD: Case of enteral cystic duplicature in adult, 25-29 year female, first case after natural birth, second one in the end of second pregnancy. Open surgical solution with exstirpation. CONCLUSION: Cystic duplication of the rectum belongs to congenital anomalies, rarely occurring even in adulthood. The second opinion and quality preoperative diagnostics played a key role in the case, leading in both cases to primary, complete exstirpation, without any reoperation or complications. The surgical approach was chosen parasacral section, laterally differentiated according to the location of the dominant part of the cyst.


Assuntos
Cistos/cirurgia , Período Periparto , Reto/anormalidades , Adulto , Cistos/patologia , Feminino , Humanos , Gravidez , Doenças Retais , Reto/cirurgia
5.
BJOG ; 127(10): 1249, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32449275
6.
An. sist. sanit. Navar ; 43(1): 93-97, ene.-abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193682

RESUMO

La miocardiopatía periparto (MCPP) es una miocardiopatía idiopática que cursa con insuficiencia cardiaca secundaria a disfunción de ventrículo izquierdo al final del embarazo o en los primeros meses tras el parto. El diagnóstico se realiza mediante electrocardiograma, radiografía de tórax y aumento de péptidos natriuréticos. La ecografía a pie de cama puede aportar datos que ayuden al diagnóstico precoz. El tratamiento se realiza siguiendo las guías clínicas de insuficiencia cardiaca, con la precaución de manejo de los fármacos potencialmente teratogénicos. La importancia de esta patología radica en que afecta a mujeres en edad fértil y en que es potencialmente mortal, por lo que debe mantenerse un elevado índice de sospecha para su diagnóstico y realizar diagnóstico diferencial con otras entidades. En esta nota clínica presentamos una serie de casos de MCPP con el objetivo de revisar el diagnóstico y el tratamiento de esta entidad


Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that is caused by heart failure secondary to a dysfunction of the left ventricle at the end of pregnancy or in the first months following childbirth. The diagnosis is performed by electrocardiogram, radiography of the thorax and increase of natriuretic peptides. Bedside radiography can contribute with data that help early diagnosis. Treatment is carried out following clinical guidelines for heart failure, taking into account potentially teratogenic drugs. The importance of this pathology lies in that it affects women at a fertile age and is potentially mortal, which is why there must be a high index of suspicion for its diagnosis and a differential diagnosis with other entities. In this clinical note we present a series of cases of PPCM with the goal of reviewing the diagnosis and treatment of this entity


Assuntos
Humanos , Feminino , Gravidez , Adulto , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico por imagem , Período Periparto , Eletrocardiografia , Diagnóstico Precoce , Insuficiência Cardíaca/terapia , Diagnóstico Diferencial
8.
Am J Nurs ; 120(5): 17, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332349
9.
Pregnancy Hypertens ; 20: 124-130, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32299059

RESUMO

OBJECTIVE: To compare characteristics and outcomes of women with chronic hypertension (cHTN) between those with normal and abnormal plasma angiogenic profiles. STUDY DESIGN: This secondary analysis explored associations between angiogenic markers soluble fms-like tyrosine kinase-1 (sFlt1) and placental growth factor (PlGF) drawn prior to delivery among women with history of cHTN who were enrolled between 22 and 41 weeks. Patients were divided into two groups based on sFlt1/PlGF ratio, namely low sFlt1/PlGF (<85) and high sFlt1/PlGF (≥85) ratio. RESULTS: Of the 115 patients, 76% were African American. Compared to women with low sFlt1/PlGF (n = 78), patients with high sFlt1/PlGF (n = 37) had higher median antenatal blood pressures (systolic mmHg 179 vs 155; diastolic 106 vs 91), lower gestational age at delivery (34.7 vs 38.2 weeks), lower birthweight (1940 vs 3103 g), and a higher prevalence of preterm delivery <34 (40.5% vs 7.7%) and <37 weeks (64.9% vs 20.5%), all p < 0.001. Importantly, more women with high sFlt1/PlGF had a diagnosis of superimposed preeclampsia (62.2% vs 26.9%, p = 0.003), preeclampsia with severe features (59.5% vs 20.5%, p < 0.0001), maternal adverse outcomes (24.3% vs 3.9%, p = 0.002), neonatal intensive care unit admissions (71.9% vs 40.8%; p = 0.003), severe postpartum hypertension (67.6% vs 38.5%, p = 0.01) and longer hospital stays (median 6.0 vs 4.5 days, p = 0.003). DISCUSSION: In contrast to patients with a low ratio, high sFlt1/PlGF is characterized by an increased risk of maternal adverse outcomes and prematurity. Incorporation of angiogenic biomarkers while managing cHTN may improve accuracy of early identification of adverse outcomes to improve outcomes.


Assuntos
Hipertensão Induzida pela Gravidez/sangue , Obesidade/sangue , Fator de Crescimento Placentário/sangue , Nascimento Prematuro/sangue , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Adulto , Afro-Americanos , Biomarcadores/sangue , Peso ao Nascer , Pressão Sanguínea , Chicago/epidemiologia , Doença Crônica , Feminino , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/etnologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Obesidade/diagnóstico , Obesidade/etnologia , Obesidade/fisiopatologia , Período Periparto/sangue , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/etnologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Saúde da População Urbana
10.
Anim Sci J ; 91(1): e13365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32285581

RESUMO

The present study was conducted to examine whether colostrum supplementation in peripartum goats increases the antimicrobial peptides in their milk. Goats were orally administered 2 ml of colostrum whey products (colostrum group) or water (control group) daily, from 2 weeks before until 2 weeks after kidding. Body weights of mothers and kids were measured. Blood, milk, and fecal samples were collected from the mothers, and blood samples were collected from the kids. Concentrations of milk antimicrobial peptides (beta-defensin, cathelicidin, lactoferrin, S100A7, lactoperoxidase, and immunoglobulin A [IgA]) were determined. IgA and nutritional parameters (glucose, total cholesterol, triglyceride, ketone bodies, and non-esterified fatty acids) were also determined in the blood of mothers and kids. Milk IgA and lactoferrin concentrations were higher in the colostrum group than in the control group. Conversely, lower milk concentrations of S100A7 were observed in the colostrum group than that in the control group. Plasma IgA concentrations were higher for kids from the colostrum group than for those from the control group. These results suggest that oral administration of colostrum in pregnant goats increases IgA concentration in postpartum milk, which can subsequently improve the health of their kids.


Assuntos
Fenômenos Fisiológicos da Nutrição Animal , Peptídeos Catiônicos Antimicrobianos/metabolismo , Colostro , Dieta/veterinária , Suplementos Nutricionais , Lactoferrina/metabolismo , Leite/metabolismo , Proteínas do Soro do Leite/administração & dosagem , beta-Defensinas/metabolismo , Administração Oral , Animais , Feminino , Cabras , Imunoglobulina A/metabolismo , Lactoperoxidase/metabolismo , Período Periparto , Gravidez
11.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 332-336, 2020 Mar 06.
Artigo em Chinês | MEDLINE | ID: mdl-32187942

RESUMO

Thallium is a highly toxic heavy metal. The adverse maternal and infant health effects caused by thallium exposure during pregnancy have also attracted more and more scholars' attention. This study focused on the sources of thallium exposure and its influencing factors, the association between thallium exposure during pregnancy and pregnancy complications and adverse birth outcomes in newborns, the effects of thallium exposure during pregnancy on children's growth and development after birth. In terms of potential mechanisms, the related research progress was reviewed in this study, which could provide a new basis for further research on the harm, prevention and control of thallium exposure during pregnancy.


Assuntos
Poluentes Ambientais/toxicidade , Exposição Materna/efeitos adversos , Complicações na Gravidez , Efeitos Tardios da Exposição Pré-Natal , Tálio/toxicidade , Criança , Poluentes Ambientais/metabolismo , Feminino , Humanos , Lactente , Saúde do Lactente , Recém-Nascido , Período Periparto , Gravidez
12.
Res Vet Sci ; 130: 126-132, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32172001

RESUMO

The objectives were to evaluate differences in circulating prepartum metabolites, minerals, cytokines and hormones based on postpartum disease category and determine critical circulating concentrations of prepartum analytes associated with postpartum disease in 229 cattle from 11 commercial dairies in Alberta, Canada. Blood was collected at 8.8 ± 2.1 d prepartum and analyzed for a wide array of analytes. Cattle were categorized as healthy (n = 76) or as having inflammatory (INF; n = 28), metabolic (MET; n = 34) or inflammatory and metabolic (INFMET; n = 91) postpartum diseases. The prepartum circulating concentrations of Cu were lesser (0.84 vs. 0.90 µg/mL; P = 0.02) and concentrations of Mo (19.1 vs. 16.5 ng/mL; P = 0.04) and NEFA (0.27 vs. 0.18 mmol/L; P = 0.01) were greater in INFMET cattle compared with healthy cattle. The critical threshold for Cu, Mo and NEFA prepartum concentration that predicted INFMET was ≤ 0.81 µg/mL (sensitivity 45.5% and specificity 74.3%), ≥ 9.91 ng/mL (sensitivity 70.0% and specificity 52.7%) and ≥ 0.19 mmol/L (sensitivity 62.2% and specificity 79.7%), respectively. Regardless of differences in the prepartum circulating concentrations of Cu, Mo and NEFA among healthy cattle and those with postpartum disease, the use of these analytes to predict the incidence of postpartum diseases was limited.


Assuntos
Doenças dos Bovinos/metabolismo , Bovinos/metabolismo , Citocinas/sangue , Hormônios/sangue , Minerais/sangue , Alberta , Animais , Doenças dos Bovinos/sangue , Ácidos Graxos não Esterificados/sangue , Feminino , Período Periparto/metabolismo , Período Pós-Parto
13.
PLoS One ; 15(3): e0230386, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32218573

RESUMO

Probenecid has been used for decades in the treatment of gout but recently has also been found to improve outcomes in patients with heart failure via stimulation of the transient receptor potential vanilloid 2 (TRPV2) channel in cardiomyocytes. This study tested the use of probenecid on a novel mouse model of peripartum cardiomyopathy (PPCM) as a potential treatment option. A human mutation of the human heat shock protein 20 (Hsp20-S10F) in mice has been recently shown to result in cardiomyopathy, when exposed to pregnancies. Treatment with either probenecid or control sucrose water was initiated after the first pregnancy in both wild type and Hsp20-S10F mice. Serial echocardiography was performed during subsequent pregnancies and hearts were collected after the third pregnancies for staining and molecular analysis. Hsp20-S10F mice treated with probenecid had decreased mortality, hypertrophy, TRPV2 expression and molecular parameters of heart failure. Probenecid treatment also decreased apoptosis as evidenced by an increase in the level of Bcl-2/Bax. Probenecid improved survival in a novel mouse model of PPCM and may be an appropriate therapy for humans with PPCM as it has a proven safety and tolerability in patients with heart failure.


Assuntos
Canais de Cálcio/genética , Cardiomiopatias/tratamento farmacológico , Proteínas de Choque Térmico HSP20/genética , Insuficiência Cardíaca/tratamento farmacológico , Probenecid/farmacologia , Canais de Cátion TRPV/genética , Animais , Apoptose/efeitos dos fármacos , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/genética , Cardiomiopatias/patologia , Modelos Animais de Doenças , Ecocardiografia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/patologia , Humanos , Camundongos , Mutação/genética , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/patologia , Período Periparto/efeitos dos fármacos , Gravidez , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/genética
14.
Prev Vet Med ; 176: 104931, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32135413

RESUMO

The aim of this study was to evaluate the effects of pegbovigrastim injection (Imrestor, Elanco Animal Health, Greenfield, IN) on production parameters and postpartum disease occurrence (retained placenta, metritis, displaced abomasum, and clinical mastitis) in dairy cows. Study cows (n = 270) were blocked by parity group (multiparous or primiparous) and randomly assigned to control (CON, n = 144) or pegbovigrastim treatment (IMR, n = 126). Ten ± 4 days before expected calving and again at calving, IMR cows received 2.7 mL of Imrestor and CON cows received 2.7 mL of 0.9 % saline. Milk yield, fat, protein, lactose, solids nonfat (SNF) percent, and somatic cell count (SCC), body condition, hygiene, and lameness were evaluated weekly. Animals were evaluated for metritis twice weekly through rectal temperature, palpation, and uterine discharge evaluation until 30 days in milk. Farm personnel recorded other postpartum diseases. The MIXED procedure of SAS was used to evaluate milk composition and milk yields were analyzed as repeated measures in time with block, treatment, calving month, and lactation week included in mixed models. The GLIMMIX procedure was used to evaluate mastitis and metritis occurrence. Variables entered a model if P ≤ 0.10 when screened individually. Variables with P ≤ 0.10 were kept in the final model. Milk yield, fat, protein, lactose, SNF, and log of SCC were not significantly affected by treatment. Clinical mastitis occurrence did not differ between treatments, but only 17 cases were detected. Compared to CON, IMR treated cows had increased clinical metritis incidence, and were 2.46 times more likely to develop the disease. No difference was observed on puerperal metritis ocurrence. Cows given pegbovigrastim injections had increased odds of developing clinical signs of metritis, but no negative effects on milk production or composition were observed.


Assuntos
Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Fatores Imunológicos/administração & dosagem , Lactação , Mastite Bovina/tratamento farmacológico , Leite/metabolismo , Proteínas Recombinantes/administração & dosagem , Animais , Bovinos , Contagem de Células/veterinária , Indústria de Laticínios , Feminino , Incidência , Mastite Bovina/epidemiologia , Mississippi/epidemiologia , Paridade , Período Periparto
15.
Arch Gynecol Obstet ; 301(5): 1159-1165, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32221710

RESUMO

PURPOSE: To assess changing trends, role of the triad patient-pregnancy-health professionals and health care cost in emergency peripartum hysterectomy (EPH). METHODS: Demographics, indications, perinatal outcomes, perioperative complications in EPH cases performed in a 10-year period were extracted from the local birth registry. Experience of health professionals in the management of the post-partum haemorrhage was valued. Two subgroups (Period I, 2009-2013 vs. Period II, 2014-2018) were recognized. Overall and detailed EPH ratios/1000 deliveries were calculated. Cost analysis was achieved in agreement with the diagnosis-related group (DGR) system. RESULTS: A total of 39 EPH were performed among 36,053 deliveries. EPH incidence increased from 0.8 to 1.32‰ across study periods (p < 0.001). The mean maternal age (36.9 ± 4.7 vs. 38.9 ± 5.9 years, p = 0.035) and the high socio-economic status (0 vs. 19.2%, p = 0.027) were statistically different. Multiparity (84.6 vs. 96.2%, p = 0.005), previous caesarean section (CS) (0.9 ± 0.9 vs. 1.2 ± 1.6, p = 0.049), and emergent CS (7.7 vs. 19.2%, p = 0.048) were found statistically different. In Period II, increased attempts in conservative approaches (7.7 vs. 36.8%, p = 0.007), reduction in blood loss (3184 ± 1753 vs. 2511 ± 1252 mL, p = 0.045), advanced age of gynecologists performing EPH (54.5 ± 9.2 vs. 60.3 ± 6.4 years, p = 0.024), and augmented health care costs (mean DRG of € 2.782 vs. 3.371,95, p < 0.001) were observed. CONCLUSIONS: As a "near-miss" event, advances on identification of EPH factors are mandatory. Time-trend analyses might add information and address novel strategies.


Assuntos
Cesárea/métodos , Histerectomia/métodos , Período Periparto/fisiologia , Adulto , Emergências , Feminino , Humanos , Mortalidade Materna , Gravidez , Estudos Retrospectivos , Fatores de Risco
16.
Animal ; 14(S1): s144-s154, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32024563

RESUMO

Inflammatory cascades are a critical component of the immune response to infection or tissue damage, involving an array of signals, including water-soluble metabolites, lipid mediators and several classes of proteins. Early investigation of these signaling pathways focused largely on immune cells and acute disease models. However, more recent findings have highlighted critical roles of both immune cells and inflammatory mediators on tissue remodeling and metabolic homeostasis in healthy animals. In dairy cattle, inflammatory signals in various tissues and in circulation change rapidly and dramatically, starting just prior to and at the onset of lactation. Furthermore, several observations in healthy cows point to homeostatic control of inflammatory tone, which we define as a regulatory process to balance immune tolerance with activation to keep downstream effects under control. Recent evidence suggests that peripartum inflammatory changes influence whole-body nutrient flux of dairy cows over the course of days and months. Inflammatory mediators can suppress appetite, even at levels that do not induce acute responses (e.g. fever), thereby decreasing nutrient availability. On the other hand, inhibition of inflammatory signaling with non-steroidal anti-inflammatory drug (NSAID) treatment suppresses hepatic gluconeogenesis, leading to hypoglycemia in some cases. Over the long term, though, peripartum NSAID treatment substantially increases peak and whole-lactation milk synthesis by multiparous cows. Inflammatory regulation of nutrient flux may provide a homeorhetic mechanism to aid cows in adapting to rapid changes in metabolic demand at the onset of lactation, but excessive systemic inflammation has negative effects on metabolic homeostasis through inhibition of appetite and promotion of immune cell activity. Thus, in this review, we provide perspectives on the overlapping regulation of immune responses and metabolism by inflammatory mediators, which may provide a mechanistic underpinning for links between infectious and metabolic diseases in transition dairy cows. Moreover, we point to novel approaches to the management of this challenging phase of the production cycle.


Assuntos
Bovinos/fisiologia , Comportamento Alimentar , Homeostase , Mediadores da Inflamação/metabolismo , Inflamação/veterinária , Transdução de Sinais , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Bovinos/imunologia , Citocinas/metabolismo , Feminino , Gluconeogênese/efeitos dos fármacos , Lactação , Fígado/efeitos dos fármacos , Fígado/metabolismo , Leite/metabolismo , Período Periparto
17.
Radiol Clin North Am ; 58(2): 431-443, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044016

RESUMO

There are various complications that can occur in the postpartum period, including pain, bleeding, and infection. These include complications related to cesarean section, postpartum hemorrhage and hematomas, bladder injury, torsion and uterine dehiscence, and rupture. It is important the radiologist is aware of these entities and the associated imaging features to help guide timely and appropriate management.


Assuntos
Cesárea/efeitos adversos , Complicações na Gravidez/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Período Periparto , Período Pós-Parto , Gravidez , Transtornos Puerperais/diagnóstico por imagem
18.
Animal ; 14(S1): s44-s54, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32024567

RESUMO

Aspects of neutrophil function are diminished or dysregulated in dairy cows in the weeks just before and after calving, which appears to be an important contributor to the occurrence of retained placenta, mastitis, metritis and endometritis. The timing and mechanisms by which specific elements of neutrophil function are impaired are only partially understood. Oxidative burst capacity is the element of neutrophil function most consistently shown to be impaired in the week after calving, but that observation may partially be biased because oxidative burst has been studied more than other functions. There is sufficient evidence to conclude that the availability of calcium and glucose, and exposure to elevated concentrations of non-esterified fatty acids or ß-hydroxybutyrate affect some aspects of neutrophil function. However, these factors have mostly been studied in isolation and their effects are not consistent. Social stressors such as a competitive environment for feeding or lying space should plausibly impair innate immune function, but when studied under controlled conditions such effects have generally not been produced. Similarly, treatment with recombinant bovine granulocyte colony-stimulating factor consistently produces large increases in circulating neutrophil count with modest improvements in function, but this does not consistently reduce the incidence of clinical diseases thought to be importantly attributable to impaired innate immunity. Research is now needed that considers the interactions among known and putative risk factors for impaired neutrophil function in dairy cows in the transition period.


Assuntos
Doenças dos Bovinos/imunologia , Endometrite/veterinária , Imunidade Inata , Mastite Bovina/imunologia , Placenta Retida/veterinária , Ácido 3-Hidroxibutírico/metabolismo , Adaptação Fisiológica , Animais , Bovinos , Endometrite/imunologia , Metabolismo Energético , Ácidos Graxos não Esterificados/metabolismo , Feminino , Fator Estimulador de Colônias de Granulócitos , Hipocalcemia , Lactação , Contagem de Leucócitos , Neutrófilos/metabolismo , Período Periparto , Placenta Retida/imunologia , Gravidez , Proteínas Recombinantes
19.
Curr Opin Anaesthesiol ; 33(3): 305-310, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32049882

RESUMO

PURPOSE OF REVIEW: Preeclampsia remains an important cause of maternal and neonatal morbidity and mortality. Recent interest in angiogenic biomarkers as a prognostic indicator is reviewed, together with analgesic, anaesthetic and critical-care management of the preeclamptic patient. RECENT FINDINGS: There has been recent interest in the angiogenic biomarkers placental growth factor and soluble fms-like tyrosine kinase-1 in establishing the diagnosis of preeclampsia and guiding its management. Neuraxial blocks are recommended for both labour and operative delivery if not contraindicated by thrombocytopenia or coagulopathy, although a safe lower limit for platelet numbers has not been established. For spinal hypotension phenylephrine is noninferior to ephedrine in preeclamptic parturients and may offer some benefits. When general anaesthesia is required, efforts must be made to blunt the hypertensive response to laryngoscopy and intubation. Transthoracic echocardiography has emerged as useful technique to monitor maternal haemodynamics in preeclampsia. SUMMARY: Improvements in the diagnosis of preeclampsia may lead to better outcomes for mothers and babies. Peripartum care requires a multidisciplinary team approach with many preeclamptic women receiving neuraxial analgesia or anaesthesia. Women with severe preeclampsia may require critical-care support and this should meet the same standards afforded to other acutely unwell patients.


Assuntos
Anestesia Obstétrica , Anestesiologistas , Hemodinâmica/fisiologia , Bloqueio Nervoso , Pré-Eclâmpsia/fisiopatologia , Adulto , Analgesia Epidural/efeitos adversos , Anestesia Geral , Anestesia Obstétrica/efeitos adversos , Biomarcadores , Ecocardiografia , Feminino , Humanos , Período Periparto , Fator de Crescimento Placentário , Gravidez , Prognóstico
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