Inequality, Zika epidemics, and the lack of reproductive rights in Latin America.

It is well-documented that structural economic inequalities in Latin America are expressed through and reinforce existing gender gaps. This article aims to look at the relationship between structural inequalities and reproductive health in the case of the Zika epidemic. The consequences of the epidemic will continue to affect the same women whose access to comprehensive reproductive health services, including safe abortion, is restricted at best.

The relationship between mode of delivery and sexual health outcomes after childbirth.

INTRODUCTION: Several factors are implicated in the women's sexuality after childbirth. Nevertheless, there is conflicting evidence about the influence of mode of delivery (MD) AIM: To prospectively evaluate the relationship between MD and sexual health outcomes after childbirth METHODS: A prospective cohort study conducted between May 2005 and March 2007 included 831 pregnant women recruited from primary care clinics of the public sector in São Paulo, Brazil. The exposure variable was MD: uncomplicated vaginal delivery (spontaneous vaginal delivery without episiotomy or any kind of perineal laceration); complicated vaginal delivery (either forceps or normal, with episiotomy or any kind of perineal laceration) and cesarean delivery. Socio-demographic and obstetric data were obtained through a questionnaire applied during the antenatal and postnatal period. Crude and adjusted risk ratios, with 95% confidence intervals, were calculated using Poisson regression to examine the associations between MD and sexual health outcomes. MAIN OUTCOME MEASURES: The three main sexual health outcomes were later resumption of sexual life, self-perception of decline of sexual life (DSL), and presence of sexual desire. RESULTS: One hundred and forty-one women (21.9%) resumed sexual life 3 or more months after delivery. Although 87.1% of women had desire, DSL occurred in 21.1% of the cohort. No associations were found between MD and sexual health outcomes. CONCLUSIONS: Women's sexuality after childbirth were not influenced by the type of delivery. Efforts to improve the treatment of sexual problems after childbirth should focus beyond MD.

Evaluation of d-dimer as outcome biomarker in COVID-19 acute respiratory distress patients.

Acute respiratory distress syndrome is a significant complication in critical care patients. COVID-19 (C19)-associated severe respiratory failure is related to it, and d-dimer rise predicts a worse outcome. To investigate the association between d-dimer and the severity of this respiratory syndrome, we conducted a study in C19 intubated patients. A retrospective, single-center observational study was conducted with 64 C19 adult intubated patients. Strata of d-dimer results between patients was evaluated using survival analysis. Survival was higher in mild respiratory distress patients. D-dimer showed poor sensitivity and specificity in predicting respiratory failure severity. Risk assessment for death showed a higher prevalence of admission d-dimer results (HR 1.335; 95% CI 0.695-2.564). Our sample confidently represented the medical profile of C19 severe patients. Sepsis development in C19 is associated with the inflammatory storm in respiratory distress syndrome. As the receiver operating curves show, the increase in d-dimer results is consistent with inflammation rather than a prognostic biomarker. As expected, severe respiratory distress patients presented higher mortality. In summary, d-dimer results are not associated with the prognosis of C19 respiratory distress syndrome patients.

Materno-infantilism, feminism and maternal health policy in Brazil.

In the last days of 2011, President of Brazil Dilma Rousseff issued a provisional measure (or draft law) entitled "National Surveillance and Monitoring Registration System for the Prevention of Maternal Mortality" (MP 557), as part of a new maternal health programme. It was supposed to address the pressing issue of maternal morbidity and mortality in Brazil, but instead it caused an explosive controversy because it used terms such as nascituro (unborn child) and proposed the compulsory registration of every pregnancy. After intense protests by feminist and human rights groups that this law was unconstitutional, violated women's right to privacy and threatened our already limited reproductive rights, the measure was revised in January 2012, omitting "the unborn child" but not the mandatory registration of pregnancy. Unfortunately, neither version of the draft law addresses the two main problems with maternal health in Brazil: the over-medicalisation of childbirth and its adverse effects, and the need for safe, legal abortion. The content of this measure itself reflects the conflictive nature of public policies on reproductive health in Brazil and how they are shaped by close links between different levels of government and political parties, and religious and professional sectors.

Equity and women's health services for contraception, abortion and childbirth in Brazil.

This paper addresses equity in health and health care in Brazil, examining unjust disparities between women and men, and between women from different social strata, with a focus on services for contraception, abortion and pregnancy. In 2010 women's life expectancy was 77.6 years, men's was 69.7 years. Women are two-thirds of public hospital services users and assess their health status less positively than men. The total fertility rate was 1.8 in 2011, and contraceptive prevalence has been high among women at all income levels. The proportion of sterilizations has decreased; lower-income women are more frequently sterilized. Abortions are mostly illegal; women with more money have better access to safe abortions in private clinics. Poorer women generally self-induce abortion with misoprostol, seeking treatment of complications from public clinics. Institutional violence on the part of health professionals is reported by half of women receiving abortion care and a quarter of women during childbirth. Maternity care is virtually universal. The public sector has fewer caesarean sections, fewer low birthweight babies, and more rooming-in, but excessive episiotomies and inductions. Privacy, continuity of care and companionship during birth are more common in the private sector. To achieve equity, the health system must go beyond universal, unregulated access to technology, and move towards safe, effective and transparent care.

The possible role of selenium status in adverse pregnancy outcomes.

The present study reviews the possible role of Se status during pregnancy regarding adverse pregnancy outcomes, with emphasis on those related to diminished antioxidant activity and increased oxidative stress. Studies have reported that Se could play an important role in adverse outcomes such as miscarriages, neural tube defects, diaphragmatic hernia, premature birth, low birth weight, pre-eclampsia, glucose intolerance and gestational diabetes. Also, low Se status has been associated with adverse outcomes among HIV-infected pregnant women and their offspring. Nevertheless, the function of Se in the aetiology of pregnancy complications is yet to be elucidated. Available evidence presents the following limitations: most study designs do not allow conclusions about causal relationships; study populations, selection of subjects, research setting, procedures for defining sample size and analytical methods are often poorly described; many studies fail to adjust for important confounding variables. In addition, population studies assessing the relationship between Se intake during pregnancy and health outcomes are scarce. Further research is still needed to clarify the role of Se status in adverse pregnancy outcomes, especially those related to augmented oxidative stress.

Sexual and reproductive health and rights in public health education.

This paper addresses the challenges faced in mainstreaming the teaching of sexual and reproductive health and rights into public health education. For this paper, we define sexual and reproductive health and rights education as including not only its biomedical aspects but also an understanding of its history, values and politics, grounded in gender politics and social justice, addressing sexuality, and placed within a broader context of health systems and global health. Using a case study approach with an opportunistically selected sample of schools of public health within our regional contexts, we examine the status of sexual and reproductive health and rights education and some of the drivers and obstacles to the development and delivery of sexual and reproductive health and rights curricula. Despite diverse national and institutional contexts, there are many commonalities. Teaching of sexual and reproductive health and rights is not fully integrated into core curricula. Existing initiatives rely on personal faculty interest or short-term courses, neither of which are truly sustainable or replicable. We call for a multidisciplinary and more comprehensive integration of sexual and reproductive health and rights in public health education. The education of tomorrow's public health leaders is critical, and a strategy is needed to ensure that they understand and are prepared to engage with the range of sexual and reproductive health and rights issues within their historical and political contexts.

Nitric oxide-induced vasorelaxation in response to PnTx2-6 toxin from Phoneutria nigriventer spider in rat cavernosal tissue.

INTRODUCTION: Priapism is one of several symptoms observed in accidental bites by the spider Phoneutria nigriventer. The venom of this spider is comprised of many toxins, and the majority has been shown to affect excitable ion channels, mainly sodium (Na(+) ) channels. It has been demonstrated that PnTx2-6, a peptide extracted from the venom of P. nigriventer, causes erection in anesthetized rats and mice. AIM: We investigated the mechanism by which PnTx2-6 evokes relaxation in rat corpus cavernosum. MAIN OUTCOME MEASURES: PnTx2-6 toxin potentiates nitric oxide (NO)-dependent cavernosal relaxation. METHODS: Rat cavernosal strips were incubated with bretylium (3 × 10(-5) M) and contracted with phenylephrine (PE; 10(-5) M). Relaxation responses were evoked by electrical field stimulation (EFS) or sodium nitroprusside (SNP) before and after 4 minutes of incubation with PnTx2-6 (10(-8) M). The effect of PnTx2-6 on relaxation induced by EFS was also tested in the presence of atropine (10(-6) M), a muscarinic receptor antagonist, N-type Ca(2+) channel blockers (ω-conotoxin GVIA, 10(-6) M) and sildenafil (3 × 10(-8) M). Technetium99m radiolabeled PnTx2-6 subcutaneous injection was administrated in the penis. RESULTS: Whereas relaxation induced by SNP was not affected by PnTx2-6, EFS-induced relaxation was significantly potentiated by this toxin as well as PnTx2-6 plus SNP. This potentiating effect was further increased by sildenafil, not altered by atropine, however was completely blocked by the N-type Ca(2+) channels. High concentrated levels of radiolabeled PnTx2-6 was specifically found in the cavernosum tissue, suggesting PnTx2-6 is an important toxin responsible for P. nigriventer spider accident-induced priapism. CONCLUSION: We show that PnTx2-6 slows Na(+) channels inactivation in nitrergic neurons, allowing Ca(2+) influx to facilitate NO/cGMP signalling, which promotes increased NO production. In addition, this relaxation effect is independent of phosphodiesterase enzyme type 5 inhibition. Our data displays PnTx2-6 as possible pharmacological tool to study alternative treatments for erectile dysfunction.

Scintigraphic imaging using technetium-99m-labeled ceftizoxime in an experimental model of acute osteomyelitis in rats.

PURPOSE: To investigate inflammatory (zymosan) and infectious (Staphylococcus aureus) processes in experimental models in rats using technetium-99m-labeled ceftizoxime (CFT). METHODS: Male Wistar rats were used for the development of the inflammatory (zymosan) and infectious (S. aureus) processes in the medullary cavity of the left tibia. Sterile saline was used for the control group. At 48 h after induction of the processes, the animals were anesthetized and scintigraphic images were acquired at 1, 2, 4, and 6 h after intravenous injection of 0.1 ml of 99mTc-CFT (55 MBq). Quantitative analysis of the scintigraphic images was performed by counting the radioactivity in the regions of interest. Samples of tibia were taken for histopathological examination. RESULTS: The images showed that 99mTc-CFT presented higher tropism to infectious foci than with the inflammatory site. The average value of the target/nontarget ratio of the 99mTc-CFT was significantly higher in the infected (2.40+/-0.22) than in the inflamed tibia (1.50+/-0.05) and the control group (1.05+/-0.04) for all of the investigated times. The histological data showed a similar inflammatory response for both the S. aureus and zymosan groups. CONCLUSION: The 99mTc-CFT presented a high tropism and retention for an infected region in this model of osteomyelitis, thereby constituting an interesting strategy to distinguish aseptic from septic sites.

Influence of biomaterials on scintigraphic diagnosis of periprosthetic infections. Ceftizoxime-99m technetium model.

PURPOSE: To compare the influence of two metallic implants in the diagnosis of periprosthetic infection using 99m technetium-labeled ceftizoxime. METHODS: Twenty rats were randomly divided into four groups, which received sterile and contaminated titanium and stainless steel implants. After 3 weeks, scintilographic images were obtained using a gamma chamber. Radioactivity counts were obtained for the region of interest (ROI) on the operated and non-operated paws. RESULTS: Groups A, B, and C showed homogenous distribution of the radiopharmaceutical. Hyper uptake was observed in the operated paw from group D. The ROI target count was higher in the two groups with stainless steel implants. Among the control groups, the count was higher in the stainless steel group. Furthermore, among the contaminated groups, the uptake was higher in the stainless steel group, with a significant difference. The target: non-target ratio was significantly lower in the control and contaminated groups with both titanium and stainless steel, but the comparison between control groups and contaminated groups was only significant in the former. The cpm/g observed after a decay of 48h showed statistically significant differences between groups. CONCLUSION: Different biomaterials used in implants have an influence on the results of scintigraphy with 99mTc-CFT.

Pulmonary phagocyte depression induced by an acid or alkaline solution in a rat model of peritonitis.

BACKGROUND: Peritonitis is a surgical problem with a high mortality rate attributable to various complications, including respiratory infection. This complication is more common under certain conditions reflective of the origin of peritonitis, suggesting that the composition of the peritoneal fluid exerts an influence on the intensity of the macrophage and peritoneal response. To establish a correlation among macrophage function, absorption of bacteria from the peritoneal cavity, and the pH of the peritoneal fluid, we carried out this study. METHODS: Thirty female Wistar rats were divided into three equal groups, all of which received infusions of 0.9% saline by parietal puncture. In group A (control), the saline pH was 7.0; in group B, it was 2.5; and in group C, it was 8.5. After 40 min, 0.25 mL of a suspension containing 10(11) colony-forming units of (99m)Tc-labeled Escherichia coli was infused by the same route. After another 40 min, samples of vena caval blood, spleen, liver, and lung were removed; the radioactivity was counted; bacterial absorption was determined; and the proportional radioactivity/g of tissue was calculated. The values were compared among the groups by the Student t-test, with the level of significance set at p < 0.05. RESULTS: There was significantly greater bacterial absorption in group B than in group C (p = 0.004) but no differences in the numbers of bacteria in the liver and spleen. Bacteria were significantly more numerous in the peripheral blood in group B than in groups A and C (p = 0.04 for both). Pulmonary phagocytosis was significantly reduced in group B compared with group A (p = 0.008) and group C (p = 0.005). CONCLUSION: Peritonitis associated with acidic conditions in the peritoneal cavity is correlated with a reduction in pulmonary phagocytosis and an increase in the numbers of nonphagocytized bacteria in the peripheral blood, possibly representing a direct or indirect cause of the higher incidence of pneumonia and sepsis in these individuals.

[Prevalence of intimate partner violence against women in regions of Brazil]. / Prevalência da violência contra a mulher por parceiro íntimo em regiões do Brasil.

OBJECTIVE: To analyze the results from the "WHO Multi-country Study on Women's Health and Domestic Violence", on the prevalence of intimate partner violence against women found in Brazil. METHODS: This cross-sectional study was part of the "WHO Multi-country Study on Women's Health and Domestic Violence against women", which was carried out in ten countries between 2000 and 2003. All the countries used a standardized structured questionnaire, devised for this study. In order to obtain data from contrasting settings within each country, the biggest city and a rural region were investigated whenever feasible. A representative sample of women aged 15 to 49 years was selected from the city of São Paulo and 15 municipalities in a rural region of the northeast, the Zona da Mata de Pernambuco. The study included 940 women from São Paulo and 1,188 from Zona da Mata de Pernambuco who had had an intimate partner at some time in their lives. Violence was classified as psychological, physical and sexual types, and was analyzed in relation to overlapping, recurrence of episodes, severity and when it occurred. RESULTS: The women in São Paulo and Pernambuco respectively reported the following at least once in their lifetimes: psychological (N=383; 41.8% and N=580; 48.9%); physical (N=266; 27.2% and N=401; 33.7%); sexual (N=95; 10.1% and N=170; 14.3%) violence. There was significant overlapping among the types of violence, which seemed to be associated with the most severe types of violence. The greatest single type was psychological violence, in São Paulo and Pernambuco (N=164; 17.5% and N=206; 17.3%), and the smallest was sexual violence (N=2; 0.2% and N=12; 1.0%). CONCLUSIONS: The results show that violence is a very common phenomenon. The findings reiterate previous international studies results with regard to high magnitude and overlapping of types of intimate partner violence.

Prevention of bacterial translocation using glutamine: a new strategy of investigation.

OBJECTIVE: This study investigated the role of glutamine (Gln) on bacterial translocation in an intestinal obstruction model by using Escherichia coli labeled with technetium 99m (99mTc-E. coli). METHODS: Intestinal obstruction was performed by a single ligature of the terminal ileum in rats. Animals in the control group (group 1) were sham operated (not obstructed). Experimental group 2 had intestinal obstruction. Groups 1 and 2 were not treated with Gln. Groups 3 and 4 were treated with Gln for 7 d before surgery with 250 and 500 mg x kg(-1) x d(-1), respectively. A suspension containing 100 million colony-forming units/mL of (99m)Tc-E. coli was injected into the lumen of the ileum. Twenty-four hours after surgery, blood, mesenteric lymph nodes, livers, spleens, and lungs were collected for determination of radioactivity. The Mann-Whitney U test was performed for statistical analysis. P

[The impact of the type of hospital and delivery on the gestational age in São Paulo city, 2013-2014]. / O impacto do tipo de hospital e tipo de parto sobre a idade gestacional ao nascer no Município de São Paulo, 2013-2014.

INTRODUCTION:: There was a left-shift on the distribution curve of gestational age (GA) and a reduction of the proportion of live births of 40 weeks, when compared to the expected standard in many countries. OBJECTIVE:: To study the distribution of gestational age births in São Paulo city (SP) and its relationship with the type of hospital and delivery. METHODS:: Data were extracted from Live Birth Information System (SINASC) linked to the National Database of Health Establishments (CNES) in 2013 and 2014. Data are presented according to birth in public (SUS) and private (non SUS) hospitals, type of delivery and gestational age, standardized according to the mother's age. RESULTS:: There was a left-shift in GA curve for total births which was more pronounced among cesarean births and private hospitals. The median GA of public hospitals was 39 weeks, while in the private hospitals, 38 weeks. The proportion of preterm births (9,5%) was similar in public and private hospitals, but among public hospital there was a higher proportion of very preterm births (<32 weeks), while (34-36) in private hospitals late preterm and early term were more frequent. CONCLUSIONS:: The change in the distribution of gestational age in SP is related to the type of hospital and the proportion of cesarean sections in private hospitals.

Morphologic and Functional Study of Heterotopic Splenic Tissue Allografts in Rabbits.

OBJECTIVES: To assess the viability and induction of immunotolerance of nonvascularized splenic alloimplants. The phagocytic functions of splenic implants also were studied. MATERIALS AND METHODS: Thirty-six adult female New Zealand and California rabbits were used, and these animals were divided into the following 5 groups: (n = 6 / groups 1-4) group 1 (sham operations); group 2 (total splenectomy); group 3 (implantation of autologous sliced splenic tissue in the greater omentum following splenectomy); group 4 (implantation of allogenic sliced splenic tissue in the greater omentum after splenectomy); and group 5 (n = 12) (implanting allogenic sliced splenic tissue in the greater omentum after splenectomy and receiving oral cyclosporine at a dosage of 40 mg/kg/d). All animals were followed for 120 days after the operations, then received venous injections of China ink (groups 1, 2, 3, 4, 5A) or a colloidal radiopharmaceutical (group 5B), and subsequently underwent reoperations. Hematimetric examinations were performed, and the histologic aspects and phagocytic functions of the implants were assessed. RESULTS: Spontaneous immunotolerance was not induced by sliced splenic allografts implanted in the greater omentum. The use of cyclosporine did not preserve the viabilities of the implants. All animals in group 3, which were subjected to autologous implants, exhibited viable implants that exhibited phagocytic function, although this phagocytic function was reduced compared with that of the normal spleen. CONCLUSIONS: No viable spleen alloimplants were observed regardless of the presence of cyclosporine. Spontaneous immunotolerance was not induced by sliced splenic alloimplants.

Scintigraphic imaging with technetium-99M-labelled ceftizoxime is a reliable technique for the diagnosis of deep sternal wound infection in rats.

PURPOSE: To evaluate whether scintigraphy with technetium-99m-labeled ceftizoxime ((99m)Tc-CFT) can differentiate mediastinitis from aseptic inflammation associated with sternotomy. METHODS: Twenty female Wistar rats were randomly distributed into four groups: S (control) -partial upper median sternotomy with no treatment; SW (control) - sternotomy and treatment of sternal wounds with bone wax; SB - sternotomy and infection with Staphylococcus aureus; SWB - sternotomy with bone wax treatment and bacterial infection. Scintigraphy with (99m)Tc-CFT was performed eight days after surgery and images were collected 210 and 360 min after infusion of the radiopharmaceutical. RESULTS: No animals exhibited clinical signs of wound infection at the end of the experiment, although histological data verified acute inflammatory response in those experimentally infected with bacteria. Scintigraphic images revealed that tropism of (99m)Tc-CFT to infected sternums was greater than to their non-infected counterparts. Mean counts of radioactivity in bacteria-infected sternal regions (SB and SWB) were significantly higher (p = 0.0007) than those of the respective controls (S and SW). CONCLUSION: Scintigraphy with technetium-99m-labeled ceftizoxime is a method that can potentially detect infection post sternotomy and differentiate from aseptic inflammation in animals experimentally inoculated with S. aureus.

Efficacy of (99m)Tc-Labeled Ceftizoxime in the Diagnosis of Subclinical Infections Associated with Titanium Implants in Rats.

BACKGROUND: Metal implants are used frequently in orthopedic procedures and the occurrence of subclinical low-virulence infection is difficult to diagnose. The objective of this study was to examine the hypothesis that peri-prosthetic subclinical infections may be diagnosed effectively in a murine model system using scintigraphic imaging with (99m)Tc-labeled ceftizoxime. METHODS: A sample population of 3-mo old Wistar rats (mean weight 327 g) was divided randomly into a control group (n=6), which received sterile implants, and an experimental group (n=6), which received implants contaminated with Staphylococcus aureus strain ATCC6538-P. Animals were anesthetized and femoral titanium implants were fixed beneath muscle tissue in left hind limbs. Three weeks after surgery, animals were injected with (99m)Tc-ceftizoxime solution (62.9 MBq) and scintigraphic images were obtained at 3.5 and 6.5 h after tracer injection. RESULTS: According to the scintigraphic images, the radiopharmaceutical showed affinity for the operated thigh areas of experimental animals but not for those of the control group. There was no difference between the control and experimental groups regarding the amount of radioactivity in the regions of interest measured at 3.5 h after injection of radiolabeled antibiotic, but the between-group difference determined at 6.5 h after treatment was statistically significant (p=0.026). Moreover, the level of radioactivity recorded in resected thigh tissues derived from experimental animals was greater than that of the control group (p=0.035). CONCLUSION: (99m)Tc-ceftizoxime scintigraphy can localize preferentially periprosthetic-infected areas adjacent to metal implants in a murine model. Furthermore, the radiolabeled antibiotic appears to be capable of detecting alterations in the micro-environment close to the implant and of reaching the bacteria attached to the implant surface.