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AIM: To develop evidence-based clinical algorithms for the assessment and management of spontaneous, uncomplicated labour and vaginal birth. POPULATION: Pregnant women at any stage of labour, with singleton, term pregnancies considered to be at low risk of developing complications. SETTING: Health facilities in low- and middle-income countries. SEARCH STRATEGY: We searched for relevant published algorithms, guidelines, systematic reviews and primary research studies on Cochrane Library, PubMed, and Google on terms related to spontaneous, uncomplicated labour and childbirth up to 01 June 2023. CASE SCENARIOS: Three case scenarios were developed to cover assessments and management for spontaneous, uncomplicated first, second and third stage of labour. The algorithms provide pathways for definition, assessments, diagnosis, and links to other algorithms in this series for management of complications. CONCLUSIONS: We have developed three clinical algorithms to support evidence-based decision making during spontaneous, uncomplicated labour and vaginal birth. These algorithms may help guide health care staff to institute respectful care, appropriate interventions where needed, and potentially reduce the unnecessary use of interventions during labour and childbirth.

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Background: Caesarean section (CS) is the most performed major surgery worldwide. Surgical techniques used for CS vary widely and there is no internationally accepted standardization. We conducted an overview of systematic reviews (SR) of randomized controlled trials (RCT) to summarize the evidence on surgical techniques or procedures related to CS. Methods: Searches were conducted from database inception to 31 January 2024 in Cochrane Database of Systematic Reviews, PubMed, EMBASE, Lilacs and CINAHL without date or language restrictions. AMSTAR 2 and GRADE were used to assess the methodological quality of the SRs and the certainty of evidence at outcome level, respectively. We classified each procedure-outcome pair into one of eight categories according to effect estimates and certainty of evidence. The overview was registered at PROSPERO (CRD 42023208306). Findings: The analysis included 38 SRs (16 Cochrane and 22 non-Cochrane) published between 2004-2024 involving 628 RCT with a total of 190,349 participants. Most reviews were of low or critically low quality (AMSTAR 2). The SRs presented 345 procedure-outcome comparisons (237 procedure versus procedure, 108 procedure versus no treatment/placebo). There was insufficient or inconclusive evidence for 256 comparisons, clear evidence of benefit for 40, possible benefit for 17, no difference of effect for 13, clear evidence of harm for 14, and possible harm for 5. We found no SRs for 7 pre-defined procedures. Skin cleansing with chlorhexidine, Joel-Cohen-based abdominal incision, uterine incision with blunt dissection and cephalad-caudal expansion, cord traction for placental extraction, manual cervical dilatation in pre-labour CS, changing gloves, chromic catgut suture for uterine closure, non-closure of the peritoneum, closure of subcutaneous tissue, and negative pressure wound therapy are procedures associated with benefits for relevant outcomes. Interpretation: Current evidence suggests that several CS surgical procedures improve outcomes but also reveals a lack of or inconclusive evidence for many commonly used procedures. There is an urgent need for evidence-based guidelines standardizing techniques for CS, and trials to fill existing knowledge gaps. Funding: UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO).

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BACKGROUND: Magnesium sulphate is the drug of choice for the prevention and treatment of women with eclampsia. Regimens for administration of this drug have evolved over the years, but there is no clarity on the comparative benefits or harm of alternative regimens. This is an update of a review first published in 2010. OBJECTIVES: To assess if one magnesium sulphate regimen is better than another when used for the care of women with pre-eclampsia or eclampsia, or both, to reduce the risk of severe morbidity and mortality for the woman and her baby. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (29 April 2022), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised trials and cluster-randomised trials comparing different regimens for administration of magnesium sulphate used in women with pre-eclampsia or eclampsia, or both. Comparisons included different dose regimens, intramuscular versus intravenous route for maintenance therapy, and different durations of therapy. We excluded studies with quasi-random or cross-over designs. We included abstracts of conference proceedings if compliant with the trustworthiness assessment. DATA COLLECTION AND ANALYSIS: For this update, two review authors assessed trials for inclusion, performed risk of bias assessment, and extracted data. We checked data for accuracy. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: For this update, a total of 16 trials (3020 women) met our inclusion criteria: four trials (409 women) compared regimens for women with eclampsia, and 12 trials (2611 women) compared regimens for women with pre-eclampsia. Most of the included trials had small sample sizes and were conducted in low- and middle-income countries. Eleven trials reported adequate randomisation and allocation concealment. Blinding of participants and clinicians was not possible in most trials. The included studies were for the most part at low risk of attrition and reporting bias. Treatment of women with eclampsia (four comparisons) One trial compared a loading dose-alone regimen with a loading dose plus maintenance dose regimen (80 women). It is uncertain whether either regimen has an effect on the risk of recurrence of convulsions or maternal death (very low-certainty evidence). One trial compared a lower-dose regimen with standard-dose regimen over 24 hours (72 women). It is uncertain whether either regimen has an effect on the risk of recurrence of convulsion, severe morbidity, perinatal death, or maternal death (very low-certainty evidence). One trial (137 women) compared intravenous (IV) versus standard intramuscular (IM) maintenance regimen. It is uncertain whether either route has an effect on recurrence of convulsions, death of the baby before discharge (stillbirth and neonatal death), or maternal death (very low-certainty evidence). One trial (120 women) compared a short maintenance regimen with a standard (24 hours after birth) maintenance regimen. It is uncertain whether the duration of the maintenance regimen has an effect on recurrence of convulsions, severe morbidity, or side effects such as nausea and respiratory failure. A short maintenance regimen may reduce the risk of flushing when compared to a standard 24 hours maintenance regimen (risk ratio (RR) 0.27, 95% confidence interval (CI) 0.08 to 0.93; 1 trial, 120 women; low-certainty evidence). Many of our prespecified critical outcomes were not reported in the included trials. Prevention of eclampsia for women with pre-eclampsia (five comparisons) Two trials (462 women) compared loading dose alone with loading dose plus maintenance therapy. Low-certainty evidence suggests an uncertain effect with either regimen on the risk of eclampsia (RR 2.00, 95% CI 0.61 to 6.54; 2 trials, 462 women) or perinatal death (RR 0.50, 95% CI 0.19 to 1.36; 2 trials, 462 women). One small trial (17 women) compared an IV versus IM maintenance regimen for 24 hours. It is uncertain whether IV or IM maintenance regimen has an effect on eclampsia or stillbirth (very low-certainty evidence). Four trials (1713 women) compared short postpartum maintenance regimens with continuing for 24 hours after birth. Low-certainty evidence suggests there may be a wide range of benefit or harm between groups regarding eclampsia (RR 1.99, 95% CI 0.18 to 21.87; 4 trials, 1713 women). Low-certainty evidence suggests there may be little or no effect on severe morbidity (RR 0.96, 95% CI 0.71 to 1.29; 2 trials, 1233 women) or side effects such as respiratory depression (RR 0.80, 95% CI 0.25 to 2.61; 2 trials, 1424 women). Three trials (185 women) compared a higher-dose maintenance regimen versus a lower-dose maintenance regimen. It is uncertain whether either regimen has an effect on eclampsia (very low-certainty evidence). Low-certainty evidence suggests that a higher-dose maintenance regimen has little or no effect on side effects when compared to a lower-dose regimen (RR 0.79, 95% CI 0.61 to 1.01; 1 trial 62 women). One trial (200 women) compared a maintenance regimen by continuous infusion versus a serial IV bolus regimen. It is uncertain whether the duration of the maintenance regimen has an effect on eclampsia, side effects, perinatal death, maternal death, or other neonatal morbidity (very low-certainty evidence). Many of our prespecified critical outcomes were not reported in the included trials. AUTHORS' CONCLUSIONS: Despite the number of trials evaluating various magnesium sulphate regimens for eclampsia prophylaxis and treatment, there is still no compelling evidence that one particular regimen is more effective than another. Well-designed randomised controlled trials are needed to answer this question.

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La aceptación de padecer una enfermedad crónica y aprender a convivir con ésta puede ser un proceso lento para el paciente y su familia. Los niños y los adolescentes con una enfermedad crónica se enfrentan a un desafío que requiere afrontar la responsabilidad y exigencias de la necesidad de un tratamiento diario a largo plazo que muchas veces requiere adaptar sus actividades y su vida para cumplir con el mismo. El objetivo del tratamiento en las enfermedades crónicas es minimizar los síntomas, alcanzar el control o modificar la evolución natural para lograr una calidad de vida adecuada. Adherencia significa la aceptación de un rol activo en el propio cuidado de la salud, pero que debe comprender la colaboración entre el paciente, su familia y el equipo de salud. Esta colaboración debe incluir confianza, términos como negociación, toma de decisiones en forma conjunta y comunicación para determinar el tratamiento adecuado de la enfermedad. La adherencia al tratamiento es un problema y constituye un reto y una preocupación para los médicos que tratan a pacientes con enfermedades crónicas porque la falta de adherencia genera empeoramiento de la enfermedad, aumento del número de hospitalizaciones, altos costos para el paciente, la familia y el sistema de salud.

Accepting to suffer from a chronic disease and learning to live with this disease can be a slow process for the patient and their family. Children and adolescents with a chronic disease face a challenge that requires facing the responsibility and demands of the need for long-term daily treatment that often requires adapting their activities and their lives to comply with it. The goal of treatment in chronic diseases is to minimize symptoms, achieve control, or modify the natural history to achieve an adequate quality of life. Adherence means the acceptance of an active role in one's own health care but that must include collaboration between the patient, his family and the health team. This collaboration should include trust, terms such as negotiation, joint decision-making, and communication to determine the appropriate treatment for the disease. Adherence to treatment is a problem and constitutes a challenge and concern for physicians who treat patients with chronic diseases because lack of adherence leads to a worsening of the disease, an increase in the number of hospitalizations, high costs for the patient, the family and the health system.

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Mating partners need to recognize, assess each other, and exchange information through behavioral events that occur before, during, and after mating. Sexual signals, as well as life history traits, are influenced by selective pressures and environmental factors that can vary across distant geographical areas. Allocosa senex is a sand-dwelling wolf spider which constructs burrows along the sandy coasts of Argentina, Brazil, and Uruguay. Females are the mobile sex that searches for males and initiates courtship. They prefer males which construct longer burrows, and males prefer virgin females in good body condition. The objective of this study was to compare sexual behavior patterns, as well as body characteristics and burrow dimensions, between two geographically distant locations of A. senex, one in Uruguay (Uruguayan location) and the other from central Argentina (Argentinean location). We found differences in the number of male abdominal vibrations, male and female touches during mating, and number of erections of male leg spines, which all were higher in matings of Argentinean pairs. On the other hand, male body mass and female body condition were higher in Uruguayan individuals. The wide distribution of A. senex could be determining variations in the biotic and abiotic features that affect the species, generating differences in the strength of selective forces acting on individuals from the two studied locations.

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La presentación en forma de póster en congresos o reuniones científicas es una alternativa a la presentación oral que inició en la década de 1970. Un póster en una reunión científica o un congreso es una representación gráfica ampliada que contiene un título, el nombre de los autores y de los centros y textos y figuras que explican un proyecto, una investigación o una experiencia. Algunos congresos han empezado a utilizar el póster electrónico (e-poster). Se trata de pósteres digitales confeccionados de la misma manera y con las mismas características que los convencionales, pero que se presentan en formato digital y son expuestos de manera constante en pantallas o mediante proyecciones en zonas dispuestas a tal efecto. Para realizar un póster de contenido científico se deben considerar dos aspectos fundamentales y complementarios, como son el contenido que vamos a expresar a través del póster y el aspecto que se va a presentar, que influirá de manera importante en la transmisión del contenido y en el guiado de su lectura a los posibles receptores.

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Traditional studies on sexual communication have focused on the exchange of signals during courtship. However, communication between the sexes can also occur during or after copulation. Allocosa brasiliensis is a wolf spider that shows a reversal in typical sex roles and of the usual sexual size dimorphism expected for spiders. Females are smaller than males and they are the roving sex that initiates courtship. Occasional previous observations suggested that females performed body shaking behaviors during copulation. Our objective was to analyze if female body shaking is associated with male copulatory behavior in A. brasiliensis, and determine if this female behavior has a communicatory function in this species. For that purpose, we performed fine-scaled analysis of fifteen copulations under laboratory conditions. We video-recorded all the trials and looked for associations between female and male copulatory behaviors. The significant difference between the time before and after female shaking, in favor of the subsequent ejaculation is analyzed. We discuss if shaking could be acting as a signal to accelerate and motivate palpal insertion and ejaculation, and/or inhibiting male cannibalistic tendencies in this species.

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El objetivo del presente trabajo fue evaluar la prueba de rivanol para el diagnóstico de brucelosis caprina, determinando su sensibilidad y especificidad. La prueba se realizó con antígeno comercial de Brucella abortus, utilizando las diluciones 1:25, 1:50, 1:100, 1:200 y 1:400. Para determinar la sensibilidad se utilizaron 64 sueros de caprinos con infección demostrada por aislamiento de B. melitensis, la especificidad se evaluó con 50 sueros de caprinos procedentes de hatos y de zonas libres de brucelosis. La especificidad en cabras vacunadas se obtuvo usando sueros de 22 cabras jóvenes de 3 a 4 meses de edad vacunadas con dosis clásica (1 x 109 ufc/ml) de Rev 1 B. melitensis por vía subcutánea y 59 cabras adultas vacunadas con dosis reducida (1 x 105 ufc/ml) de Rev 1 por vía subcutánea, a partir de los cuales se colectaron muestras serológicas los días 7, 15, 30, 60, 90, 120, 150, 180 y 210 posvacunación. Del grupo de animales infectados 54 sueros resultaron positivos con títulos que variaron de 1:25 a 1:400, resultando la sensibilidad de 83 por ciento. El grupo de caprinos procedentes de zonas libres de brucelosis no presentó ningún resultado positivo, por lo que la especificidad fue del 100 por ciento. El grupo de cabras jóvenes vacunadas con dosis clásica presentó de los 7 a los 90 días 100 por ciento de reactores; a los 120 y 150 días, 27 por ciento; de los 180 a los 240 días, 9 por ciento. Los sueros de cabras vacunadas con dosis reducida reaccionaron 100 por ciento de los 7 a los 90 días; a los 120 y 150 días, 35 por ciento; a los 180 días, 21 por ciento; y a los 210 y 240 días, 6 por ciento de positivos. Se concluye que la prueba de rivanol no ofrece ninguna ventaja para ser utilizada en el diagnóstico de la brucelosis caprina como prueba confirmatoria.

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Antecedentes: El cisplatino es efectivo en el tratamiento del cáncer de ovario, testículo, pulmón, cabeza y cuello. Diversos efectos adversos han sido asociados con el empleo de este fármaco, entre ellos insuficiencia renal, neurotoxicidad, mielosupresión y alteraciones metabólicas. La anemia se ha descrito como un efecto frecuente con relación a dosis cumulativas. Objetivo: Evaluar el índice de reducción de la hemoglobina y el impacto de los bajos niveles de hemoglobina sobre el estado funcional de los pacientes oncológicos tratados con cisplatino. Pacientes: Mayores de 20 años con neoplasias avanzadas susceptibles de ser tratadas con esquemas de quimioterapia a base de cisplatino y que recibieron al menos tres ciclos de tratamiento. Sangrado gastrointestinal, enfermedad ósea metastásica, insuficiencia renal, hemoglobina menor a 10 g en la determinación previa al inició del tratamiento, así como terapia con corticosteroides o eritropoyetina recombinante fueron considerados como criterios de exclusión. Métodos: Estudio retrospectivo de enero de 1994 a diciembre de 1997. Se aplicó cisplatino, solo o en combinación, a dosis de 80 a 100 mg/m², en infusión de 8-10 horas, cada 21 días. Se utilizó terapia profiláctica con manitol, solución salina, suplemento de sulfato de magnesio y terapia antiemética con ondansetron 24 mg/día. Los niveles de hemoglobina y la capacidad funcional fueron determinados antes de cada ciclo mediante la escala de karnofsky. También se evaluó edad, sexo, tipo de neoplasia, estadio clínico y número de ciclos de quimioterapia aplicados. El análisis estadistico fue realizado con métodos descriptivos y pruebas de Kruskall-Wallis y de Spearman, Resultados: Treinta pacientes fueron incluidos, edad promedio 55.6 ñ 14.3 años, 17 hombres y 13 mujeres...

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Objetivo. Determinar las alteraciones en la tensión arterial que sufre pacientes oncológicos como resultados de la infusión de cisplatino. Pacientes. Ingresaron con diagnóstico comprobado de neoplasia maligna, edades comprendidas entre 25 y 68 años, diagnóstico comprobado de neoplasia maligna y quimioterapia con esquemas a base de cisplatino entre enero de 1996 y diciembre de 1997. Método. El fármaco fue aplicado a dosis de 80 a 100 mg/m², en infusión continua durante ocho horas, con prehidratación con base en solución salina al 0.9 por ciento, manitol al 20 por ciento, 100 mL, durante 30 minutos, así como terapia antiemética con base en ondansetrón y difenhilhidramina, cada 21 días. La tensión arterial se evaluó durante el primero, tercero y quinto ciclos en decúbito supino, al inicio y al final de la infusión de la droga. Se consideró la elevación de 10 o más mm Hg como hipertensión arterial. Resultados. Diecisiete hombre y 14 mujeres de edad promedio 53.1 ñ 12.3 años, rango 28 a 68; de los cuales 19 fueron mayores a 50 años (61.2 por ciento). Con neoplasia de pulmón, nueve (29 por ciento); ovario, cuatro (12.9 por ciento), testículo, tres (9.6 por ciento), melanoma y cérvix uterino dos (6.4 por ciento) y casos individuales de endometrio, mama, esófago, tumor de Merkel, cariocarcinoma, linfoma, próstata, trompa de Falopio, vías biliares, vejiga y estómago para un total de 31 pacientes. Estadios clínicos I, un caso (3.2 por ciento); II, seis (19.3 por ciento); III, 11 (35.4 por ciento) y IV, 12 (38.7 por ciento), con un caso no etapificado. Se aplicaron 128 ciclos, de los que 102 fueron evaluables. La tesnsión arterial media previa al inicio del primer ciclo fue 94.3 ñ 8.6 y al final 95.3 ñ 9.5 mm Hg, p=0.68; al inicio del tercer ciclo fue 98.6 ñ 9.9 y al final la lectura fue de 97.1 ñ 7.3 mm Hg, p=0.630; mientras que para el quinto ciclo el valor inicial fue de 96.6 ñ 8.8 y al final de 95.1 ñ 13.5 mm Hg, p=0724. La estimación de tensión arterial media, previa y posterior a la infusión del fármaco durante el primero, tercero y quinto ciclos no mostró diferencia significativa...

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