RESUMO

OBJECTIVE: In Ecuador, the reported maternal death rate was 45.71 per 100,000 live births in 2013. This may be partly due to a lack of maternal knowledge of obstetric warning signs during pregnancy, delivery and the post-partum period. This study sought to evaluate awareness of obstetric warning signs among pregnant women in relation to individual demographic and area-level socio-economic indicators. STUDY DESIGN: We conducted a cross-sectional analysis of data collected by Ecuador's Ministry of Health at the conclusion of a national maternal health campaign (2014-2015). A nationally representative sample of 3435 pregnant women from the nine administrative zones completed surveys regarding basic demographics and their awareness of obstetric warning signs. METHODS: We defined eight obstetrical warning signs according to the literature and Ecuadorian practice that could occur during pregnancy, delivery and the post-partum period (severe headache, strong abdominal ache, bleeding or presence of malodorous secretion, rupture of the amniotic sac, high fever, abnormal presentation of the baby, decrease in baby's movements and delayed labour). A woman was considered 'aware' if she recognised at least four of the eight warning signs and stated she would seek immediate healthcare at their presentation. For each administrative zone, four socio-economic indicators (poverty, illiteracy, unemployment and subemployment) were obtained from the National Institute of Statistics and Census. Correlates of awareness of the obstetric warning signs were evaluated using hierarchical logistic models clustered by the administrative zone. RESULTS: Nationally, 86.9% of women were 'aware' of obstetric warning signs. After adjustment for age, socio-economic indicators and clustering, indigenous participants were 59% less likely to be aware of obstetric warning signs than mestizos (odds ratio [OR] = 0.41, 95% confidence interval [CI] = 0.28-0.59). For every 1% increase in area poverty, participants had a 5% decreased likelihood of being aware of obstetric warning signs (OR = 0.95, 95% CI = 0.93-0.96), adjusting for age, ethnicity and other socio-economic indicators. The most effective source of campaign information about obstetric warning signs was personal communication with a healthcare professional, as opposed to mass media advertisements (OR = 1.90, 95% CI = 1.34-2.71). CONCLUSIONS: A majority of Ecuadorian pregnant and post-partum women are aware of obstetric warning signs. Indigenous ethnicity and area-level poverty are associated with a lack of awareness. Personal communication with a healthcare professional was the most effective source of information. These findings have implications for improvement of maternal awareness of warning signs.

Assuntos

RESUMO

El síndrome de Felty se caracteriza por reunir la tríada compuesta por: artritis reumatoide, neutropenia y esplenomegalia. Es una enfermedad autoinmune poco frecuente, con compromiso sistémico, articular y extra articular. Se desarrolla en personas de mediana edad, con historia de artritis reumatoide crónica deformante. El diagnóstico es eminentemente clínico y el tratamiento está enfocado a disminuir el dolor articular, las altas tasas de infecciones y evitar las deformidades óseas. Presentamos una paciente de 69 años de edad, diagnosticada en nuestro hospital, motivo por el que realizamos revisión bibliográfica de la entidad.

Felty's syndrome has such as main feature the triad composed by: rheumatoid arthritis, neutropenia and splenomegaly. It is unusual autoimmune disease that compromises the nervous system as well as joint affectation and extra joint. This illness develops in middle aged subjects with arthritis rheumatoid chronic deform history. The diagnosis is clinical and the focus treatment is to diminish the articular pain, to reduce the infections high rates and to avoid the bony deformities. We report a clinical case of a patient who is 69 years-old, she was diagnosed in our hospital and we reviewed the bibliographic entity.

RESUMO

El síndrome de Felty se caracteriza por reunir la tríada compuesta por: artritis reumatoide, neutropenia y esplenomegalia. Es una enfermedad autoinmune poco frecuente, con compromiso sistémico, articular y extra articular. Se desarrolla en personas de mediana edad, con historia de artritis reumatoide crónica deformante. El diagnóstico es eminentemente clínico y el tratamiento está enfocado a disminuir el dolor articular, las altas tasas de infecciones y evitar las deformidades óseas. Presentamos una paciente de 69 años de edad, diagnosticada en nuestro hospital, motivo por el que realizamos revisión bibliográfica de la entidad.(AU)

Feltys syndrome has such as main feature the triad composed by: rheumatoid arthritis, neutropenia and splenomegaly. It is unusual autoimmune disease that compromises the nervous system as well as joint affectation and extra joint. This illness develops in middle aged subjects with arthritis rheumatoid chronic deform history. The diagnosis is clinical and the focus treatment is to diminish the articular pain, to reduce the infections high rates and to avoid the bony deformities. We report a clinical case of a patient who is 69 years-old, she was diagnosed in our hospital and we reviewed the bibliographic entity.(AU)

RESUMO

A total of 287 neurons were antidromically driven in quasi-cortical regions, i.e., anterior olfactory nucleus (24%), basolateral amygdala (13%), main olfactory bulb (4%), prefrontal cortex (37%), and in the hippocampal formation (22%) following macro- and microstimulation of the rat's ventrostriopallidal region (VSPR). In addition, a substantial number of units (n = 175) were also transynaptically affected in all these structures by shocks delivered to the VSPR. Excitatory effects were detected in 50 neurons (56.1% of responsive cells), 36 cells (40.4%) responding with inhibition of spontaneous discharges. Conversely, stimulation of cortical and quasi-cortical regions antidromically discharged (n = 37) or transynaptically affected (n = 151) units in the VSPR; 168 neurons were not responsive to VSPR stimulation. Axon collateralization (branching) of 14 neurons in anterior olfactory nucleus, basolateral amygdala, and hippocampal formation was revealed with the use of the reciprocal collision test. Conduction properties of 35 neurons, evaluated by paired-pulse stimulation, indicated that only 26% showed a significant increase in conduction velocity and a decrease in threshold during the supernormal phase. The present findings confirm and extend previous neuroanatomical studies that have, first, described strong interconnections between the neocortex and striatal structures, and second, that the VSPR as suggested by previous structural, hodological, and histochemical studies, seems to maintain a more close relationship with olfactory related structures than hitherto suspected.

Assuntos

RESUMO

Antidromic unit driving was utilized to demonstrate afferent projections from prefrontal cortical (PFC) and quasi-cortical structures (main olfactory bulb, MOB; anterior olfactory nucleus, AON; basolateral amygdaloid nucleus, BLA) to the ventrostriopallidal region (VSPR) of the rat. In all regions explored, a substantial number of antidromically invaded neurons were found following electrical stimulation of the VSPR. In addition, both the AON and the amygdalostriatal zone harbor cells with branched axons which innervate the MOB and the VSPR and the agranular insular cortex and the VSPR, respectively. These results support and extend previous neuroanatomical and neurophysiological data on afferent connections of the VSPR and emphasize the fact that several regions of the basal forebrain, which are actively involved in processing of olfactory information, and the VSPR, are more closely interrelated than hitherto suspected.

Assuntos

RESUMO

PURPOSE OF THE STUDY: evaluate biological and medical characteristics of the grand multipara and her offspring in the neonatal period. TYPE OF STUDY: comparative and retrospective. SITE: Hospital of the Jundiai School of Medicine. PATIENTS: study group--134 grand multiparas; control group--100 primiparas. All patients were admitted to the Franco da Rocha Hospital, the maternity school of the Jundiai School of Medicine. INTERVENTION: analytical study. MEASURES AND RESULTS: hypertension, haemorrhage, twins, premature labor, pelvic location, and anemia were the complications seen in group 1. Cesarean section was indicated in the presence of a prior cesarean section, and fetal distress was the indication followed in group 2. Post partum damage to soft tissue was more prevalent in group 1. Premature labor and perinatal mortality were more frequent in group 1. CONCLUSION: The authors conclude that GMP were women with a high risk and, thus, they suggest adequate antenatal assistance as an important measure to decrease perinatal and maternal mortality.

Assuntos

RESUMO

Alzheimer's disease (AD) is considered to be the number one health problem and seems to be reaching epidemic proportion in the USA. The cause of AD is not known, a reliable animal model of the disease has not been found and appropriate treatment of this dementia is wanting. The present review focuses on the possibility that a virus or exogenous toxic materials may gain access to the CNS using the olfactory mucosa as a portal of entry. Anterograde and retrograde transport of the virus/zeolites to olfactory forebrain regions, which receive primary and secondary projections from the main olfactory bulb (MOB) and which, in turn, project centrifugal axons to the MOB, may initiate cell degeneration at such loci. Pathological changes may, thus, be initially confined to projecting and intrinsic neurons localized in cortical and subcortical olfactory structures; arguments are advanced which favor the view that excitotoxic phenomena could be mainly responsible for the overall degenerative picture. Neurotoxic activity may follow infection by the virus itself, be facilitated by loss of GABAergic terminals in olfactory cortex, develop following repeated episodes of physiological long term potentiation (which unmasks NMDA receptors) or be due to excessive release, faculty re-uptake or altered glutamate receptor sensitivity. Furthermore, a reduction in central inhibitory inputs to the MOB might then result in disinhibition of mitral/tufted neurons and enhance the excitotoxic phenomena in the MOB projecting field. Within this context, and in line with recent studies, it is believed that pathology begins at cortical (mainly olfactory) regions, basal forebrain neurons being secondarily affected due to retrograde degeneration. In addition, failure to produce a critical level of neurotrophic factors by a damaged MOB and olfactory cortex, could adversely affect survival of basal cholinergic neurons which innervate both regions. Support for these hypothesis is provided, first, by recent reports on pathological findings in AD brains which seem to involve preferentially the olfactory and entorhinal cortices, the olfactory amygdala and the hippocampus, all of which receive primary or secondary projections from the MOB; secondly, by the presence of severe olfactory deficits in the early stages of the disease, mainly of a discriminatory nature, which points to a malfunction of central olfactory structures.

Assuntos

RESUMO

Field potential and single unit recordings were used to assess the connections of the olfactory tubercle (OT) with the main olfactory bulb (MOB) and the piriform cortex (PC) in urethane-anesthetized rats. Current generators of depth profiles evoked in OT following MOB stimulation were localized 300 microns superficial to those elicited by PC shocks, suggesting that afferents from the MOB and PC end in different regions of the OT. Following MOB and PC stimulation antidromically invaded neurons were recorded in the ventral pallidal regions of the OT and in the vicinity of the islands of Calleja, respectively. These results demonstrate that the OT, which receives a monosynaptic input from the MOB, projects back to the bulb and that the PC seems to be also reciprocally linked with differentiated structures in the OT.

Assuntos

Assuntos

RESUMO

Following main olfactory bulb (MOB) stimulation at frequencies of 0.1-0.3 Hz, in addition to early field potentials, a frequency-sensitive, surface negative late N2 wave (latency range: 63-96 msec) followed occasionally by a late N3 transient, was evoked in the piriform cortex and endopiriform nucleus of the rat. The N2 wave inverted polarity at the Ib-II cortical layer interface (P2 wave) and was associated with late unit discharges 200 to 1200 microns deep to the turnover point. Response probability, peak latency, recovery curve and frequency-sensitivity of the P2 wave were not significantly different in animals under urethane or pentobarbital. Current-source-density (CSD) analysis revealed that the N2 wave generators were localized to the Ib-II layer interface. Since inhibitory activity does not contribute substantially to the second derivative curve, CSD analysis strengthens the assumption that late components (LCs) are excitatory events (compound EPSPs) presumably generated on the proximal apical dendritic segments of pyramidal cells by association axons. The early "b" wave in a test response was facilitated, rather than occluded, when a LC was present in the conditioning response, or when the priming volley was delivered to the mediodorsal thalamic nucleus. Clustering of unit and field activity in two distinct periods of the evoked response separated by a prolonged interval of cell silence suggests that cortical coding of olfactory cues might be more efficiently achieved by temporal modulation of the neuronal response rather than by spatial distribution of firing patterns.

Assuntos

Assuntos

Assuntos

RESUMO

Reciprocal putative connections of the prefrontal cortex (PFC) (agranular insular, ventral and lateral orbital region) with the ipsi and contralateral main olfactory bulb (IOB; COB), the mediodorsal thalamic nucleus (MD), the basolateral amygdaloid nucleus (BLA) and the piriform cortex (PC) were investigated with electrophysiological techniques. Evoked field responses and orthodromic unit driving, generated in PFC following electrical stimulation of the above mentioned structures, were abolished following topical application of KCl, except for COB evoked mass potentials. Thus, locally generated activity was elicited in agranular insular cortex following IOB activation, the same region where recently, the taste cortex in the rat was localized. Since gustatory-visceral afferent information reaches insular cortex via 2-3 synaptic relays, autonomic, olfactory and gustatory inputs may interact at this level, and, as suggested previously for the mouse, play a key integrative role in flavor perception. Antidromically invaded neurons, 47% of which were identified by the collision-extinction technique, were also found in PFC areas which overlapped to a considerable extent with those from which orthodromic unit responses were obtained. In particular, closely spaced neurons in ventrolateral orbital (VLO) and lateral orbital (LO) regions were antidromically invaded following IOB and PC shocks; some neurons antidromically discharged by IOB were also transsynaptically activated following PC stimulation. These findings are in agreement with recent neuroanatomical studies which demonstrate axonal projections from PFC neurons to the IOB and COB in the rat and South American armadillo. In addition, stimulation of PFC regions dorsal to the rhinal fissure mostly inhibited spontaneous unit discharges recorded at the mitral cell layer of the IOB, suggesting that this effect may be partially mediated by excitatory inputs of prefrontal axons onto granule cells. The conduction properties, antidromic thresholds and activity-dependent variations in conduction velocity (CV) of bulbopetal neurons in prefrontal cortex were found to be similar to those exhibited by cells projecting to the IOB from olfactory peduncle regions, but not to those present in bulbopetal neurons of the horizontal limb of diagonal band, indicating that the OB may be subjected to centrifugal control by at least two cell groups differing in both histochemical and electrophysiological properties.

Assuntos

Assuntos

Assuntos

Assuntos

Assuntos