RESUMO
BACKGROUND: Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies. METHODS: CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined five elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the five intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intra-abdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967. FINDINGS: Between May 20, 2007, and Dec 31, 2010, 15â935 women were recruited. There were no statistically significant differences within any of the intervention pairs for the primary outcome: blunt versus sharp entry risk ratio 1·03 (95% CI 0·91-1·17), exterior versus intra-abdominal repair 0·96 (0·84-1·08), single-layer versus double-layer closure 0·96 (0·85-1·08), closure versus non-closure 1·06 (0·94-1·20), and chromic catgut versus polyglactin-910 0·90 (0·78-1·04). 144 serious adverse events were reported, of which 26 were possibly related to the intervention. Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section. INTERPRETATION: These findings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects. FUNDING: UK Medical Research Council and WHO.
Assuntos
Cesárea/métodos , Complicações na Gravidez/cirurgia , Prática Profissional/estatística & dados numéricos , Adulto , Argentina , Cesárea/estatística & dados numéricos , Recesariana/métodos , Recesariana/estatística & dados numéricos , Chile , Feminino , Gana , Humanos , Índia , Quênia , Paquistão , Gravidez , Resultado da Gravidez , Sudão , Técnicas de Fechamento de Ferimentos/estatística & dados numéricosRESUMO
OBJECTIVE: To examine sex differences in barriers to contraceptive use by using a national sample of 4539 participants from The National Longitudinal Study of Adolescent Health. STUDY DESIGN: The National Longitudinal Study of Adolescent Health used a study design in which data from Wave 1 were collected between 1994 and 1995. Participants older than 15 years or sexually active were queried regarding various real or potential barriers to contraceptive use. RESULTS: Boys were significantly more likely than girls to believe that using birth control interferes with pleasure during intercourse, is difficult to obtain, is morally wrong, is expensive, is bothersome, involves too much planning, and makes people think they are seeking sex. Significant differences were observed between boys and girls on a summative barrier scale. CONCLUSIONS: Male adolescents held stronger views regarding barriers to contraceptive use. More effective and relevant programming can take place at the school and community levels to address these potential barriers on the basis of sex differences.
Assuntos
Comportamento do Adolescente , Atitude , Comportamento Contraceptivo , Adolescente , Comportamento Contraceptivo/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores SexuaisRESUMO
This study examined the relationship between barriers to using birth control and actual use of birth control among a national sample of Mexican-American adolescents. Participants were either over age 15 or sexually active (regardless of age). They responded to survey items on birth control use. Chi-square analysis and t tests were used to investigate whether barriers to using birth control were related to actual use during first intercourse and most recent sexual intercourse. It was found that nonusers had significantly higher barrier scores compared with users of birth control. The results indicate that attitudes toward birth control are associated with actual birth control use among Mexican-American adolescents. Additionally, males and females may have distinct barriers to using birth control. It was concluded that a better understanding of the sexual attitudes and beliefs associated with birth control is needed in order to improve programs seeking to increase the use of birth control among this rapidly expanding, high-risk population.
Assuntos
Comportamento do Adolescente/psicologia , Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/estatística & dados numéricos , Hispânico ou Latino/psicologia , Americanos Mexicanos/estatística & dados numéricos , Adolescente , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Comportamento Sexual/psicologia , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
Overcrowding is a significant factor contributing to endemic infection with Sarcoptes scabiei in human and animal populations. However, since scabies mites from different host species are indistinguishable morphologically, it is unclear whether people can be infected from scabies-infested animals. Molecular fingerprinting was done using three S. scabiei-specific single locus hypervariable microsatellite markers, with a combined total of 70 known alleles. Multilocus analysis of 712 scabies mites from human and dog hosts in Ohio, Panama and Aboriginal communities in northern Australia now shows that genotypes of dog-derived and human-derived scabies cluster by host species rather than by geographic location. Because of the apparent genetic separation between human scabies and dog scabies, control programs for human scabies in endemic areas do not require resources directed against zoonotic infection from dogs.
Assuntos
Doenças do Cão/parasitologia , Sarcoptes scabiei/genética , Escabiose/parasitologia , Alelos , Animais , Análise por Conglomerados , DNA/química , Impressões Digitais de DNA/veterinária , Repetições de Dinucleotídeos/genética , Reservatórios de Doenças , Doenças do Cão/epidemiologia , Cães , Eletroforese/veterinária , Variação Genética , Genótipo , Humanos , Marsupiais , Havaiano Nativo ou Outro Ilhéu do Pacífico , Northern Territory/epidemiologia , Ohio/epidemiologia , Panamá/epidemiologia , Reação em Cadeia da Polimerase/veterinária , Coelhos , Escabiose/epidemiologia , Pele/parasitologia , Vitória/epidemiologia , ZoonosesRESUMO
The T-helper (Th) cell immune response following immunization of C3H (H-2k) mice with a recombinant vaccinia (VAC) virus (TC-5A) expressing the structural proteins (capsid, E1 and E2) of the attenuated vaccine strain (TC-83) of Venezuelan equine encephalitis (VEE) virus was compared with the immune response induced in mice after immunization with TC-83 virus. TC-5A virus elicited Th cells that strongly recognized both VAC and TC-83 viruses in in vitro lymphoblastogenesis tests. Th-cell activation was associated with elevated levels of interleukin-2. TC-5A virus induced long-term humoral immunity; VEE virus-binding and neutralizing antibodies were detected in mouse sera collected from mice 16 months after a single immunization.
Assuntos
Vírus da Encefalite Equina Venezuelana/imunologia , Sindbis virus/imunologia , Linfócitos T Auxiliares-Indutores/imunologia , Vacinas Sintéticas/imunologia , Vaccinia virus/imunologia , Vacinas Virais/imunologia , Animais , Formação de Anticorpos , Reações Antígeno-Anticorpo , Imunização , Imunofenotipagem , Interleucina-2/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C3H , Vacinas Atenuadas/imunologiaRESUMO
To identify T-helper (Th)-cell epitopes, we analyzed 25 synthetic peptides, which included most of the 495-amino-acid sequence of the envelope (E)-glycoprotein of dengue 2 virus. The peptides were analyzed in three mouse strains, BALB/c (H-2d), C57BL/6 (H-2b), and outbred NIH-Swiss, for their ability to elicit antibody or prime the Th-cell compartment following two inoculations in Freund's incomplete adjuvant. Sixteen peptides were able to elicit an antipeptide antibody response in one or more mouse strain. Eleven antipeptide serum pools were able to bind to virus in ELISA. Fifteen peptides primed one or more haplotype for an in vitro antipeptide Th-cell response as measured by blastogenesis. Th-cell activation was generally confirmed by measurable in vitro production of interleukin (IL)-2/IL-4. Nine peptides that were positive for in vitro blastogenesis, 1-2, 35, 4-6, 79, 142, 208, 06, 16, and 17, elicited virus-reactive Th-cells in vitro in H-2d mice. Two of these peptides (4-6 and 17) were able to prime virus-reactive Th-cells in H-2b mice. Nine peptides primed outbred mice in vitro for an antiviral antibody response significantly greater than that seen in animals primed with an irrelevant peptide. These results correlate with, and expand on, our previous observations based on a smaller set of synthetic peptides derived from the E-glycoprotein of Murray Valley encephalitis virus and suggest that synthetic peptides can function as E-glycoprotein Th-cell epitopes. The similarity of results between two distantly related flaviviruses suggests that E-glycoprotein Th-cell epitopes are consistent in location and activity.
Assuntos
Antígenos Virais/imunologia , Vírus da Dengue/imunologia , Epitopos/imunologia , Linfócitos T Auxiliares-Indutores/imunologia , Proteínas do Envelope Viral/imunologia , Animais , Anticorpos Antivirais/biossíntese , Anticorpos Antivirais/sangue , Antígenos Virais/sangue , Glicoproteínas/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Fragmentos de Peptídeos/imunologia , Proteínas do Envelope Viral/sangueRESUMO
cDNA molecules encoding the structural proteins of the virulent Trinidad donkey and the TC-83 vaccine strains of Venezuelan equine encephalitis (VEE) virus were inserted under control of the vaccinia virus 7.5K promoter into the thymidine kinase gene of vaccinia virus. Synthesis of the capsid protein and glycoproteins E2 and E1 of VEE virus was demonstrated by immunoblotting of lysates of CV-1 cells infected with recombinant vaccinia/VEE viruses. VEE glycoproteins were detected in recombinant virus-infected cells by fluorescent antibody (FA) analysis performed with a panel of VEE-specific monoclonal antibodies. Seven E2-specific epitopes and two of four E1-specific epitopes were demonstrated by FA.
Assuntos
Vírus da Encefalite Equina Venezuelana/genética , Proteínas Recombinantes de Fusão/biossíntese , Proteínas Recombinantes/biossíntese , Vaccinia virus/genética , Proteínas Virais/biossíntese , Anticorpos Monoclonais , Sequência de Bases , Clonagem Molecular , DNA , Vírus da Encefalite Equina Venezuelana/metabolismo , Epitopos/genética , Imunofluorescência , Immunoblotting , Plasmídeos , RNA Viral , Proteínas Recombinantes de Fusão/genética , Vaccinia virus/metabolismo , Proteínas do Envelope Viral/biossíntese , Proteínas do Envelope Viral/genética , Proteínas Virais/genética , Proteínas Estruturais ViraisRESUMO
Mice immunized with recombinant vaccinia virus (VACC) expressing Venezuelan equine encephalitis (VEE) virus capsid protein and glycoproteins E1 and E2 or with attenuated VEE TC-83 virus vaccine developed VEE-specific neutralizing antibody and survived intraperitoneal challenge with virulent VEE virus strains including Trinidad donkey (subtype 1AB), P676 (subtype 1C), 3880 (subtype 1D), and Everglades (subtype 2). However, unlike immunization with TC-83 virus, immunization with the recombinant VACC/VEE virus did not protect mice from intranasal challenge with VEE Trinidad donkey virus. These results suggest that recombinant VACC/VEE virus is a vaccine candidate for equines and humans at risk of mosquito-transmitted VEE disease but not for laboratory workers at risk of accidental exposure to aerosol infection with VEE virus.
Assuntos
Vírus da Encefalite Equina Venezuelana/imunologia , Encefalomielite Equina/prevenção & controle , Encefalomielite Equina Venezuelana/prevenção & controle , Vacinas Sintéticas , Vacinas , Vacinas Virais , Animais , Anticorpos Antivirais/biossíntese , Capsídeo/imunologia , Reações Cruzadas , Vírus da Encefalite Equina Venezuelana/genética , Ensaio de Imunoadsorção Enzimática , Feminino , Glicoproteínas/imunologia , Testes de Inibição da Hemaglutinação , Masculino , Camundongos , Camundongos Endogâmicos , Testes de Neutralização , Vacinas/imunologia , Vacinas Atenuadas , Vacinas Sintéticas/imunologia , Vaccinia virus/genética , Vaccinia virus/imunologia , Vacinas Virais/imunologiaRESUMO
We have previously characterized with monoclonal antibodies (MAbs) seven unique epitopes on the two envelope glycoproteins of Venezuelan equine encephalomyelitis (VEE) virus vaccine strain TC-83. The epitopes important in protection from VEE virus infection were determined in passive antibody transfer studies, with virulent VEE (Trinidad donkey) virus as the challenge virus. Selected high-avidity MAbs to the three major protective epitopes (E2c, E1b, and E1d) were assayed for in vitro complement activity. All three fixed murine complement to high titer. Limited pepsin digestion of the anti-E2c in the presence of cysteine resulted in a rapid decrease and complete loss of complement-fixing ability by 2 h, but the majority of mice, except at the lowest dilution of MAb, were protected until the Fc termini were cleaved at 3 h. Anti-E2c F(ab')2 would neutralize VEE (Trinidad donkey) virus more efficiently than either Fab' or Fab; none of the fragments would fix complement or was effective in passive protection. C5-deficient mice and mice depleted of C3 with cobra venom factor were still protected from VEE (Trinidad donkey) virus challenge after passive transfer of either anti-E2c or anti-E1b MAb. The results show that the anti-E2c MAb mediates neutralization through bivalent binding at a critical site on the virion and that Fc effector functions, other than complement, are necessary for protection. Although the ability of the anti-E2c MAb to fix complement was associated with its ability to protect in vivo, no direct cause-and-effect relationship was found. Since the epitope defined by the anti-E1d antibody is found on the cell membrane, but is not expressed on the infectious virion, protection in mice was most likely mediated at the cellular level, possibly by inhibition of the final stages of virion maturation.
Assuntos
Proteínas do Sistema Complemento/imunologia , Encefalomielite Equina/imunologia , Encefalomielite Equina Venezuelana/imunologia , Fragmentos Fc das Imunoglobulinas/imunologia , Fragmentos de Imunoglobulinas/imunologia , Animais , Anticorpos Monoclonais , Epitopos , Glicoproteínas/imunologia , Camundongos , Testes de Neutralização , Pepsina A/metabolismoRESUMO
The neutralization (N) site on the gp56 (E2) surface glycoprotein of the TC-83 vaccine strain of Venezuelan equine encephalomyelitis (VEE) virus has been characterized using monoclonal antibodies. Five new epitopes (E2d-h) were identified three of which could be mapped into the critical N site by using a competitive binding assay (CBA). Antibodies reactive with these three epitopes had either N or N and hemagglutination-inhibition activity. All epitopes contained within this N site elicited monoclonal antibodies that could protect mice from peripheral virus challenge. Antibodies reactive with the N site on other subtypes of VEE virus (IC and II) bound to, but failed to neutralize, TC-83 virus. Epitopes defined by these antibodies could be located outside of the N site on TC-83 virus by CBA. Antigenic activity of all epitopes except E2d was resistant to treatment with 2% SDS, 3% beta-mercaptoethanol, or cleavage with Staphylococcus aureus V8 protease. Those antibodies which defined epitopes located within the N site of TC-83 with CBA bound the same V8 fragments in immunoblots. Those antibodies which defined epitopes not located within the N site bound a different set of fragments than neutralizing antibodies. These results indicate that there is a specific N site on the E2 of VEE virus which undergoes significant antigenic drift while maintaining structural and functional integrity.
Assuntos
Vírus da Encefalite Equina Venezuelana/imunologia , Epitopos/imunologia , Proteínas Virais/imunologia , Animais , Anticorpos Monoclonais/isolamento & purificação , Complexo Antígeno-Anticorpo , Linhagem Celular , Chlorocebus aethiops , Cricetinae , Ensaio de Imunoadsorção Enzimática , Hibridomas/imunologia , Rim , Plasmocitoma/imunologia , Conformação ProteicaRESUMO
We have previously characterized seven unique antigenic epitopes on the two envelope glycoproteins of the Venezuelan equine encephalomyelitis (VEE) virus vaccine strain, TC-83, by using monoclonal antibodies. The in vitro function of virus neutralization was primarily associated with one epitope on the gp56 (gp56c). To determine which epitopes were important in protecting animals from VEE infection, purified monoclonal antibodies were inoculated i.v. into 3-wk-old Swiss mice. Twenty-four hours later these animals were challenged i.p. with 100 IPLD50 of virulent VEE virus (Trinidad donkey). High-avidity anti-gp56c, anti-gp50b, anti-gp50c, and anti-gp50d monoclonal antibodies protected animals from virus challenge. Rabbit antisera to the gp56 and the gp50 glycoproteins were also effective in protecting mice from challenge with virulent VEE virus. Less antibody was needed to protect animals if the antibody was directed against the critical neutralization site. Less avid antibodies to the gp56c and gp50b epitopes demonstrated little or no protection in vivo. Protection, therefore, appeared to be a function of the passive antibody's specificity, avidity, and ability to bind to virion antigenic determinants topologically proximal to the critical neutralization site.
Assuntos
Alphavirus/imunologia , Anticorpos Monoclonais/imunologia , Antígenos Virais/imunologia , Vírus da Encefalite Equina do Leste/imunologia , Glicoproteínas/imunologia , Proteínas Virais/imunologia , Animais , Anticorpos Antivirais/imunologia , Formação de Anticorpos , Reações Cruzadas , Epitopos , Imunização , Imunização Passiva , Memória Imunológica , Cinética , CamundongosAssuntos
Anticorpos Antibacterianos/análise , Formação de Anticorpos , Imunidade Celular , Streptococcus agalactiae/imunologia , Aglutininas , Animais , Especificidade de Anticorpos , Sangue , Feminino , Haplorrinos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/imunologia , Pan troglodytes , Papio , Fagocitose , Faringe/microbiologia , Gravidez , Coelhos/imunologia , Infecções Estreptocócicas/imunologia , Streptococcus agalactiae/isolamento & purificação , Cordão Umbilical , Vagina/microbiologiaAssuntos
Peso Corporal , Proteínas Alimentares , Recém-Nascido Prematuro , Tirosina , Sangue , Humanos , Recém-NascidoRESUMO
At the Trinidad Nutrition Centre hemoglobin levels were determined in 555 pregnant women and a third of these were found to be less than 10 gm percent. Serum iron levels were diminished and total iron binding capacity increased wile the present saturation of TIBC was decreased in this anemic group. Serum folic acid levels were low but serum Vit. B12 levels normal. Average total protein intake was 56 gm (49 percent of animal and 51 percent of vegetable sources), representing a deficit of 26.8 percent in total protein intake. Average iron intake was 10.3 mg (20 percent of animal and 80 percent of vegetable sources), representing a 31.3 percent deficiency. In 84 percent of the patients anemia was of the hypochromic microcytic type. The authors intend to investigate further whether the high proportion of iron intake from vegetable sources plays any part in the production of anemia (AU)