RESUMO
OBJECTIVE: To describe obstetrical providers' delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. DESIGN: Cross-sectional study. SETTING: Two public and two private hospitals in Argentina. POPULATION: Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services. METHODS: Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey. MAIN OUTCOME MEASURES: Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. RESULTS: 168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19-18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58-12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request. CONCLUSIONS: Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina. TWEETABLE ABSTRACT: Non-medically indicated c-section? 74% of sampled Argentine OB providers support women's right to choose.
Assuntos
Atitude do Pessoal de Saúde , Cesárea , Procedimentos Cirúrgicos Eletivos/métodos , Obstetrícia , Preferência do Paciente , Adulto , Argentina/epidemiologia , Atitude Frente a Saúde , Cesárea/ética , Cesárea/psicologia , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Obstetrícia/ética , Obstetrícia/métodos , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Direitos do Paciente , Gravidez , Utilização de Procedimentos e Técnicas/estatística & dados numéricosRESUMO
BACKGROUND: Helicobacter pylori (H. pylori) is the main etiologic agent of chronic gastritis and it is an important cause of gastric damage. The celiac disease can affect the morphology and the function of the gastrointestinal tract from the stomach to the colon and it is frequently associated with chronic gastritis. AIM: to assess the presence of H. pylori in gastric biopsies and in feces of pediatric patients with celiac disease and to relate it with the symptoms. PATIENTS AND METHODS: Pediatric patients with celiac disease attending the Gastroenterology Service at the "Avelino Castelán" Hospital in Resistencia (Argentina) were included in the study. Gastric biopsies samples were obtained by endoscopy for histological studies, the symptoms and socio-epidemiological characteristics were recorded and the polimerase chain reaction(PCR) was applied in feces in order to detect the presence of H. pylori. RESULTS: Thirty one patients with celiac disease were studied (16 female and 15 male; age range:1-14 years; median 6.7 years); 14 (45.2%) were positive for H. pylori in gastric biopsy and among them, only 2 (14.2%) were positive for H. pylori in stool samples. There were not significant differences between symptoms between H. pylori positive and negative patients. CONCLUSION: 45.2% of the patients with celiac disease were infected by H. pylori. There was no correlation between the frequencies of bacterial detection in feces and in gastric biopsies. The clinical manifestations of celiac disease did not increase in children infected with H. pylori.
Assuntos
Doença Celíaca/microbiologia , Fezes/microbiologia , Helicobacter pylori/isolamento & purificação , Estômago/microbiologia , Estômago/patologia , Adolescente , Biópsia , Doença Celíaca/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos ProspectivosRESUMO
A double-blind, placebo-controlled randomized study of danazol was performed to determine if the drug has a therapeutic effect in patients with myelodysplastic syndromes (MDS). Fifty evaluable patients with MDS were randomized to receive, a single daily oral dose of either danazol (600 mg/day) or matching placebo. Treatment was continued, when possible, for a period of 6 months. Response was based on clinical course, peripheral blood counts with white blood cells differential, platelet, reticulocyte at specified intervals. Repeat bone marrow aspirates and biopsy were also done. Significant differences was observed between the treatment groups in response to test drug. Increase in hemoglobin, granulocytes, platelets and improvement in survival was noted in danazol group. Side effects were minimal. Our study suggests that danazol exerts a beneficial therapeutic effect in patients with MDS.