RESUMO
Introduction: Immigration has increased significantly in Chile. Despite that all pregnant women, regardless of nationality and immigration status, have the right to access to all healthcare services during pregnancy, childbirth, and postpartum, inequities in health care outcomes and health provision have been reported. During COVID-19 pandemic, these inequities are completely unknown. Objective: The aim of this study was to compare the incidence of c-sections according to mother's migration status, as well as other maternal care and perinatal outcomes in women giving birth at San José Hospital in Santiago, Chile, during the COVID-19 pandemic. Methods: A retrospective cohort study was designed including 10,166 registered single births at the San José Hospital between March 2020 and August 2021. To compare between groups, statistical tests such as Chi-square and Fisher's exact were used. Log Binomial regression models were performed adjusted for potential confounding variables. To estimate the strength of association the relative risk was used. Results: Immigrant mothers account for 48.1% of the registered births. Compared to non-immigrant women, immigrants exhibit a higher proportion of c-section, specifically, emergency c-section (28.64% vs. 21.10%; p-value < 0.001) but a lower proportion of and having a preterm birth (8.24% vs. 13.45%; p < 0.05), receiving personalized childbirth care (13.02% vs. 14.60%; p-value < 0.05), companion during labor and childbirth (77.1% vs. 86.95%; p-value < 0.001), And postpartum attachment to newborn (73% vs. 79.50%; p-value < 0.001). The proportion of COVID exposure was not significant between groups, not the severity also. Haitians had a highest risk of undergoing emergency c-section (aRR = 1.61) and Venezuelans had a highest risk of elective c-section (aRR = 2.18) compared to non-immigrants. Conclusion: This study reports high rates of c-sections in the entire population, but in immigrant populations it is even higher. Additionally, it found gaps in maternal care and perinatal outcomes between immigrants and non-immigrants. More studies are needed to elucidate the possible causes of these differences and establish new regulations to protect the reproductive rights of the immigrant population.
RESUMO
PURPOSE: Changes in calbindin (CB) expression have been reported in patients with temporal lobe epilepsy (TLE) with controversial implications on hippocampal functions. The aim of this study was to determine the CB immunoreactivity in hippocampal dentate gyrus of patients who underwent epilepsy surgery for drug-resistant TLE with and without comorbid depression and/or memory deficits. METHODS: Selected hippocampal samples from patients with TLE who underwent epilepsy surgery were included. Clinical and complementary assessment: EEG, video-EEG, MRI, psychiatric assessment (structured clinical interview, DSM-IV), and memory assessment (Rey auditory verbal learning test, RAVLT; Rey-Osterrieth complex figure test, RCFT), were determined before surgery. Hippocampal sections were processed using immunoperoxidase with the anti-calbindin antibody. The semiquantitative analysis of CB immunoreactivity was determined in dentate gyrus by computerized image analysis (ImageJ). RESULTS: Hippocampal sections of patients with TLE and HS (n = 24) and postmortem controls (n = 5) were included. A significant reduction of CB+ cells was found in patients with TLE (p < 0.05, Student's t-test). Among TLE cases (n = 24), depression (n = 12) and memory deficit (n = 17) were determined. Depression was associated with a higher % of cells with the CB dendritic expression (CB-sprouted cells) (F(1, 20) = 11.81, p = 0.003, hp2 = 0.37), a higher CB+ area (µm2) (F(1, 20) = 5.33, p = 0.032, hp2 = 0.21), and a higher optical density (F(1, 20) = 15.09, p = 0.001, hp2 = 0.43) (two-way ANOVA). The GAF scale (general assessment of functioning) of DSM-IV inversely correlated with the % of CB-sprouted cells (r = -0.52, p = 0.008) and with the CB+ area (r = -0.46, p = 0.022). CONCLUSIONS: In this exploratory study, comorbid depression was associated with a differential pattern of CB cell loss in dentate gyrus combined with a higher CB sprouting. These changes may indicate granular cell dysmaturation associated to the epileptic hyperexcitability phenomena. Further investigations should be carried out to confirm these preliminary findings.
Assuntos
Calbindinas/genética , Depressão/genética , Epilepsia do Lobo Temporal/genética , Adulto , Calbindinas/imunologia , Comorbidade , Giro Denteado/imunologia , Depressão/fisiopatologia , Eletroencefalografia , Epilepsia/complicações , Epilepsia/cirurgia , Epilepsia do Lobo Temporal/complicações , Epilepsia do Lobo Temporal/cirurgia , Feminino , Perfilação da Expressão Gênica/métodos , Hipocampo/metabolismo , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtornos da Memória/complicações , Pessoa de Meia-Idade , Neurônios/metabolismo , Projetos Piloto , Lobo Temporal/metabolismo , Transcriptoma/genéticaRESUMO
Los accidentes cerebrovasculares en personas menores de 45 años han pasado a ser un capítulo especial dentro de la patología neurológica, y los médicos internistas tienen que enfrentarse con una frecuencia cada vez mayor a esta patología. El siguiente es un estudio retrospectivo de casos para tratar de aclarar algunos aspectos clínicos y epidemiológicos sobre dicha entidad nosológica. El estudio evaluó 24 pacientes con déficit neurológico agudo menores de 45 años hospitalizados en el Servicio de Medicina III, Hospital Vargas, Caracas, entre Enero de 1989 y Diciembre de 1993, encontrándose predominio de sexo femenino (17/24)(estadísticamente significativo P menor de 0,01). El promedio de edad para sexo femenino fue de 34,4 años (DS 8,1) y para sexo masculino 34,4 años (DS 4,4). Dominaron los fenómenos isquémicos sobre hemorrágicos (58,3 por ciento vs 33,3 por ciento). El 87,5 por ciento de los eventos evolucionaron hacia déficit establecido. El territorio comprometido estuvo relacionado con arteria cerebral media en el 64 por ciento de los casos sin dominancia hemisférica. La causa del déficit fue desconocida en el 50 por ciento de los casos. La evolución de los pacientes fue en el 62 por ciento de los casos hacia una limitación importante