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Background: Idiopathic dilated cardiomyopathy (IDCM) myocardial inflammation may be associated with external triggering factors such as infectious agents. Here, we searched if moderate/severe heart transplantation rejection is related to the presence of myocardial inflammation in IDCM explanted hearts, associated with microbial communities. Method: Receptor myocardial samples from 18 explanted hearts were separated into groups according to post-transplant outcome: persistent moderate rejection (PMR; n = 6), moderate rejection (MR; n = 7) that regressed after pulse therapy, and no rejection (NR; n = 5)/light intensity rejection. Inflammation was quantified through immunohistochemistry (IHC), and infectious agents were evaluated by IHC, molecular biology, in situ hybridization technique, and transmission electron microscopy (TEM). Results: NR presented lower numbers of macrophages, as well as B cells (p = 0.0001), and higher HLA class II expression (p ≤ 0.0001). PMR and MR showed higher levels of Mycoplasma pneumoniae (p = 0.003) and hepatitis B core (p = 0.0009) antigens. NR presented higher levels of parvovirus B19 (PVB19) and human herpes virus 6 (HHV6) and a positive correlation between Borrelia burgdorferi (Bb) and enterovirus genes. Molecular biology demonstrated the presence of M. pneumoniae, Bb, HHV6, and PVB19 genes in all studied groups. TEMâ¯revealed structures compatible with the cited microorganisms. Conclusions: This initial study investigating on infectious agents and inflammation in the IDCM explanted hearts showed that the association between M. pneumoniae and hepatitis B core was associated with a worse outcome after HT, represented by MR and PMR, suggesting that different IDCM microbial communities may be contributing to post-transplant myocardial rejection.
Assuntos
Cardiomiopatia Dilatada , Microbiota , Parvovirus B19 Humano , Coração , Humanos , MiocárdioRESUMO
Microbial communities are considered decisive for maintaining a healthy situation or for determining diseases. Acute myocardial infarction (AMI) is an important complication of atherosclerosis caused by the rupture of atheroma plaques containing proinflammatory cytokines, reactive oxygen species, oxidized low-density lipoproteins (oxLDL), damaged proteins, lipids, and DNA, a microenvironment compatible with a pathogenic microbial community. Previously, we found that archaeal DNA-positive infectious microvesicles (iMVs) were detected in vulnerable plaques and in the sera of Chagas disease patients with heart failure. Now, we characterize and quantify the levels of serum microbiome extracellular vesicles through their size and content using morphomolecular techniques to differentiate clinical outcomes in coronary artery disease (CAD). We detected increased numbers of large iMVs (0.8-1.34 nm) with highly negative surface charge that were positive for archaeal DNA, Mycoplasma pneumoniae antigens and MMP9 in the sera of severe AMI patients, strongly favoring our hypothesis that pathogenic archaea may play a role in the worst outcomes of atherosclerosis. The highest numbers of EVs <100 nm (exosomes) and MVs from 100 to 200 nm in the stable atherosclerotic and control healthy groups compared with the AMI groups were indicative that these EVs are protective, entrapping and degrading infectious antigens and active MMP9 and protect against the development of plaque rupture. Conclusion: A microbiome with pathogenic archaea is associated with high numbers of serum iMVs in AMI with the worst prognosis. This pioneering work demonstrates that the morphomolecular characterization and quantification of iEVs in serum may constitute a promising serum prognostic biomarker in CAD.
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Background: Archaeal genes present in Trypanosoma cruzi may represent symbionts that would explain development of heart failure in 30% of Chagas disease patients. Extracellular vesicles in peripheral blood, called exosomes (< 0.1 µm) or microvesicles (>0.1 µm), present in larger numbers in heart failure, were analyzed to determine whether they are derived from archaea in heart failure Chagas disease. Methods: Exosomes and microvesicles in serum supernatant from 3 groups were analyzed: heart failure Chagas disease (N = 26), asymptomatic indeterminate form (N = 21) and healthy non-chagasic control (N = 16). Samples were quantified with transmission electron microscopy, flow cytometer immunolabeled with anti-archaemetzincin-1 antibody (AMZ 1, archaea collagenase) and probe anti-archaeal DNA and zymography to determine AMZ1 (Archaeal metalloproteinase) activity. Results: Indeterminate form patients had higher median numbers of exosomes/case vs. heart failure patients (58.5 vs. 25.5, P < 0.001), higher exosome content of AMZ1 antigens (2.0 vs. 0.0; P < 0.001), and lower archaeal DNA content (0.2 vs. 1.5, P = 0.02). A positive correlation between exosomes and AMZ1 content was seen in indeterminate form (r = 0.5, P < 0.001), but not in heart failure patients (r = 0.002, P = 0.98). Higher free archaeal DNA (63.0 vs. 11.1, P < 0.001) in correlation with exosome numbers (r = 0.66, P = 0.01) was seen in heart failure but not in indeterminate form (r = 0.29, P = 0.10). Flow cytometer showed higher numbers of AMZ1 microvesicles in indeterminate form (64 vs. 36, P = 0.02) and higher archaeal DNA microvesicles in heart failure (8.1 vs. 0.9, P < 0.001). Zymography showed strong% collagenase activity in HF group, mild activity in IF compared to non-chagasic healthy group (121 ± 14, 106 ± 13 and 100; P < 0.001). Conclusions: Numerous exosomes, possibly removing and degrading abnormal AMZ1 collagenase, are associated with indeterminate form. Archaeal microvesicles and their exosomes, possibly associated with release of archaeal AMZ1 in heart failure, are future candidates of heart failure biomarkers if confirmed in larger series, and the therapeutic focus in the treatment of Chagas disease.
Assuntos
Archaea/fisiologia , Doença de Chagas/imunologia , Insuficiência Cardíaca/imunologia , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Bactérias/sangue , Biomarcadores , Doença de Chagas/sangue , Colagenases , Exossomos , Feminino , Citometria de Fluxo , Insuficiência Cardíaca/sangue , Humanos , Masculino , Metaloproteases , Microscopia Eletrônica de Transmissão , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The etiology of myxomatous mitral valve degeneration (MVD) is not fully understood and may depend on time or environmental factors for which the interaction of infectious agents has not been documented. The purpose of the study is to analyze the effect of Mycoplasma pneumoniae (Mp), Chlamydophila pneumoniae (Cp) and Borrelia burgdorferi (Bb) on myxomatous mitral valve degeneration pathogenesis and establish whether increased in inflammation and collagen degradation in myxomatous mitral valve degeneration etiopathogenesis. METHODS: An immunohistochemical test was performed to detect the inflammatory cells (CD20, CD45, CD68) and Mp, Bb and MMP9 antigens in two groups. The in situ hybridization was performed to detect Chlamydophila pneumoniae and the bacteria study was performed using transmission electron microscopy. Group 1 (n = 20), surgical specimen composed by myxomatous mitral valve degeneration, and group 2 (n = 20), autopsy specimen composed by normal mitral valve. The data were analyzed using SigmaStat version 20 (SPSS Inc., Chicago, IL, USA). The groups were compared using Student's t test, Mann-Whitney test. A correlation analysis was performed using Spearman's correlation test. P values lower than 0.05 were considered statistically significant. RESULTS: By immunohistochemistry, there was a higher inflammatory cells/mm2 for CD20 and CD45 in group 1, and CD68 in group 2. Higher number of Mp and Cp antigens was observed in group 1 and more Bb antigens was detected in group 2. The group 1 exhibited a positive correlation between the Bb and MVD percentage, between CD45 and Mp, and between MMP9 with Mp. These correlations were not observed in the group 2. Electron microscopy revealed the presence of structures compatible with microorganisms that feature Borrelia and Mycoplasma characteristics. CONCLUSIONS: The presence of infectious agents, inflammatory cells and collagenases in mitral valves appear to contribute to the pathogenesis of MVD. Mycoplasma pneumoniae was strongly related with myxomatous mitral valve degeneration. Despite of low percentage of Borrelia burgdorferi in MD group, this agent was correlated with myxomatous degeneration and this may occour due synergistic actions between these infectious agents likely contribute to collagen degradation.
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Borrelia burgdorferi/patogenicidade , Chlamydophila pneumoniae/patogenicidade , Valva Mitral/microbiologia , Valva Mitral/patologia , Mycoplasma pneumoniae/patogenicidade , Idoso , Estudos de Casos e Controles , Chicago , Chlamydophila pneumoniae/genética , Colágeno/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Microscopia Eletrônica de Transmissão , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/patologia , Miocardite/microbiologia , Miocardite/patologia , Fatores de RiscoRESUMO
Previous studies showed the presence of Mycoplasma pneumoniae (M. pneumoniae) and membrane-shed microparticles (MPs) in vulnerable atherosclerotic plaques. H&S Science and Biotechnology developed PTCTS, composed by natural particles from medicinal plants (PTC) combined with trans-Sialidase (TS), to combat MPs and Mycoplasma pneumoniae. Our aim was to determine the effects of the different components of PTCTS in a rabbit model of atherosclerosis. Rabbits were fed with high cholesterol diet for 12 weeks and treated during the last 6 weeks with either vehicle, PTC, TS, or PTCTS. Lipid profile and quantification of MPs positive for Mycoplasma pneumoniae and oxidized LDL antigens were carried out. Aortas and organs were then histologically analyzed. PTCTS reduced circulating MPs positive for Mycoplasma pneumoniae and oxidized LDL antigens, reduced the plaque area in the abdominal aorta, and caused positive remodeling of the ascendant aorta. PTC caused positive remodeling and reduced plaque area in the abdominal aorta; however, TS had a lipid lowering effect. PTCTS components combined were more effective against atherosclerosis than individual components. Our data reinforce the infectious theory of atherosclerosis and underscore the potential role of circulating MPs. Therefore, the removal of Mycoplasma-derived MPs could be a new therapeutic approach in the treatment of atherosclerosis.
Assuntos
Aterosclerose/tratamento farmacológico , Glicoproteínas/administração & dosagem , Mycoplasma pneumoniae/efeitos dos fármacos , Neuraminidase/administração & dosagem , Placa Aterosclerótica/tratamento farmacológico , Animais , Aorta Abdominal/efeitos dos fármacos , Aorta Abdominal/patologia , Aterosclerose/metabolismo , Aterosclerose/microbiologia , Aterosclerose/patologia , Produtos Biológicos/administração & dosagem , Produtos Biológicos/química , Colesterol na Dieta/farmacologia , Dieta Hiperlipídica/efeitos adversos , Modelos Animais de Doenças , Glicoproteínas/química , Humanos , Lipoproteínas LDL/metabolismo , Masculino , Mycoplasma pneumoniae/patogenicidade , Neuraminidase/química , Plantas Medicinais/química , Placa Aterosclerótica/microbiologia , Placa Aterosclerótica/patologia , CoelhosRESUMO
A presente revisão descreve os principais achados anatomopatológicos que caracterizam a cardiopatia chagásica crônica, discute a teoria autoimune e parassimpaticopriva que dominaram a explicação patogenética nas ultimas décadas e propõe novos caminhos a partir de achados mais recentes. Esses achados se relacionam com a presença de outros microrganismos que talvez tenham sejam levados até o miocárdio por estarem em simbiose com o T. cruzi, como micoplasmas, clamídias e arqueias. As arqueias têm como característica aumentar a inflamação por apresentarem antígenos aos linfócitos T CD8+. A inflamação exacerbada pode levar à vasodilatação da microcirculação e à falha na distribuição de sangue no miocárdio, ocasionando áreas de isquemia em regiões distais de dupla irrigação. Isto explicaria as regiões de afilamento e dilatação aneurismática ventricular, bem como a fibrose e infiltração gordurosa do sistema de condução (feixe de His, nó sinoatrial e atrioventricular). Esses microrganismos no interior da fibra cardíaca podem induzir uma resposta imunológica com fibrose ao redor dos cardiomiócitos, os quais se tornam extremamente hipertróficos por não entrarem em apoptose. A simbiose entre esses microrganismos pode levar à produção de micropartículas infecciosas que circulam e fazem parte da patogenia da descompensação cardíaca. Assim, a ação terapêutica na doença de Chagas deveria incluir a eliminação simultânea desses diferentes microrganismos e não somente do T. cruzi
This review describes the main anatomopathological findings that characterize chronic Chagasic cardiomyopathy, discusses the autoimmune and parasympathetic dysautonomia theories that have dominated the pathogenic explanation in recent decades, and proposes new routes based on the most recent findings. These findings relate to the presence of other microorganisms, such as micoplasmas, chlamydias and archaea, that are perhaps carried to the myocardium as they are in symbiosis with T. cruzi. A characteristic of archaea is that they increase inflammation by presenting T CD8+ lymphocyte antigens. Exacerbated inflammation may lead to vasodilation of the microcirculation and failure of blood distribution in the myocardium, leading to areas of ischemia in distal regions of double irrigation. This would explain the regions of thinning and dilation of the ventricular aneurysm, as well as the fibrosis and fatty infiltration of the conduction system (His bundle, sinoatrial node and atrioventricular node). These microorganisms in the interior of the heart fiber may lead to an immunological response with fibrosis around the cardiomyocytes, which become extremely hypertrophic, as they do not enter apoptosis. The symbiosis between these microorganisms can lead to the production of infectious microparticles that circulate and form part of the pathogenesis of decompensated heart failure. The therapeutic conduct in Chagas disease should therefore include the simultaneous elimination of these different microorganisms, and not only of T. cruzi
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Arritmias Cardíacas/complicações , Doença de Chagas/patologia , Insuficiência Cardíaca/etiologia , Trypanosoma cruzi/parasitologia , Infecções/diagnóstico , Inflamação/diagnósticoRESUMO
OBJECTIVE: Exercise is a protective factor for cardiovascular morbidity and mortality, with unclear mechanisms. Changing the myocardial metabolism causes harmful consequences for heart function and exercise contributes to metabolic adjustment modulation. Peroxisome proliferator-activated receptors (PPARs) are also myocardium metabolism regulators capable of decreasing the inflammatory response. We hypothesized that PPAR-α is involved in the beneficial effects of previous exercise on myocardial infarction (MI) and cardiac function, changing the expression of metabolic and inflammatory response regulators and reducing myocardial apoptosis, which partially explains the better outcome. METHODS AND RESULTS: Exercised rats engaged in swimming sessions for 60 min/day, 5 days/week, for 8 weeks. Both the exercised rats and sedentary rats were randomized to MI surgery and followed for 1 week (EI1 or SI1) or 4 weeks (EI4 or SI4) of healing or to sham groups. Echocardiography was employed to detect left ventricular function and the infarct size. Additionally, the TUNEL technique was used to assess apoptosis and immunohistochemistry was used to quantitatively analyze the PPAR-α, TNF-α and NF-κB antigens in the infarcted and non-infarcted myocardium. MI-related mortality was higher in SI4 than in EI4 (25% vs 12%), without a difference in MI size. SI4 exhibited a lower shortening fraction than EI4 did (24% vs 35%) and a higher apoptosis/area rate (3.97±0.61 vs 1.90±1.82) in infarcted areas (both p=0.001). Immunohistochemistry also revealed higher TNF-α levels in SI1 than in EI1 (9.59 vs 4.09, p<0.001) in infarcted areas. In non-infarcted areas, EI4 showed higher levels of TNF-α and positive correlations between PPAR-α and NF-κB (r=0.75, p=0.02), in contrast to SI4 (r=0.05, p=0.87). CONCLUSION: Previously exercised animals had better long-term ventricular function post-MI, in addition to lower levels of local inflammatory markers and less myocardial apoptosis, which seemed to be related to the presence of PPAR-α.
Assuntos
Infarto do Miocárdio/metabolismo , PPAR alfa/metabolismo , Condicionamento Físico Animal/fisiologia , Animais , Apoptose/fisiologia , Feminino , Inflamação/metabolismo , Modelos Animais , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , NF-kappa B/metabolismo , PPAR alfa/análise , Distribuição Aleatória , Ratos Wistar , Tempo , Fator de Necrose Tumoral alfa/metabolismo , Ultrassonografia , Função Ventricular/fisiologiaRESUMO
This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Brasil , Feminino , Humanos , Lactente , Masculino , Serviços de Saúde Materna/organização & administração , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , Adulto JovemRESUMO
OBJECTIVE: Exercise is a protective factor for cardiovascular morbidity and mortality, with unclear mechanisms. Changing the myocardial metabolism causes harmful consequences for heart function and exercise contributes to metabolic adjustment modulation. Peroxisome proliferator-activated receptors (PPARs) are also myocardium metabolism regulators capable of decreasing the inflammatory response. We hypothesized that PPAR-α is involved in the beneficial effects of previous exercise on myocardial infarction (MI) and cardiac function, changing the expression of metabolic and inflammatory response regulators and reducing myocardial apoptosis, which partially explains the better outcome. METHODS AND RESULTS: Exercised rats engaged in swimming sessions for 60 min/day, 5 days/week, for 8 weeks. Both the exercised rats and sedentary rats were randomized to MI surgery and followed for 1 week (EI1 or SI1) or 4 weeks (EI4 or SI4) of healing or to sham groups. Echocardiography was employed to detect left ventricular function and the infarct size. Additionally, the TUNEL technique was used to assess apoptosis and immunohistochemistry was used to quantitatively analyze the PPAR-α, TNF-α and NF-κB antigens in the infarcted and non-infarcted myocardium. MI-related mortality was higher in SI4 than in EI4 (25% vs 12%), without a difference in MI size. SI4 exhibited a lower shortening fraction than EI4 did (24% vs 35%) and a higher apoptosis/area rate (3.97±0.61 vs 1.90±1.82) in infarcted areas (both p=0.001). Immunohistochemistry also revealed higher TNF-α levels in SI1 than in EI1 (9.59 vs 4.09, p<0.001) in infarcted areas. In non-infarcted areas, EI4 showed higher levels of TNF-α and positive correlations between PPAR-α and NF-κB (r=0.75, p=0.02), in contrast to SI4 (r=0.05, p=0.87). CONCLUSION: Previously exercised animals had better long-term ventricular function post-MI, in addition to lower levels of local inflammatory markers and less myocardial apoptosis, which seemed to be related to the presence of PPAR-α.
Assuntos
Animais , Feminino , Infarto do Miocárdio/metabolismo , PPAR alfa/metabolismo , Condicionamento Físico Animal/fisiologia , Apoptose/fisiologia , Inflamação/metabolismo , Modelos Animais , Infarto do Miocárdio/patologia , Infarto do Miocárdio , NF-kappa B/metabolismo , PPAR alfa/análise , Distribuição Aleatória , Ratos Wistar , Tempo , Fator de Necrose Tumoral alfa/metabolismo , Função Ventricular/fisiologiaRESUMO
O objetivo foi avaliar a implantação da Rede Amamenta Brasil e seu impacto sobre indicadores de aleitamento materno (AM). Realizou-se análise de implantação de segundo tipo, incluindo 56 unidades básicas de saúde (UBS) de três municípios brasileiros. Para a avaliação do grau de implantação, criou-se um escore para cada UBS baseado no cumprimento dos critérios de certificação do Ministério da Saúde; para a análise dos efeitos da implantação, foram pesquisadas as prevalências de amamentação exclusiva e de amamentação. Verificou-se que 18 (32,1%) UBS cumpriam os quatro critérios preconizados para certificação. Foram incluídas no estudo 1.052 crianças menores de um ano, sendo 563 menores de seis meses. Verificou-se que as UBS que cumpriam os quatro critérios de certificação tiveram maior prevalência de amamentação exclusiva (44%), quando comparadas às demais UBS. Dificuldades para a implantação da Rede Amamenta Brasil foram identificadas, e os indicadores de AM variaram de acordo com o número de critérios de certificação cumpridos pelas UBS.
This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.
El objetivo de este artículo fue evaluar la implantación de la Red Amamanta Brasil y su impacto sobre indicadores de lactancia materna (AM). Se realizó un análisis de implantación de segundo tipo, incluyendo 56 unidades básicas de salud (UBS) de tres municipios brasileños. Para la evaluación del grado de implantación se creó un marcador para cada UBS, basado en el cumplimento de los criterios de certificación del Ministerio de Salud; y para el análisis de los efectos de la implantación fueron investigadas las prevalencias de lactancia materna exclusiva y lactancia. Se verificó que 18 (32,1%) UBS cumplían los cuatro criterios preconizados para certificación. Se incluyeron en el estudio 1.052 niños menores de un año, siendo 563 menores de seis meses. Se verificó que las UBS que cumplían los cuatro criterios de certificación tuvieron mayor prevalencia de lactancia materna exclusiva (44%) cuando se comparan con las demás UBS. Dificultades para la implantación de la Red Amamanta Brasil fueron identificadas y los indicadores de AM variaron de acuerdo con el número de criterios de certificación cumplidos por las UBS.
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Adulto , Feminino , Humanos , Lactente , Masculino , Adulto Jovem , Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde , Atenção Primária à Saúde/estatística & dados numéricos , Brasil , Serviços de Saúde Materna/organização & administração , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de SaúdeRESUMO
OBJECTIVE: to identify characteristics of women who have suffered severe lactational mastitis. METHOD: a descriptive, retrospective, documentary, quantitative study was performed. Data were collected from patient records of 114 hospitalized women from January of 2009 to December of 2013. Data were analyzed by using descriptive statistics. RESULTS: a higher percentage of severe lactational mastitis was found in young, primiparous women who had completed high school, who had no partner, and did not have a job; 96.5% of women had breast complications before admission and remained hospitalized an average of 4.4 days; at discharge, 23.7% of women had weaned their infants. CONCLUSION: this study showed that severe lactational mastitis can cause great harm to the woman and the baby.
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Aleitamento Materno , Mastite/patologia , Adolescente , Adulto , Feminino , Hospitalização , Humanos , Lactação , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
RESUMO Objetivo: identificar as características de mulheres que sofreram mastite lactacional grave. Método: estudo descritivo, retrospectivo e documental, com abordagem quantitativa. Os dados foram coletados de registros da assistência nos prontuários de 114 mulheres internadas no período de janeiro de 2009 a dezembro de 2013. Análise mediante estatística descritiva. Resultados: constatou-se maior porcentagem de mastite lactacional grave em mulheres jovens, primíparas, com ensino médio completo, que não tinham companheiro e não trabalhavam fora do lar; 96,5% das mulheres tiveram alguma intercorrência mamária antes da internação e permaneceram internadas em média 4,4 dias; na alta hospitalar 23,7% das mulheres desmamaram. Conclusão: este estudo mostrou que a mastite lactacional grave pode causar grandes danos à mulher e ao bebê.
RESUMEN Objetivo: identificar las características de las mujeres que sufrieron mastitis severa de la lactancia. Método: se realizó investigación descriptiva, retrospectiva y documental con enfoque cuantitativo. Datos eran recogidos procedentes de los registros de hospitalización de las 114 mujeres ingressadas de enero de 2009 a diciembre de 2013. El análisis mediante estadística descriptiva Resultados: encontrado una mayor proporción de mastitis de la lactancia severa en mujeres jóvenes, primíparas, que habían completado la escuela secundaria, que no tenían pareja, y que no trabajan fuera de casa, el 96,5% de las mujeres tenía alguna complicación de mama antes de su ingreso al hospital y permanecieron hospitalizados un promedio de 4,4 días, al momento del alta 23,7% de las mujeres renunció a la lactancia materna. Conclusión: este estudio mostró que la mastitis de la lactancia severa puede causar un gran daño a la mujer y el bebé.
ABSTRACT Objective: to identify characteristics of women who have suffered severe lactational mastitis. Method: a descriptive, retrospective, documentary, quantitative study was performed. Data were collected from patient records of 114 hospitalized women from January of 2009 to December of 2013. Data were analyzed by using descriptive statistics. Results: a higher percentage of severe lactational mastitis was found in young, primiparous women who had completed high school, who had no partner, and did not have a job; 96.5% of women had breast complications before admission and remained hospitalized an average of 4.4 days; at discharge, 23.7% of women had weaned their infants. Conclusion: this study showed that severe lactational mastitis can cause great harm to the woman and the baby.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Aleitamento Materno , Mastite/patologia , Lactação , Estudos Retrospectivos , Fatores de Risco , HospitalizaçãoRESUMO
OBJECTIVE: To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding. METHODS: This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance. RESULTS: Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables. CONCLUSIONS: We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals.
Assuntos
Aleitamento Materno/estatística & dados numéricos , Serviços de Saúde Materna , Adulto , Brasil , Estudos Transversais , Feminino , Promoção da Saúde , Maternidades , Humanos , Lactente , Masculino , Gravidez , Adulto JovemRESUMO
ABSTRACT OBJECTIVE To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding. METHODS This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance. RESULTS Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables. CONCLUSIONS We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals.
RESUMO OBJETIVO Analisar se o apoio oferecido pelas maternidades associa-se à maior prevalência de aleitamento materno exclusivo e predominante. MÉTODOS Estudo transversal, com amostra representativa de 916 crianças com menos de seis meses nascidas em maternidades, em Ribeirão Preto, SP, em 2011. As maternidades foram avaliadas em relação ao cumprimento dos Dez Passos para o Sucesso do Aleitamento Materno. Foram coletados dados sobre padrão de amamentação, hospital de nascimento e demais características. O efeito individualizado do fator de estudo sobre o aleitamento materno exclusivo e o predominante foi avaliado mediante análise de regressão múltipla de Poisson, com variância robusta. RESULTADOS O aleitamento materno predominante tendeu a ser mais prevalente quanto maior o número de passos cumpridos (p de tendência = 0,057). Os passos relacionados a não oferecer bicos artificiais a crianças amamentadas e a encorajar o estabelecimento de grupos de apoio à amamentação associaram-se, respectivamente, à maior prevalência de aleitamento materno exclusivo (RP = 1,26; IC95% 1,04;1,54) e predominante (RP = 1,55; IC95% 1,01;2,39), após ajuste pelas variáveis de confusão. CONCLUSÕES Observou-se associação positiva entre o apoio oferecido pelas maternidades e as prevalências de aleitamento materno exclusivo e predominante. Os resultados trazem subsídios para que localidades com características semelhantes (municípios com hospitais que cumprem os Dez Passos para o Sucesso do Aleitamento Materno) incentivem a amamentação, por meio da promoção, proteção e apoio ao aleitamento materno em maternidades.
Assuntos
Humanos , Feminino , Gravidez , Lactente , Adulto , Adulto Jovem , Aleitamento Materno/estatística & dados numéricos , Serviços de Saúde Materna , Brasil , Estudos Transversais , Promoção da Saúde , MaternidadesRESUMO
Este trabalho descreve atividades realizadas por meio da parceria entre um programa de atenção ao recém-nascido em um município do interior do estado de São Paulo e uma instituição de ensino superior de enfermagem de uma universidade pública. As atividades são desenvolvidas por graduandos do referido curso e profissionais do Floresce uma Vida; envolvem orientações às puérperas nas maternidades vinculadas ao Sistema Único de Saúde acerca dos cuidados com o recém-nascido, acompanhamento do crescimento e desenvolvimento, vacinação, apoio e incentivo ao aleitamento materno, além de agendamento de consultas de puericultura e puerpério. Tais ações desenvolvem competências durante a formação do enfermeiro e o capacitam para interagir com a mãe e o recém-nascido, realizar educação em saúde, como também ampliam a visão para além do cuidado biológico, incluindo aspectos de demanda social, emocional, cultural, da inserção da família na atenção prestada para mãe e recém-nascido e da articulação de setores e serviços de saúde.
This paper describes a partnership established between a newborn care program implemented in a city in the interior of São Paulo, Brazil and the nursing program of a public university. The activities are performed by nursing undergraduates together with the program team and include guidance provided to mothers in maternity hospitals linked to the Brazilian Health System concerning newborn care, growth and developmental monitoring, immunization, and support and encouragement of breastfeeding, in addition to the scheduling of childcare and postpartum appointments. These actions develop competencies during the nurses' education and qualify students to interact with mothers and newborns, providing health education and broadening their view beyond biological care to include aspects concerning social, cultural and emotional demands, the inclusion of families in the care provided to mothers and infants, and those related to cooperation among health sectors and services.
Este trabajo describe las actividades realizadas por medio de la sociedad entre un programa de atención al recién nacido en un municipio del interior del estado de São Paulo y una institución de enseñanza superior de enfermería de una universidad pública. Las actividades son desarrolladas por alumnos del referido curso y profesionales del Florece una Vida; que involucran orientaciones a las puérperas en las maternidades vinculadas al Sistema Único de Salud acerca de los cuidados con el recién nacido, acompañamiento del crecimiento y desarrollo, vacunación, apoyo e incentivo al amamantamiento materno, además del apuntamiento de consultas de puericultura y puerperio. Tales acciones desarrollan competencias durante la formación del enfermero y lo capacitan para interaccionar con la madre y el recién nacido, realizar educación en salud, así como ampliar la visión para más allá del cuidado biológico, incluyendo aspectos de la demanda social, emocional, cultural, de la inserción de la familia en la atención prestada para la madre y el recién nacido y de la articulación de sectores y servicios de salud.
Assuntos
Humanos , Recém-Nascido , Educação em Saúde , Assistência Integral à SaúdeRESUMO
OBJETIVO : Analisar a associação entre grau de implantação da Rede Amamenta Brasil e prevalência de aleitamento materno exclusivo. MÉTODOS : Estudo transversal, com amostra representativa de 916 crianças < 6 meses em Ribeirão Preto, SP, em 2011. Foram coletados dados sobre aleitamento materno, local de acompanhamento ambulatorial e demais características, durante a Campanha Nacional de Vacinação. O fator de estudo correspondeu ao local de acompanhamento ambulatorial: Privado; Público não Rede; Público com Oficina da Rede; e Público certificado na Rede. O efeito individualizado do fator de estudo sobre o desfecho foi avaliado mediante análise de regressão de Poisson com variância robusta. RESULTADOS : A comparação entre os locais privados (categoria de referência) e os demais mostrou relação dose-resposta significativa com elevação progressiva da prevalência de aleitamento materno exclusivo em locais públicos não Rede, em locais públicos com Oficina da Rede e em locais públicos certificados na Rede (p = 0,047). A Razão de Prevalência para amamentação exclusiva foi igual a 1,47 (IC95% 1,00;2,17) para o estrato das Unidades Básicas de Saúde certificadas na Rede, após ajuste pelas variáveis de confusão. CONCLUSÕES : A prevalência de aleitamento materno exclusivo em < 6 meses foi maior nos locais certificados na Rede, evidenciando a relevância de investir na certificação de Unidades Básicas de Saúde nessa ação. .
OBJETIVO : Analizar la asociación entre grado de implantación de la Red Amamanta Brasil y prevalencia de lactancia materna exclusiva. MÉTODOS : Estudio transversal, con muestra representativa de 916 niños < 6 meses en Ribeirão Preto, SP, en 2011. Se colectaron datos sobre lactancia materna, lugar ambulatorio de acompañamiento y demás características, durante la Campaña Nacional de Vacunación. El factor de estudio correspondió con el lugar ambulatorio de acompañamiento: Privado; Público no-Red Pública con Oficina de la Red; y Público certificado en la Red. El efecto individualizado del factor de estudio sobre el resultado fue evaluado mediante análisis de regresión de Poisson con varianza robusta. RESULTADOS : La comparación entre los lugares privados (categoría de referencia) y los demás mostró relación dosis-respuesta significativa con elevación progresiva de la prevalencia de lactancia materna exclusiva en lugares públicos no-Red, en lugares públicos con Oficina de la Red, y en lugares públicos certificados en la Red (p= 0,047). El Cociente de Prevalencia para lactancia exclusiva fue igual a 1,47 (IC95% 1,00;2,17) para el estrato de las Unidades Básicas de Salud certificadas en la Red, posterior al ajuste por las variables de confusión. CONCLUSIONES : La prevalencia de lactancia materna exclusiva en < 6 mese fue mayor en los lugares certificados en la Red. Es relevante invertir en la certificación de ésta acción en las Unidades Básicas de Salud. .
OBJECTIVE : To evaluate the association between the level of implementation of the Brazilian Breastfeeding Network and the prevalence of exclusive breastfeeding. METHODS : Cross-sectional study of a representative sample of 916 infants < 6 months, in Ribeirao Preto, SP, Southeastern Brazil, in 2011. Data on breastfeeding, place of outpatient care and other characteristics were collected during the National Vaccination Campaign. The factor studied is where outpatient care took place: Private; Non-Network Public; Public with Network Workshop; and Public certified by Network. The individualized effect of the factor studied on the outcome was analyzed using Poisson regression with robust variance. RESULTS : The comparison between private (reference category) and other outpatient care showed significant dose-response relationship with a progressive increase in the prevalence of exclusive breastfeeding in public non-Network, public with Network Workshop and public accredited by Network outpatient care (p = 0.047). As regards the Basic Health Units accredited by Network category, the Prevalence Ratio of exclusive breastfeeding was equal to 1.47 (95%CI 1.00;2.17), after adjustment for confounding variables. CONCLUSIONS : The prevalence of exclusive breastfeeding for infants < 6 months was higher in places accredited by the Brazilian Breastfeeding Network, which evinces the importance of investing in accreditation of Basic Units of Health by this strategy. .
Assuntos
Adulto , Feminino , Humanos , Lactente , Masculino , Aleitamento Materno , Serviços de Saúde Materna , Programas Nacionais de Saúde , Brasil , Estudos Transversais , Promoção da Saúde , Atenção Primária à SaúdeRESUMO
OBJECTIVE: To evaluate the quality of life and its association with daily physical activity and disease control in acromegalic patients. SUBJECTS AND METHODS: A cross-sectional, case series study, composed of 42 patients recruited from the Neuroendocrinology Unit of the University Hospital of Brasilia. Level of physical activity was accessed by the International Physical Activity Questionnaire (IPAQ 6-short-form), which evaluates the weekly time spent on physical activity of moderate to vigorous intensity in different contexts of life. Quality of life was evaluated by The Medical Outcome Study Questionnaire Short Form (SF-36). Data was compared to growth hormone (GH) and insulin-like growth factor (IGF-1) levels. Students' t test and Fisher test were used, p < 0.05, SPSS 17.0. RESULTS: Twenty-two women, aged 51.33 ± 14.33 and 20 men, aged 46.2 ± 13.18 were evaluated. Arthralgia was present in 83% of cases. In men, the most common sites of pain were the knees (73%), spine (47% lumbar, and 53% thoracic and cervical segments), hands and wrists (40%). Higher scores on SF-36 were observed in patients with intermediate or high levels of physical activity, in the domains social functioning (75 CI 57.3-92.6), general health (75.5 CI 60.4-90.5), mental health (70 CI 57.8-82.1). CONCLUSIONS: In this study, the presence and severity of physical disability and pain were not associated with initial GH and IGF-1 levels or time of exposure to GH excess. However, the patients considered controlled, with normal a normal age-adjusted IGF-1, presented higher scores in SF-36, in physical and emotional domains, compared with patients with persistent hypersomatotrophism. These findings suggest benefits of metabolic control in self-reported quality of life.
Assuntos
Acromegalia/metabolismo , Atividades Cotidianas , Hormônio do Crescimento Humano/metabolismo , Atividade Motora/fisiologia , Qualidade de Vida/psicologia , Adenoma/patologia , Adulto , Idade de Início , Idoso , Estudos Transversais , Feminino , Humanos , Fator de Crescimento Insulin-Like I/análise , Masculino , Pessoa de Meia-Idade , Medição da Dor , Neoplasias Hipofisárias/patologia , Autorrelato , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the quality of life and its association with daily physical activity and disease control in acromegalic patients. SUBJECTS AND METHODS: A cross-sectional, case series study, composed of 42 patients recruited from the Neuroendocrinology Unit of the University Hospital of Brasilia. Level of physical activity was accessed by the International Physical Activity Questionnaire (IPAQ 6-short-form), which evaluates the weekly time spent on physical activity of moderate to vigorous intensity in different contexts of life. Quality of life was evaluated by The Medical Outcome Study Questionnaire Short Form (SF-36). Data was compared to growth hormone (GH) and insulin-like growth factor (IGF-1) levels. Students' t test and Fisher test were used, p < 0.05, SPSS 17.0. RESULTS: Twenty-two women, aged 51.33 ± 14.33 and 20 men, aged 46.2 ± 13.18 were evaluated. Arthralgia was present in 83% of cases. In men, the most common sites of pain were the knees (73%), spine (47% lumbar, and 53% thoracic and cervical segments), hands and wrists (40%). Higher scores on SF-36 were observed in patients with intermediate or high levels of physical activity, in the domains social functioning (75 CI 57.3-92.6), general health (75.5 CI 60.4-90.5), mental health (70 CI 57.8-82.1). CONCLUSIONS: In this study, the presence and severity of physical disability and pain were not associated with initial GH and IGF-1 levels or time of exposure to GH excess. However, the patients considered controlled, with normal a normal age-adjusted IGF-1, presented higher scores in SF-36, in physical and emotional domains, compared with patients with persistent hypersomatotrophism. These findings suggest benefits of metabolic control in self-reported quality of life.
OBJETIVO: Avaliar a qualidade de vida e sua associação com a prática de vida diária e controle metabólico em pacientes portadores de acromegalia. SUJEITOS E MÉTODOS: Estudo seccional de série de casos, composto por 42 pacientes recrutados na Unidade de Neuroendocrinologia do Hospital Universitário de Brasília. O nível de atividade física foi estimado pelo Questionário Internacional de Atividade Física (IPAQ-6), que avalia o tempo gasto semanalmente em atividades físicas que variam de intensidade em diferentes contextos de vida. A qualidade de vida foi avaliada pelo questionário SF-36. Os dados obtidos foram comparados aos níveis de hormônio do crescimento (GH) e fator de crescimento semelhante à insulina (IGF-1). Os testes t Students e Fisher foram aplicados e p < 0,05 foram considerados significativos, SPSS 17.0. RESULTADOS: Avaliaram-se 22 mulheres com idades de 51,33 ± 14,33 e 20 homens com idades de 46,2 ±13,18. Artralgia foi relatada em 83% dos pacientes. Em homens, os sítios de dor mais comuns foram os joelhos (73%), coluna vertebral (47% lombar, 53% segmentos torácico e cervical), mãos e quadris (40%). Os maiores escores no SF-36 foram observados em pacientes com níveis intermediário ou alto de atividade física, sobretudo nos domínios social (75 CI 57,3-92,6), saúde geral (75,5 CI 60,4-90,5), saúde mental (70 CI 57,8-82,1). CONCLUSÕES: A presença e a severidade do prejuízo no desempenho físico e dor não se associaram com Gh e IGF-1 no diagnóstico, tempo de exposição prévio à doença. Todavia, pacientes considerados controlados apresentaram melhores escores nos domínios físico e emocional, comparados com pacientes com hipersomatotrofismo persistente. Tais achados sugerem benefícios do controle metabólico na qualidade de vida.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividades Cotidianas , Acromegalia/metabolismo , Hormônio do Crescimento Humano , Atividade Motora/fisiologia , Qualidade de Vida/psicologia , Idade de Início , Adenoma/patologia , Estudos Transversais , Fator de Crescimento Insulin-Like I/análise , Medição da Dor , Neoplasias Hipofisárias/patologia , Autorrelato , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To evaluate the association between the level of implementation of the Brazilian Breastfeeding Network and the prevalence of exclusive breastfeeding. METHODS: Cross-sectional study of a representative sample of 916 infants < 6 months, in Ribeirao Preto, SP, Southeastern Brazil, in 2011. Data on breastfeeding, place of outpatient care and other characteristics were collected during the National Vaccination Campaign. The factor studied is where outpatient care took place: Private; Non-Network Public; Public with Network Workshop; and Public certified by Network. The individualized effect of the factor studied on the outcome was analyzed using Poisson regression with robust variance. RESULTS: The comparison between private (reference category) and other outpatient care showed significant dose-response relationship with a progressive increase in the prevalence of exclusive breastfeeding in public non-Network, public with Network Workshop and public accredited by Network outpatient care (p = 0.047). As regards the Basic Health Units accredited by Network category, the Prevalence Ratio of exclusive breastfeeding was equal to 1.47 (95%CI 1.00;2.17), after adjustment for confounding variables. CONCLUSIONS: The prevalence of exclusive breastfeeding for infants < 6 months was higher in places accredited by the Brazilian Breastfeeding Network, which evinces the importance of investing in accreditation of Basic Units of Health by this strategy.
Assuntos
Aleitamento Materno , Serviços de Saúde Materna , Programas Nacionais de Saúde , Adulto , Brasil , Estudos Transversais , Feminino , Promoção da Saúde , Humanos , Lactente , Masculino , Atenção Primária à SaúdeRESUMO
Objetivo: Desenvolvimento de um modelo biológico para acesso cirúrgico em abdômen infectado, em ratos isogênicos F344, com 10-11 meses de idade, submetidos à peritonite por E.coli (Escherichia coli) e anastomose de cólon ascendente, estudando as alterações histopatológicas e expressão de TNAa na área perianastomótica, fígado, rim e baço. Material e Método: Foram formados 4 grupos de machos e 4 grupos de fêmeas: G1 inoculado com uma suspensão contendo 1-8 x 106 UFC (Unidade formadoras de colônias)/mL de E.coli; G2 submetido a anastomose de cólon ascendente; G3 inoculado com a suspensão de E.coli e submetido à anastomose de cólon ascendente 24 horas após a infecção; G4 controle. Decorridas 48 horas da infecção e 24 da cirurgia os ratos foram eutanasiados e a alça anastomosada, o fígado, o rim e o baço foram submetidos à análise histopatológica e a expressão de TNAa. Os cortes histológicos tratados por imuno-histoquimica para detecção de TNFa foram avaliados em 5 campos/lâmina usando um analisador de imagem (Quantimet-500 Leica). Os resultados obtidos foram comparados aplicando-se ANOVA e o teste de Tukey. Resultados: Na quantificação do TNFa, os grupos 2 e 3 apresentaram médias próximas de expressão do antígeno, 6,67 +/- 2,04 um 6,16 +/- 2,39 um respectivamente, e maiores quando comparadas com os grupos inoculado e controle (2,48 +/- um e 3,83 +/- 2,19 um). Conclusão: As lesões associadas à infecção aguda observadas em cólon ascendente anastomosado, fígado, rim e baço, as quais foram acompanhadas pela expressão de TNFa somente nas células inflamatórias da área perianastomótica, sugerem que ratos isogênicos F344, com 10-11 meses de idade, inoculados por E. coli, são modelos biológicos adequados para estudos de acesso cirurgico em abdômen infectado. CEAU nº 562/02.(AU)
Objective: Development of a biological model for surgical approach to abdominal infection in inbred rats F344, between 10 to 11 months of age, subject to Escherichia coli (E.coli) peritonitis and anastomosis of the ascending colon, studying the histopathological changes and expression of TNFa at the perianastomotic area, liver, kidney and spleen. Materials and Methods: We formed groups of four male and four female> G1 inoculated with a suspension containing 8.1 x 10 CFU (colony-forming units)/mL E.coli, G2 underwent anastomosis of the ascending colon; G3 inoculated with the suspension of E. coli and subjected to the anastomisis of the ascending colo 24 hours after infection, G4 control. After 48 hours of infection and 24 of the surgery the rats were euthanized and the handle anastomosed. liver kidney and spleen were subjected to histological analysis and expression of TNFa. The histological treated by immunohistochemical detection of TNFa were evaluated in 5 fields/blade using an image analyzer (Leica Quantimet-500). The results were compared by applying ANOVA and Tukey test. Results: In the quantification of TNFa, groups 2 and 3 showed averages close of antigen expression, 6.67 2.04 um 6.16 2.39 um respectively, and higher when compared with the inoculated and control groups (2.49 1.36 um and 3.83 2.19 um). Conclusion: the lesions associated with acute infection observed in anastomosed colon, liver, kidney and spleenwich were accompanted by the expression of TNFa only in perianastomotic area of inflammatory cells suggest that inbred rats F344, between 10 to 11 months of age, inoculated by E. coli, are biological models suitable for studies on surgical approach to abdominal infection. CEUA No562/02(AU)