Stimulation of the P6 Acupuncture Point for Prophylaxis of Nausea and Vomiting in Pregnant Women Submitted to Cesarean Section: A Blinded Clinical Trial

In pregnant women subjected to spinal anesthesia for a Cesarean section, episodes of nausea and vomiting are common both during and following surgery. Acupuncture for the prophylaxis and treatment of these complications has been gaining in popularity due to its low cost, simplicity, absence of side effects and confirmed efficacy. This study investigated the efficacy of stimulating the P6 acupoint in conjunction with the use of dexamethasone as prophylaxis for nausea and vomiting in pregnant women submitted to spinal anesthesia for a Cesarean section. The patients (n = 100) were randomly distributed into two groups. In the first group (n = 50), a site located one centimeter laterally from P6 was stimulated. This is not a true acupuncture point (sham acupuncture). In the second group (n = 50), P6 was stimulated. In both groups, 4 mg of dexamethasone were administered intravenously. A questionnaire was used to obtain information on the occurrence of nausea and vomiting during surgery and in the first 12 hours postpartum. The chi-square test and Fisher’s exact test were used to assess differences between the groups. Age and physical status were similar in both groups. The incidence of nausea during surgery was 32% (n = 16) in the control group and 22% (n = 11) in the P6 group (p > 0.05). In the first 12 hours following surgery, nausea occurred in 16% of the women in the control group (n = 6) and in 4% in the P6 group (n = 4) (p = 0.045). The incidence of vomiting in the control group was 12% (n = 6) during surgery and 10% (n = 5) in the postoperative period compared to 8% (n = 4) and 4% (n = 2), respectively, in the P6 group (p > 0.05). Although these differences were not statistically significant with the exception of the incidence of nausea in the first 12 hours postpartum, a reduction occurred in the incidence of all the outcomes evaluated in the P6 group.

Contraceptive Continuation, Pregnancy and Abortion Rate Two Years after Post Abortion Counselling

Objectives: To estimate the contraceptive use rate, pregnancy and abortion rate two years after post abortion counselling. Methods: In this current paper we conducted a cross-sectional study from September to December 2011 among women who participated of original randomized trial. In this study 118 women who had been allocated in the group that received the personalized contraceptive counselling and 103 women who had been allocated in the group that received standard counselling service were contacted by phone. The analyzed variables were the use of contraceptive methods, reasons for not using them, satisfaction in used method, and occurrence of pregnancy and abortion. Results: The pregnancy rate was lower in the personalized counselling group (p = 0.022), whereas abortion (p = 0.543) and contraceptive use rate (p = 0.270) had no difference between groups. The overall contraceptive use rate was high in both groups and the injectable method use rate was higher in personalized counselling group (p?= 0.004). Conclusions: Two years after the intervention the pregnancy rate was lower in personalized counselling group. The contraceptive use rate had no difference between the groups, except for the injectable which the use rate was higher in the personalized counselling group. These results could be encouraging because the intervention improved the uptake of one of the long-acting methods of contraception.

Women’s Perception Concerning Health Care in the Post-Partum Period: A Meta-Synthesis

This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.

Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions

Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation. Eighty-one patients submitted to general anesthesia were evaluated at a preanesthetic consultation according to the modified Mallampati classification, the Wilson score and the American Society of Anesthesiologists (ASA) difficult airway algorithm. Findings were then correlated with the Cormack-Lehane classification and with the number of attempts at endotracheal intubation. No statistically significant correlations were found between the patients’ Mallampati classification and their Cormack-Lehane grade or between the Mallampati classification and the number of attempts required to achieve endotracheal intubation. Laryngoscopy proved difficult in four patients and in all of these cases the Wilson score had been indicative of a possibly difficult airway, highlighting its good predicting sensitivity. However, the specificity of this test was low, since another 24 patients had the same Wilson score but were classified as Cormack-Lehane I/II. Moreover, two patients who had a Wilson score ≥ 4 were also classified as Cormack-Lehane grade I/II. The study concluded that the Wilson score, although seldom used in clinical practice, is a highly sensitive predictor of a difficult airway;its specificity, however, is low.

Techniques for Determining the Treatment Costs of Cervical Cancer: A Systematic Review

Background: Uterine cervical cancer (UCC) represents a public health problem in many part of the world. The use of new technologies is leading to increased treatment costs, resulting in a substantial economic impact worldwide. Standardization of economic evaluation methods is needed to improve comparisons between jurisdictions. Objective: To identify the methods used to measure the cost of treating invasive UCC, and to search for correlations between cancer treatment expenditures and local economies. Methods: We searched articles in MEDLINE, LILACS, and SciELO with no language restrictions, and included publications from January 01, 2007 to December 31, 2016. Studies were included if they described the annual direct cost of invasive cervical cancer and detailed the costing method. Complete economic evaluations were excluded. Results were described in 2016 international dollars. Results: Of 1581 studies initially reviewed, 13 articles were included in the analysis. Six articles used a bottom-up;six used a top-down approach and one used both. Annual cost per patient varied from I$ 2146.22 (Poland) to 34,351.54 (Sweden). Middle-income countries (MIC) spent median 72.52% of its GDP per capita on the treatment of invasive cervical cancer, while high-income countries (HIC) spent median 30.12% (p = 0.032). No significant difference was found when separated by costing method. Conclusions: We found that, for the treatment costs of invasive UCC, the percentages of GDP per capita were statistically higher in MIC than in HIC. However, no significant difference was found between costing methods, and the top-down approach could be used.

Management of Gestational Trophoblast Disease: A Review Integrative National and International Guidelines

GTD (Gestational Trophoblastic Disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (Gestational Trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.

Fluid Flow and Sub-Bactericidal Release of Silver from Organic Nanocomposite Coatings Enhance <i>ica</i>Operon Expression in <i>Staphylococcus epidermidis</i>

The present study investigates the effect of a silver (Ag)-containing nanocomposite coating on Staphylococcus epidermidis adhesion and icaA gene expression. Bacterial interactions with organic coatings with and without Ag nanoclusters were assessed through a combination of both conventional phenotypic analysis, using microscopy, and genotypic analysis, using the relative reverse transcription Real-Time Polymerase Chain Reaction (RT-PCR). The results suggest that the incorporation of Ag in organic coatings can significantly decrease bacterial adhesion and viability with time, in comparison to the organic coating alone. The initial Ag release though at concentrations lower than the bactericidal, significantly increased icaA gene expression for the bacteria interacting with the Ag containing coating two hours post adhesion, especially under the higher shear rate. Stress-inducing conditions such as sub-bactericidal concentrations of Ag and high shear rate can therefore increase icaA expression, indicating that analysis of gene expression can not only refine our knowledge of bacterial-material interactions, but also yield novel biomarkers for potential use in assessing biomaterials antimicrobial performance.

Risk of Surgical Site Infection in Patients Undergoing Total Knee Arthroplasty

The aim of this study was to determine the participation of risk factors in the infection in patients who underwent total knee arthroplasty. This is a prospective longitudinal study, descriptive and analytical, that was carried out between January 2013 and December 2015. Eighty-one procedures were performed in 78 individuals, 16 males and 62 females. Three subjects underwent the procedure on both knees. The following predictive factors of infection were identified: Age, gender, comorbidities, evaluation of functional physical status using the American Society of Anesthesiologists Physical Status Classification System (ASAPS), length of hospital stay, use of prophylactic antibiotics and duration of surgery. The data was tabulated in a database using a Microsoft Excel spreadsheet. For statistical analysis, the chi-square test, chi-square test for independence and Fischer’s exact test were applied, all at a significance level of 5% (0.05). Surgical site infection was more prevalent in males (23.5%), age over 70 years (25.0%), for left gonarthrosis (17.9%), in the presence of comorbidities (17.9%), when hospital stay was 6 or more days (27.8%), in total arthroplasties of left knee (17,9%), in surgical times of up to 2 hours (20%), in the use of prophylactic antibiotics (16.7%) and in level II classification in the ASAPS (18.8%). The independence test was not significant in any of the evaluated factors (p-value greater than 0.05). The most prevalent bacteria identified in cases of infection was Staphylococcus aureus (33.2%). The risk factors studied were not statistically significant.

Oral Health and Masticatory Performance in Adults Submitted to Bariatric Surgery: A Pilot Study

Background: Obesity has reached epidemic patterns and constitutes a serious public health problem due to comorbidities and the impact on life quality of affected individuals. Bariatric surgery appears as one of the most recommended treatments;however much has been known about the effects of this intervention on the functional performance of the organism as a whole. Objective: To characterize the oral health of adults submitted to bariatric surgery, before and after the intervention, with emphasis on the performance of masticatory function. Methods: A prospective observational cohort study conducted in a public reference service to the treatment of obesity in the city of Recife, State of Pernambuco. The data were obtained during the first half of 2011, through interview, intraoral physical examination and evaluation of masticatory function. Statistical treatment adopted was a CI of 95% and the chi-square test. The collection was conducted in three stages, with initial assessment in the preoperative and follow-up at 60 and 180 days. Results: The sample consisted of 20 volunteers, aged between 23 and 58 years and mean BMI of 43.2 ± 2.8. When compared the pre-operative to the control periods, there were significant differences for variables with decreased tendency towards spontaneous gingival bleeding and increased tooth hypersensitivity and tooth mobility (p < 0.05). Regarding the masticatory function, we found significant differences for most of the variables investigated, except in the coordination of movements and breathing during this function. Conclusion: The performance of masticatory function shows differences in pre- and postoperative periods for bariatric surgery.

Physical fitness level and the risk of severe COVID-19:A systematic review

To verify systematically the association between the status of physical fitness and the risk of severe Coronavirus disease 2019(COVID-19).This systematic review is in accordance with the Preferred Reporting Items for Systematic Review and Meta Analyses(PRISMA)statement and the eligibility criteria followed the Population,Intervention,Comparison,Outcomes and Study(PICOS)recommendation.PubMed,Embase,SciELO and Cochrane electronic databases were searched.All studies that explored the relationship between the pattern of physical fitness and COVID-19 adverse outcomes(hospitalization,intensive care unit admission,intubation,or mortality),were selected.The quality of the studies was assessed by the specific scale of the Newcastle-Ottawa Scale.A total of seven observational studies were identified in this systematic review;13468 patients were included in one case-control study,two cohort studies,and four cross-sectional studies.All studies reported an inverse association between high physical fitness and severe COVID-19(hospitalization,intensive care admission,or mortality).Only some studies reported comorbidities,especially obesity and cardiovascular disorders,but the results remained unchanged after controlling for comorbidities.The quality of the seven studies included was moderate according to the Newcastle-Ottawa Quality Assessment Scale.The methodological heterogeneity of the studies included did not allow a meta-analysis of the findings.In conclusion,higher physical fitness levels were associated with lower risk of hospitalization,intensive care admissions,and mortality rates among patients with COVID-19.

Multidimensional separation due to selective spherical agglomeration—Evidence of shape separation via X-ray microtomography

Objective of this work was to develop a novel method for characterizing real 3D shapes of particles smaller than 20μm by X-ray microtomography(X-RMT).Multidimensional separation of heterogenous solids through agglomeration in suspension will improve recycling processes as the particle shape and the agglomerate size are used for shape-selective separation.In the present paper we discuss the fundamentals of X-ray tomography and the experimental setup for selective spherical agglomeration in suspension.A specific preparation method of the particulate sample for X-RMT followed by 3D image processing,are essential for the shape analysis expressed as sphericity.We also discuss the limitation of this method due to the so-called Partial Volume Effect and particle clusters in the order of magnitude of X-RMT resolution.As proof of concept,we used a mixture of graphite platelets and spheronized graphite particles for a shape selective-agglomeration in suspension.The remaining fines were analyzed and showed more platelets than in the mixture.This indicates that spheronized particles are preferably bound in the agglomerates.These findings show that,based on the discussed sample preparation and a 3D image analysis in connection with X-RMT,particle shapes of micronized particles can be discriminated.