Itineraries and methods of illegal abortion in five Brazilian state capitals

This paper presents the results of the structured interview phase of the National Abortion Survey (PNA-interviews), describing the itineraries, methods and social and demographic profile of women who had at least one illegal abortion. Structured interviews were conducted during the years 2010 and 2011 in five state capitals (Belem, Brasilia, Porto Alegre, Rio de Janeiro and Salvador) with 122 women aged between 18 and 39 who had abortions. It is a non-probabilistic sample controlled by six parameters in accordance with level of education and age to reflect the social and demographic structure found in the PNA ballot-box questionnaire phase. The majority of women interviewed had had only one abortion, but 1 in every 4 had two abortions and 1 in every 17 had a third one. The majority of abortions are among women under 19 years of age who already had children and a higher incidence is found among black women. The most common test for pregnancy is beta-HCG blood test, the pharmacy urine test and ultrassound. The prevailing method for induction is a combination of teas and misoprostol (called Cytotec in Brazil), followed by hospital assistance after induction. Women are usually helped by a relative or their partners and several women reported helping other women to have abortions.     

Exogenous recombinant human growth hormone effects during suboptimal energy and zinc intake

BACKGROUND: Energy and Zinc (Zn) deficiencies have been associated with nutritional related growth retardation as well as growth hormone (GH) resistance. In this study, the relationship between suboptimal energy and/or Zn intake and growth in rats and their response to immunoreactive exogenous recombinant human GH (GHi), was determined. RESULTS: Rats treated with GHi and fed ad-libitum energy and Zn (100/100) had increased IGFBP-3 (p < 0.05) as compared with NSS (215 +/- 23 vs. 185 +/- 17 ng/ml) along with similar body weight gain. Rats treated with GHi and fed suboptimal energy and full Zn (70/100) had significantly increased weight gain (109.0 +/- 18.2 vs. 73.8 +/- 11.0 g) and serum IGF-I levels (568 +/- 90 vs. 420 +/- 85 ng/ml), along with decreased total body water (TBW; 61.0 +/- 1.6 vs. 65.7 +/- 2.1%) as compared to NSS controls. However, body weight gain was reduced (p < 0.05) as compared with rats fed ad-libitum energy. Growth hormone treated rats fed only suboptimal Zn (100/70), had increased weight gain (217.5 +/- 13.2 vs. 191.6 +/- 17.9 g; p < 0.05) compared to those given NSS. These rats gained weight in similar amounts to those fed full Zn. Rats treated with GHi and fed both suboptimal energy and Zn (70/70) showed similar results to those fed suboptimal energy with appropriate Zn (70/100), along with significant increases in IGFBP-3 levels (322 +/- 28 vs. 93 +/- 28 ng/ml). All restricted rats had reduced 24-h EE (kcal/100 g BW) and physical activity index (oscillations/min/kg BW) and GHi did not overcome these effects. CONCLUSION: These results suggest that GHi enhances weight gain in rats with suboptimal energy and Zn intake but does not modify energy expenditure or physical activity index. Suboptimal Zn intake did not exacerbate the reduced growth or decrease in energy expenditure observed with energy restriction.     

Copper and zinc bioaccumulation and bioavailability of Ganoderma lucidum

Ganoderma lucidum is a widely recognized medicinal mushroom. The bioaccumulation and potential bioavailability of copper (Cu) and zinc (Zn), which are essentials for human health, were analyzed in G. lucidum mycelium and fruit bodies grown in the presence of these metals to test their potential utility as a food dietary supplement. Mycelia grown in culture medium with non-mycotoxic doses of Cu or Zn (25 and 50 mg/kg) were selected for evaluation of the bioavailability of these metals in the gastrointestinal tract by using an in vitro simulated digestion system. One gram of dried mycelium grown in the presence of 50 mg/kg Cu or Zn showed a bioavailability of 19% for Cu and 2% for Zn of the recommended daily intake (RDI). When production of fruit bodies was evaluated, the highest biological efficiency (23%) was reached when the substrate was enriched with 100 mg/kg Cu. Cu and Zn contents obtained either before or after digestion of fruit bodies from all metal-enriched treatments were substantially lower than those from metal-enriched mycelia. The metal bioavailability was also low: 1.5% of the Cu RDI and almost negligible for Zn. The results are discussed in relation to the RDI values exhibited by two commercial supplements. The potential incorporation of these mineral-enriched mycelia/fruit bodies in capsules, infusions, and dietary supplements is evaluated.     

Conscientious objection and abortion: rights and duties of public sector physicians

The paper analyzes conscientious objection by physicians, through the concrete situation of legal abortion in Brazil. It reviews the two main ethical frameworks about conscientious objection in public health, the incompatibility thesis and the integrity thesis, to analyze the reality of legal abortion services in the referral services of the Brazilian public health care system. From these two perspectives, a third perspective is proposed - the justification thesis, to manage the right to conscientious objection among physicians in referral services. This analysis may contribute to the organization of services for legal abortion and to the education of future physicians working in emergency obstetric care.     

Medical student attitudes toward the doctor-patient relationship

CONTEXT: Medical educators have emphasized the importance of teaching patient-centred care. OBJECTIVES: To describe and quantify the attitudes of medical students towards patient-centred care and to examine: (a) the differences in these attitudes between students in early and later years of medical school; and (b) factors associated with patient-centred attitudes. METHODS: We surveyed 673 students in the first, third, and fourth years of medical school. Our survey utilized the Patient-Practitioner Orientation Scale (PPOS), a validated instrument designed to measure individual preferences towards various aspects of the doctor-patient relationship. Total PPOS scores can range from patient-centred (egalitarian, whole person oriented) to disease- or doctor-centred (paternalistic, less attuned to psychosocial issues). Additional demographic data including gender, age, ethnicity, undergraduate coursework, family medical background and specialty choice were collected from the fourth year class. RESULTS: A total of 510 students (76%) completed data collection. Female gender (P < 0.001) and earlier year of medical school (P = 0.03) were significantly associated with patient-centred attitudes. Among fourth year students (n = 89), characteristics associated with more patient-centred attitudes included female gender, European-American ethnicity, and primary-care career choice (P < 0.05 for each comparison). CONCLUSION: Despite emphasis on the need for curricula that foster patient-centred attitudes among medical students, our data suggest that students in later years of medical school have attitudes that are more doctor-centred or paternalistic compared to students in earlier years. Given the emphasis placed on patient satisfaction and patient-centred care in the current medical environment, our results warrant further research and dialogue to explore the dynamics in medical education that may foster or inhibit student attitudes toward patient-centred care.     

Comparison between digital and conventional impression techniques in children on preference,time and comfort: A crossover randomized controlled trial

Objective

To compare the conventional alginate impression and the digital impression taken with an intraoral scanner of both dental arches in children, using a randomized crossover design.

Trial Design

This is a monocentric, controlled, superiority, randomized, crossover, open study.

Methods

Twenty-four orthodontic patients between 6 and 11 years of age underwent intraoral scanning (TRIOS 3; 3Shape) and alginate impression of both dental arches with an interval of 1 week between the two procedures. Participants were recruited from September 2021 to March 2022 and the study was completed in April 2022. Impression time for the two procedures was compared. Patients were asked which one of the two impression procedures they preferred. A questionnaire including Visual Analogue Scale (VAS) for comfort, pain, gag reflex and difficulty in breathing, was administered to the patients.

Results

Eighteen out of 24 patients preferred digital impression (75%, 95% confidence interval [CI]: 55% to 88%; P = .014). Scanning time was significantly shorter than alginate impression time (difference −118 seconds; 95% CI: −138 to −99; P < .001). Comfort was significantly higher for digital impression (difference 1.7; 95% CI: 0.5 to 2.8; P = .007). There was no difference in pain (difference −0.2; 95% CI: −1.5 to 1.0; P = .686) while gag reflex and breathing difficulties were smaller for digital impression (gag reflex difference −2.5; 95% CI: −4.0 to −0.9; P = .004 and breathing difficulties difference −1.5; 95% CI: −2.5 to −0.5; P = −.004).

Conclusions

Digital impression is preferred by children aged 6–11 years and it is significantly faster in acquisition time than conventional alginate impression.

Registration

The study was registered on ClinicalTrials.gov with registration number NCT04220957 on January 7th, 2020 ( https://clinicaltrials.gov/ct2/show/NCT04220957 ).     

Levels of endothelin-1 in embryos from control and neonatal streptozotocin-induced diabetic rats,and their relationship with nitric oxide generation

Endothelin-1 (ET-1), a potent vasoconstrictor peptide and modulator of vasoactive substances such as prostanoids and nitric oxide (NO), plays an important role during embryo and fetal development. In this work, ET-1, nitrate and nitrite, and prostaglandin E2 (PGE2) levels in embryos from control and neonatal streptozotocin-induced (n-stz) diabetic rats were assessed, and the modulatory pathways regulating the generation of these vasoactive agents investigated. Endothelin-1 concentrations were found to be increased in embryos from n-stz diabetic rats when compared with controls. Additions of spermine NONOate, a nitric oxide donor, enhanced ET-1 levels in embryos from both control and n-stz diabetic rats, whereas N(G)-monomethyl-L-arginine, a nitric oxide inhibitor, diminished embryonic ET-1 content. Thus, enhanced ET-1 levels in the embryos from n-stz diabetic rats may be related to the elevated NO levels found in those embryos. Additions of ET-1 or bosentan (an endothelin A and endothelin B receptor antagonist), did not alter PGE2 generation in embryos from either control or n-stz diabetic rats. Endothelin-1 additions diminished nitrate and nitrite levels in embryos from both control and n-stz diabetic rats, whereas bosentan stimulated nitrate and nitrite generation in those embryos. In the present work, it was found that ET-1 levels were enhanced in embryos from n-stz diabetic rats, probably as a result of NO overproduction, an alteration which may be related to embryonic abnormalities and growth delay. Endothelin-1 has been shown to be a negative modulator of embryonic NO levels, a mechanism likely to be important during development. Endothelin-1 may prevent damage induced by NO overproduction in embryos from n-stz diabetic rats.     

Anthropometric indices of school children and familiar risk factors

BACKGROUND: Overweight in adolescence predicts adverse health effects in adulthood. We carried out a primary school health program and assessed children's growth and body composition. METHODS: Were screened 869 (448 M, 421 F) primary school children: height, weight, four skinfolds, and four circumferences were measured. A family-reported questionnaire was used to determine family composition, history, and lifestyle. RESULTS: Age was 118 +/- 5 months, BMI 18 +/- 3 kg/m(2). No difference by gender was observed as for BMI or blood pressure. Girls had higher skinfold thickness at the biceps (BCF), triceps (TCF), subscapular (SSF), and suprailiac (SIF) areas (P < 0.001), hip and thigh circumferences (P < 0.01), body fat percentage (P < 0.001). Boys had higher waist circumference (P < 0.01), waist/thigh ratio, and conicity index (P < 0.001). Offspring BMI was correlated with birth weight (P < 0.05), parental BMI and scholarship level (P < 0.001), children blood pressure (P < 0.001), and hours per day spent in television viewing (P < 0.01). Family history for diabetes was associated with higher BMI, SSF, waist circumference (P < 0.05), and upper thigh (P < 0.01). Family history for hypertension was associated with higher SSF/TCF ratio (P < 0.05). CONCLUSIONS: Three of 869 children had BMI >30 kg/m(2) (2 boys and 1 girl), 33 had BMI >25 kg/m(2) (17 boys and 16 girls). The percentages of children who could be considered overweight (BMI >/=95(th) percentile of age- and sex-specific NHANES I reference data) were boys, 10.0%, and girls, 9.3%. Anthropometric and anamnestic data on child and family yield more accurate estimates of risk profile: fat distribution seems relevant for metabolic and cardiovascular disorders.     

Expression of CCR5 receptors on Reed-Sternberg cells and Hodgkin lymphoma cell lines: involvement of CCL5/Rantes in tumor cell growth and microenvironmental interactions

The expression of CCL5/Rantes by Hodgkin (H) and Reed-Sternberg (RS) cells has been recently documented. In the present study we demonstrated that the CCL5 receptor (CCR5) is constitutively expressed by Hodgkin Lymphoma (HL)-derived cell lines (i.e. L-428, KM-H2, L-1236 and L-540) as shown by immunohistochemistry, flow cytometry and western blotting and also detected by immunohistochemistry on primary H-RS cells from lymph node tissues. sCD40L never significantly affected CCR5 expression, whereas a short exposure to doxorubicin down regulated its expression. CCR5 receptors on HL cell lines were functionally active, since neutralizing anti-CCL5 monoclonal antibodies inhibited basal proliferation of HL-derived cell lines and recombinant CCR5 ligands (CCL3/Mip-1 alpha, CCL4/Mip1 beta and CCL5/Rantes) increased their clonogenic growth. CCL5 secretion by L-1236, L-428 and KM-H2 cells was stimulated by CD40 engagement and also by coculturing L-1236 cells on primary stromal fibroblasts from HL-involved lymph nodes (HLF). Coculture experiments indicated that a direct contact of H-RS cells induces HLF cells to produce CCL5. Supernatants from L-1236, L-428 and KM-H2 cells stimulated migration of purified CD4+ T-cells and eosinophils in vitro. The migratory response to HL-cell lines supernatants was only partially neutralized (CD4+ cells: 70%; esinophils: 36%) by anti-CCL5 antibodies, reinforcing the notion that multiple chemokines are involved in the recruitment of nonmalignant reactive cells in HL tissues. Taken together, our results indicate a possible involvement of the CCR5/CCR5-ligands signaling in the regulation of H-RS cells growth and in the formation/maintenance of the typical tissue microenvironment of HL.     

Nail disorders in a woman treated with ixabepilone for metastatic breast cancer

Ixabepilone (Ix) (BMS-247550) is a potent member of a new class of microtubule-stabilizing cytotoxic agents known as epothilones. In pre-clinical studies, Ix has shown anticancer activity against several cancer types, including paclitaxel-resistant models, both in vitro and in vivo. The major toxicities associated with Ix are myelosuppression, sensory neuropathy and neutropenia. Other minor side-effects include asthenia/fatigue, stomatitis, anorexia, alopecia, skin reaction, hypersensitivity reactions and a fluid-retention syndrome. Although Ix is functionally correlated to taxanes, no previous evidence exists regarding Ix-related nail disorders. Here, we report a case of a 59-year-old woman treated with Ix at 40 mg/m2 day 1 q 21 days who, after 8 cycles of therapy, developed onycholysis and subungual hemorrhagic bullas in the fingernails.