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Search Results: 1 - 10 of 14795 matches for " Zilma Silveira Nogueira Reis "
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Inten??o de uso de preservativo masculino entre jovens estudantes de Belo Horizonte: um alerta aos ginecologistas
Matos, Eliane Bragan?a de;Veiga, Ricardo Teixeira;Reis, Zilma Silveira Nogueira;
Revista Brasileira de Ginecologia e Obstetrícia , 2009, DOI: 10.1590/S0100-72032009001100008
Abstract: purpose: to investigate factors that motivate safe sex practice, searching for antecedents of the intention to use condom among the population of young students in belo horizonte. methods: a survey based on the theory of planned behavior (tpb) has been carried out in a sample of 732 students, with ages from 18 to 19 years old. using the multiple regression analysis on data obtained from an anonymous questionnaire, the importance of antecedents of the intention to use condom, such as: attitude, subjective norm, moral norm, resistance to temptation and perceived control, was investigated. differences in behavior and attitudes between high and low social classes and between men and women were also assessed, through the t-test for means' comparison between independent samples. results: in the overall sample, the significant association of attitude and behavioral intention was not detected in the tpb, a higher percent of the intention variance was explained when only one of the partners was responsible for the decision of using the condom (intention-me), than when it was a joint decision of the couple (intention-us). there has been no significant difference between high and low social class groups, but differences have been found between men and women. men have shown less resistance to the temptation of not using condom. in the evaluation of social pressure (subjective norm), medical doctors and mothers seem to have more influence on the intention to use condom, especially among women. the inclusion of the moral norm antecedent has increased the explained variance in the intention to use condom from 22 to 31%. conclusions: attitude differences between men, less resistant to the temptation of not using condom, and women, who highlight the importance of gynecologists and parents' influence in advising about safe sex, may guide campaigns to promote the regular use of condoms.
Press o arterial e concentra o plasmática do peptídeo atrial natriurético e do peptídeo natriurético tipo B, em gesta es complicadas pela pré-eclampsia
Reis Zilma Silveira Nogueira,Cabral Ant?nio Carlos Vieira,Barra Juliana Silva,Leite Henrique Vitor
Revista Brasileira de Ginecologia e Obstetrícia , 2003,
Abstract: OBJETIVO: o estudo busca determinar a existência de associa o entre a eleva o da press o arterial e os níveis plasmáticos dos peptídeos natriuréticos ANP e BNP, na gesta o complicada pela pré-eclampsia. MéTODOS: em estudo transversal caso-controle, pareado por idade gestacional, 25 grávidas normotensas e 61 portadoras de pré-eclampsia foram avaliadas quanto ao nível da press o arterial e às concentra es plasmáticas dos peptídeos natriuréticos ANP e BNP. Exames clínico e laboratoriais foram realizados para o diagnóstico de pré-eclampsia, sendo a press o arterial medida de forma n o invasiva. As dosagens hormonais foram obtidas por radioimunoensaio, após extra o em colunas Sep-pak C18. Os valores médios das concentra es plasmáticas do ANP e BNP foram comparados entre grupos com press o arterial progressivamente maiores. A correla o entre os valores da press o arterial e os níveis plasmáticos do ANP e BNP no sangue materno foi também investigada pela de análise de regress o no grupo completo de gestantes e em grupos específicos excluindo-se a hipertens o anterior à gesta o e, em seguida, excluindo-se aquelas sem hipertens o prévia. RESULTADOS: os valores plasmáticos de ANP foram 41.5±7.3, 78.4±13.1 e 89.2±13.4 pg/mL (p<0,00001) e os de BNP plasmático foram 79.5±15.8, 176.7±42.2 e 208.3±63.5 pg/mL (p=0,005), respectivamente, para os grupos de press o arterial média =107 mmHg, 107-139 mmHg e =140 mmHg. Verificou-se correla o positiva entre as concentra es plasmáticas do ANP e os níveis pressóricos na pré-eclampsia, independente da existência de estado hipertensivo prévio à gesta o (p<0,0001 para pré-eclampsia e p<0,01 para pré-eclampsia sobreposta à hipertens o arterial cr nica), ao passo que as dosagens de BNP n o se mostraram associadas à press o arterial no grupo com hipertens o arterial prévia à gesta o (p=0,004 para pré-eclampsia e p=0,18 para pré-eclampsia sobreposta à hipertens o arterial cr nica). CONCLUS O: o agravamento da hipertens o na pré-eclampsia correlacionou-se com as concentra es séricas do ANP e BNP, embora os valores do BNP possam ser influenciados pela existência de estado hipertensivo prévio.
Associa??o entre a antropometria e a leptina circulante nos compartimentos materno, fetal e placentário, na gravidez normal
Castro, Flávia Cipriano;Leite, Henrique Vitor;Pereira, Alamanda Kfoury;Reis, Zilma Silveira Nogueira;Cabral, Ant?nio Carlos Vieira;
Revista Brasileira de Ginecologia e Obstetrícia , 2004, DOI: 10.1590/S0100-72032004000900003
Abstract: purpose: to evaluate the importance of circulating maternal and fetal leptin in the healthy gestation, using its association with maternal, placental and fetal anthropometric variables, obtained at birth, and the relationship between the evaluated compartments. methods: in a transversal study a population of 33 single, healthy and term gestations was studied. the evaluated variables were maternal age, maternal weight, body mass index (bmf), weight of the newborn, placental weight, and placental index. samples of maternal blood were immediately obtained before birth and from fetal umbilical cord blood at birth. determination of serum leptin was performed using conventional radioimmunoassay. the relationships between serum leptin concentrations in maternal blood, umbilical artery and vein and the studied variables were assessed through linear regression. results: leptin levels were detected in the blood of all 33 pregnant women and their respective newborns, with maternal blood concentration (17.1±1.77 ng/ml) higher than that of umbilical vessels (vein: 9.0±1.16 ng/ml; artery: 8.23±1.02 ng/ml), p<0.0001. leptin concentrations in the maternal blood were correlated with leptin concentrations in fetal blood (artery: coef. 0.63, p=0.037; vein: coef. 0.72, p=0.006). regarding the anthropometric variables, leptin measured in the maternal blood was associated with initial and final maternal bmf (coef. 1.13; p=0.002; coef. 1,18, p=0.001) and cord leptin levels were correlated with the fetal weight at birth (vein: coef. 0.007, p=0.02; artery: coef. 0.006, p=0.02). conclusion: there was a correlation between maternal and fetal leptin production and probably by the action of similar stimuli during gestation. serum leptin was associated with the weight of the compartment where it circulates.
índice cárdio-femoral para avalia??o da anemia de fetos de gestantes isoimunizadas
Cabral, Ant?nio Carlos Vieira;Barcelos, Thales Bittencourt de;Apocalipse, Isabela Gomes Melo;Leite, Henrique Vitor;Reis, Zilma Silveira Nogueira;
Revista Brasileira de Ginecologia e Obstetrícia , 2005, DOI: 10.1590/S0100-72032005000800003
Abstract: purpose: to test a new, noninvasive method for the diagnosis of fetal anemia in red blood cell isoimmunized pregnancies. methods: the index obtained by the ratio between the ultrasonographic measurement of the biventricular outer dimension (bvod) and femur length (both in centimeters) was correlated with fetal hemoglobin values in a cross-sectional study. fifty-nine fetuses of isoimmunized pregnancies selected for invasive treatment and submitted to 130 cordocenteses for the diagnosis and treatment of anemia were included in the study. the cardiofemoral index was obtained immediately before the cordocentesis and the fetal hemoglobin index was obtained from fetal blood samples. linear regression was carried out to assess the correlation between the index and fetal hemoglobin; roc curve was applied to determine the most accurate cutoff for the diagnosis of the fetal hemoglobin concentration below 10g/dl. results: bvod measurement varied from 1.6 to 4.7 cm (average 2.5±1.3cm), and length of the femur, from 3.0 to 6.9 cm (average 4.3±0.9 cm). the cardiofemoral index varied from 0.4 to 1.0 (average 0.6±0.1). a significant inverse correlation between the cardiofemoral index and fetal hemoglobin (r2=0.37 and p<0.0001) was observed. the cutoff of 0.60 was the best to predict a level of fetal hemoglobin below or equal to 10.0g/dl: 80.85% sensitivity, 83.13% specificity, 73.8% positive predictive value, and 88.46% negative predictive value, in the diagnosis of fetuses anemia. conclusion: the cardiofemoral index allows for good accuracy in the prediction of fetal hemoglobin concentration below 10g/dl in red blood cell isoimmunized pregnancies. it may thus be applied as a noninvasive method to the diagnosis of this pathology.
Press?o arterial e concentra??o plasmática do peptídeo atrial natriurético e do peptídeo natriurético tipo B, em gesta??es complicadas pela pré-eclampsia
Reis, Zilma Silveira Nogueira;Cabral, Ant?nio Carlos Vieira;Barra, Juliana Silva;Leite, Henrique Vitor;Demian, Alim Alves;Reis, Adelina Martha dos;
Revista Brasileira de Ginecologia e Obstetrícia , 2003, DOI: 10.1590/S0100-72032003000600005
Abstract: purpose: to determine the existence of association between blood pressure rise and plasma anp and bnp levels in pregnancies complicated by preeclampsia, considering the existence of a hypertensive state before pregnancy and supportive drug influence on these hormones. methods: in a case-control transversal study, 86 pregnant women were assessed regarding arterial pressure level and plasma anp and bnp levels. clinical and laboratory tests were carried out to diagnose preeclampsia and the use of hypotensive drugs and magnesium sulfate was considered. hormone determinations were obtained through radioimmunoassay, after extraction in c18 sep-pak columns. correlation was investigated by means and regression analysis in the whole group of pregnant women and in specific groups, considering prior hypertension. results: plasma anp values were 41.5±7.3, 78.4±13.1 and 89.2±13.4pg/ml (p<0.00001) and plasma bnp values were 79.5±15.8, 176.7±42.2 and 208.3±63.5 pg/ml (p=0.005), respectively, for mean blood pressure =107 mmhg, 107-139 mmhg and =140 mmhg. it was verified that the positive correlation between plasma anp concentrations and pressure levels in preeclampsia did not depend on the existence of a hypertensive state before pregnancy (p<0.0001: preeclampsia and p<0.01: preeclampsia superimposed on chronic hypertension), whereas bnp dosages were not associated with the arterial pressure in the group with arterial hypertension prior to pregnancy (p=0.004: preeclampsia and p=0.18: preeclampsia superimposed on chronic hypertension). conclusion: aggravation of hypertension in preeclampsia correlates with serum anp and bnp concentrations, although bnp values may be influenced by the existence of a prior hypertensive state.
Antenatal Ultrasonographic Anteroposterior Renal Pelvis Diameter Measurement: Is It a Reliable Way of Defining Fetal Hydronephrosis?
Alamanda Kfoury Pereira,Zilma Silveira Nogueira Reis,Maria Candida Ferrarez Bouzada,Eduardo Araújo de Oliveira,Gabriel Osanan,Ant?nio Carlos Vieira Cabral
Obstetrics and Gynecology International , 2011, DOI: 10.1155/2011/861865
Abstract: Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9?mm), moderate (10.0 to 14.9?mm), or severe (≥15.0?mm). Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was %. Interobserver variation of ultrasonographers was %. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohen's Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69). Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis. 1. Introduction The advent of routine antenatal ultrasonography has allowed for an appreciation of the true incidence of urological abnormalities and has identified many patients who require reassessment postnatally [1]. In spite of such advances, however, the issue of antenatal hydronephrosis remains a common and challenging problem, with postnatal influences [2, 3]. There have been a number of studies assessing the accuracy of fetal renal pelvic dilatation (RPD) as an indicator of urinary tract anomalies [4–8]. The single most widely used parameter is the anteroposterior diameter (APD) of the renal pelvis, a simple parameter whose application is now widespread in prenatal diagnostics [9]. However, the reproducibility measurement of this parameter has scarcely been investigated. Furthermore, during routine ultrasound examinations, the size of the renal pelvis varies considerably over time [10]. Though the renal collecting system can be influenced by physiological conditions (maternal hydration and degree of bladder filling [11, 12]), the lack of a full technical description and validation of that measurement seems to be a central factor. The aim of our investigation was to evaluate the
Pré-eclampsia precoce e tardia: uma classifica??o mais adequada para o prognóstico materno e perinatal?
Reis, Zilma Silveira Nogueira;Lage, Eura Martins;Teixeira, Patrícia Gon?alves;Porto, Ludmila Barcelos;Guedes, Ludmila Resende;Oliveira, érica Carla Lage de;Cabral, Ant?nio Carlos Vieira;
Revista Brasileira de Ginecologia e Obstetrícia , 2010, DOI: 10.1590/S0100-72032010001200004
Abstract: purpose: to evaluate the differences between the maternal and perinatal outcomes of pregnancies complicated by preeclampsia, according to the classification as the severe/mild form, and the early/late onset form. methods: a retrospective study with 211 pregnancies complicated by preeclampsia, assessed at a university reference center from 2000 to 2010. the diagnosis and disease severity were based on the values of blood pressure, proteinuria, and clinical and laboratory findings. the pregnant's age, skin color, parity, blood pressure, urine protein semiquantitative values, presence of bilateral notch in the uterine artery dopplervelocimetry and birth conditions were compared between patients with mild and severe disease, as well as between those of early/late onset. the disease was considered to be of early onset when diagnosed at less than 34 weeks of gestational age. results: most patients had the severe form of preeclampsia (82.8%), and the onset of the condition was early in 50.7%. blood pressure values (133.6±14.8 versus 115.4 mmhg, p=0.0004 and 132.2±16.5 versus 125.7 mmhg, p=0.0004) and semiquantitative proteinuria (p=0.0003 and p=0.0005) were higher in the early and severe forms compared to mild and late forms. infant birth weight (1,435.4±521.6 versus 2,710±605.0 g, 1,923.7±807.9 versus 2,415.0±925.0 g, p<0.0001 for both) and apgar score (p=0.01 for both) were smaller for severe and early preeclampsia compared to mild and late preeclampsia. on the other hand, the presence of a bilateral notch in the uterine arteries was linked to the forms of early onset (69.2 versus 47.9%, p=0.02), whereas fetal growth restriction was more frequent in the severe forms of preeclampsia (30 versus 4.4%, p=0.008). conclusion: the preeclampsia classification based on maternal clinical parameters better reflected the conditions of fetal nutrition, while the early onset of the condition was associated with placental vasculopathy detected by dopplervelocimetry.
Análise de indicadores da saúde materno-infantil: paralelos entre Portugal e Brasil
Reis, Zilma Silveira Nogueira;Pereira, Altamiro Costa;Correia, Ricardo Jo?o Cruz;Freitas, José Alberto Silva;Cabral, Ant?nio Carlos Vieira;Bernardes, Jo?o;
Revista Brasileira de Ginecologia e Obstetrícia , 2011, DOI: 10.1590/S0100-72032011000900003
Abstract: purpose: to analyze comparatively the conditions of birth in portugal and brazil from 1975 to 2007. methods: indicators of maternal and child health: rates of maternal death and neonatal mortality, cesarean rate and public spending on health were retrospectively collected from electronic databases of health information from the unified health system (datasus) and the national institute of statistics of portugal (ine), among others. their values were descriptively analyzed in terms of trends and the temporal sanitary scenarios were presented and discussed, comparing, when possible, the information from the two countries. results: births in portugal were characterized by lower maternal mortality (12.2x76.2/100.000) and neonatal mortality (2.2x14.6/1000), compared to brazil, considering the average of the years from 2004 to 2007. the history of the conquest of maternal and child indicators of excellence in portugal involved a phase that paralleled the significant socio-economic improvements and the increasing contribution of public health, followed by another from the 1990s, involving better equipped health care units. in brazil, rates of maternal and neonatal mortality are declining, but satisfactory values have not yet been achieved. the historical difference in the amount of social spending on health, both in current and historical values, was a crucial difference between countries. despite the disparities in maternal and neonatal outcomes, cesarean section rates were equally ascendant (34.5% in portugal and 45.5% in brazil), considering the average for the period from 2004 to 2007. conclusion: the indicators of maternal and neonatal death in portugal and brazil have aligned themselves to social, economic and contributions of public investments in health. the increasing rates of caesarean section do not explain the discrepancies in maternal and neonatal outcome between countries.
Deriva??o vésico-amniótica no tratamento intra-uterino das uropatias obstrutivas: revis?o e análise crítica da experiência de um Centro de Medicina Fetal
Pereira, Alamanda Kfoury;Ozanan, Gabriel Costa;Rezende, Guilherme de Castro;Reis, Zilma Silveira Nogueira;Leite, Henrique Vitor;Cabral, Ant?nio Carlos Vieira;
Revista Brasileira de Ginecologia e Obstetrícia , 2005, DOI: 10.1590/S0100-72032005000300009
Abstract: purpose: to analyze the efficacy, safety and real advantage of vesicoamniotic shunt catheter in the intrauterine treatment of obstructive uropathy. methods: a retrospective and descriptive study, in which the evolution of 35 fetuses with obstructive uropathy, submitted to vesicoamniotic shunt from 1990 to 2004 in a fetal medical center was evaluated. all these fetuses fitted the selection criteria defined by a protocol of this service, and had the parents' consent for the procedure. the pediatric nephrology sector of the hospital das clínicas of ufmg assessed all of them after delivery to confirm the prenatal diagnosis and outcome. the dead neonates were studied by the pathological anatomy sector of ufmg. descriptive analysis of the following parameters was performed: prenatal diagnosis of the uropathy, gestational age at shunt insertion, time of catheter utilization, post-surgery complications, perinatal mortality and neonatal survival. results: posterior urethral valve was the most common uropathy (62.8%). the mean gestational age at the vesicoamniotic shunt placement was 26.1weeks and the mean time of its presence was 46 days (1-119 days). there were four intrauterine fetal deaths and 17 in the neonatal period (60% perinatal mortality). the main cause of death was pulmonary hypoplasia. olygohidramnios was present in 33/35 fetuses (94.3%) and it was reversed in 23 of them (70%); fourteen fetuses survived the neonatal period. at present, there are 4 children followed up by the pediatric sector of nephrology of hospital das clínicas. two of them have been treated with peritoneal dialysis, awaiting renal transplantation. the other two have normal renal function. their age varies from 2 months to 4 years. conclusion: the vesicoamniotic shunt may be a viable intrauterine treatment for severe obstructive uropathy, with 40% of survival rate of fetuses that might have progressed to death. however, the procedure's success was directly related to the adequate selection, and
Rastreamento de cardiopatias congênitas associadas ao diabetes mellitus por meio da concentra??o plasmática materna de frutosamina
Reis, Zilma Silveira Nogueira;Miranda, Ana Paula Brum;Rezende, Cezar de Alencar Lima;Detofol, Renan Bragan?a;Costa, Carolina Ribeiro;Cabral, Ant?nio Carlos Vieira;
Revista Brasileira de Ginecologia e Obstetrícia , 2010, DOI: 10.1590/S0100-72032010000200003
Abstract: purpose: to evaluate the importance of maternal plasma concentration of fructosamine as an indicator of fetal congenital cardiopathies in pregnancies complicated by diabetes mellitus. methods: this was a retrospective study conducted on 91 pregnant women with diabetes mellitus who underwent routine fetal echocardiography at a university reference center in fetal medicine. sixty-five patientes who presented pre-gestational diabetes mellitus and plasma fructosamine level were registered in the medical records prior to the ultrasound exam. the first measurement recorded was compared with the result of routine fetal echocardiography, carried out by a specialist physician of the service. the presence or absence of echocardiographic findings of congenital cardiopathies (efcc) was related to plasma levels of fructosamine by the mean t-test and its accuracy for efcc was verified by the roc curve. plsama fructosamine concentrations of 2.68, 2.9 and 2.23 mmol/l, which are, respectively, the local reference laboratory values, the value of the kit employed for measurement and the one of highest overall accuracy, were discussed as the cut-off values. results: efcc was found in 52.3% of the fetuses. the first measurement of fructosamine, during the prenatal care period, was performed, on average, at 20.4±8.0 weeks of pregnancy. the maternal concentration ability of the fructosamine to identify fetuses with efcc was significant (p<0.0001) and had an area under the roc curve of 0.78 (95%ci=0.66-0.89). the 2.9 mmol/l plasma concentration of fructosamine revealed efcc with better specificity, but with a higher percentage of false-negative results (96.8 and 55.9%). values above 2.68 mmol/l were associated with a probability of 4.6 to identify fetuses with efcc compared with lower values, with 58.8% of sensitivity and 87.1%, specificity. the value of 2.23 mmol/l proved to be the most overall accurate of the three values suggested, with a sensitivity of 88.2% in the identification of fe
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