Antônio Fernando de Sousa Bezerra

Abortion among adolescents: a bioethical approach

OBJECTIVES: to describe the socio-demographic, behavioral, clinical and anatomical-pathological characteristics and the type of abortion in adolescents as a way of discussing the subject from a bio-ethical perspective. METHODS: a structured questionnaire was applied to 201 adolescent girls receiving treatment for incomplete abortion and being subjected to uterine curretage, at a public maternity unit in the Northeast region of Brazil. RESULTS: the mean age was 16.1 years; most girls had a stable partner, were of mixed race, and were not accustomed to using condoms during sexual intercourse. The mean age for initiation of sexual activity was 15 years. Most had not planned the pregnancy but wanted to get pregnant. The mean gestational age of the fetus was 13.2 weeks. With regard to the type of abortion, 1.99% were spontaneous and 81.59% were certainly provoked, according to data obtained using the World Health Organization classification. Fetal and maternal tissue were 88.56% and 11.44%, respectively. Of the abortions that were certainly provoked, there was one case of the use of a hydatidiform mole. CONCLUSIONS: it is recommended that strategic family planning programs be urgently introduced and that anatomical-pathological tests be carried out on the material resulting from an abortion. Proactive bioethical reflection seems to be the tool for providing minimal guidelines for the protection and care of adolescents and for assisting health professionals.

Estudo comparativo entre o teste do pH e do KOH versus escore de Nugent para diagnóstico da vaginose bacteriana em gestantes

PURPOSE: To assess the prevalence of bacterial vaginosis and to compare the accuracy of testing pH and KOH with the Nugent gradient, the gold standard for the diagnosis of bacterial vaginosis (BV) in asymptomatic and symptomatic pregnant women at low risk. METHODS: We conducted a cross-sectional study on 321 pregnant women with gestational age between 14 and 26 weeks, 218 of them asymptomatic and 103 with vaginal complaints suggestive of bacterial vaginosis. All women were assessed by the criteria of Nugent and subjected to the measurement of vaginal pH and to the 10% KOH test. The Kappa coefficient was used to evaluate the methods in terms of diagnostic agreement. RESULTS: Most patients were adolescents (mean age 21.0±5.6 years), nulliparous and mulattos. The prevalence of bacterial vaginosis was 33.3% as estimated by the pH and KOH method and 35.5% by the Nugent method. Excellent agreement of the methods was found among asymptomatic pregnant women, with 72.5% of them showing negative results to both tests, which resulted in a high Kappa coefficient (k=0.82). The group of symptomatic women showed 49.5% positivity to both diagnostic methods, with excellent agreement (k=0.74). CONCLUSION: The prevalence of bacterial vaginosis determined by both the pH and KOH method and the Nugent score was high. The pH and KOH method can diagnose bacterial vaginosis as accurately as the Nugent criterion.

A interrupção da gravidez na adolescência: aspectos epidemiológicos numa maternidade pública no nordeste do Brasil

O abortamento provocado e praticado amplamente pelas mulheres, em contexto clandestino, no Brasil, sendo considerado uma questao de saude publica. Neste estudo, propoe-se a conhecer aspectos socio-demograficos, comportamentais, clinicos, complicacoes, e o tipo de abortamento praticado por adolescentes submetidas a curetagem uterina. Foi utilizada metodologia descritiva, atraves de entrevistas por meio de questionario estruturado no atendimento a 201 adolescentes com abortamento incompleto submetidas a curetagem uterina, em um hospital do Sistema Unico de Saude (SUS), em Maceio, Alagoas. Os principais determinantes para o abortamento foram: idade acima de dezesseis anos, com parceiro estavel; pardas; nao planejaram a gestacao; desejavam a gestacao, primigestas; idade gestacional menor que 15 semanas; raras complicacoes relacionadas ao abortamento, e utilizando a classificacao da Organizacao Mundial da Saude, observou-se abortamento provocado em 98,01% dos casos. Entre os casos de abortamentos certamente provocados, 89,19% reportaram o uso do misoprostol, o que reforca maior investimento publico na assistencia ao uso de metodos contraceptivos entre os adolescentes respeitando seus direitos sexuais e reprodutivos.

Morbidade materna e morbimortalidade perinatal associada à infecção ascendente na rotura prematura das membranas

Objetivo: avaliar as repercussoes da infeccao ascendente sobre a mae, o feto e o recem-nascido (RN) nos casos de rotura prematura das membranas (RPM). Metodos: estudo prospectivo, avaliando 50 gestantes portadoras de RPM e seus RN. A corioamnionite clinica foi rastreada por meio de criterios clinicos (curva termica, dor abdominal a palpacao e/ou amolecimento uterino, odor e caracteristicas da secrecao vaginal) e subsidiarios (leucograma e proteina C reativa). Por sua vez, a corioamnionite histologica foi avaliada com estudo macroscopico e microscopico da placenta, membranas e cordao umbilical. No estudo microscopico, utilizou-se a microscopia optica com coloracao pela hematoxilina-eosina. Os RN foram avaliados pela mensuracao do peso e indice de Apgar no 1o e 5o minuto. O leucograma e a cultura do material colhido do ouvido e aspirado gastrico complementaram o estudo. Para analise estatistica foram utilizados os testes exato de Fisher e t de Student, com nivel de significância de 5% (p<0,05). Resultados: a taxa de corioamnionite clinica foi de 29,4% (15/50), ao passo que a de corioamnionite histologica foi de 40% (20/50). Todos os casos de corioamnionite clinica apresentaram periodo de latencia (PL) superior a 24 horas. Os RN apresentaram sinais de infeccao em 31,4% (16/51), todos com PL maior que 24 horas. Os principais microrganismos isolados do conduto auditivo e aspirado gastrico dos RN foram: Klebsiella pneumoniae, Staphylococcus aureus, cocos Gram positivos e Streptococcus agalactiae - Grupo B de Lancefield (SGB). Os RN infectados apresentaram menor escore de Apgar no 1o e 5o minuto, peso ao nascer inferior e maior morbidade e mortalidade perinatal quando comparados com os RN nao infectados. Conclusoes: baseados na analise dos resultados obtidos no presente estudo, foi possivel concluir que o periodo de latencia prolongado aumenta a chance de infeccao ascendente, que, por sua vez, proporciona maior probabilidade de parto prematuro, aumentando portanto a morbidade materna (corioamnionite clinica), bem como a morbidade e mortalidade perinatal.

An application of algorithm based on abstract data types to the keratoconus diagnosis

In this paper, it is proposed a new genetic algorithm based on abstract data types approach for determination of coefficients can be adjusted by evolutionary process considering some metrics classification for keratoconus patients parameters from the ORA®. It is intended to show the efficiency of genetic algorithm based on abstract data types in the characterization of a combined solution for complex optimization problems, like the classifier.