Natália da Silva Carvalho

Demographic dynamics of the Suyá, a Jê people of the Xingu Indigenous Park, Central Brazil, 1970-2004

This paper analyses the demographic dynamics of the Suyá, a Jê people, inhabitants of the Xingu Indigenous Park, Mato Grosso State, Brazil, during the years 1970-2004. Data was gathered from medical records of the São Paulo Federal University Health Program at the Xingu Indigenous Park. The demographic characteristics addressed include composition by age and sex, crude birth rates, general mortality rates, mortality rates by age and sex, proportional mortality by sex, age, and basic causes of death. The results show a population recovery process, with growth rates of 3% per year between 1970 and 2004. In addition to moderate birth rates and declining mortality rates, migration has also played an important role in the demographic dynamics. Mortality indicators show a decline in general and infant mortality rates, higher death rates among women, higher proportions of deaths among individuals < 1 and 50+ years of age, and major causes of death to be infectious diseases and cancer.

The Importance of IgG Avidity and the Polymerase Chain Reaction in Treating Toxoplasmosis during Pregnancy: Current Knowledge

A brief report on the nature and epidemiology of T. gondii infection is firstly presented. The importance of the specific IgG avidity test and polymerase chain reaction (PCR) for toxoplasmosis is discussed, along with their significance and importance as auxiliary methods for determining the most likely time for the initial infection by this coccidian and for defining the therapeutic strategy. Lastly, practical comments are made in relation to the classical therapeutic regimens, with special attention to the indications for fetal treatment, when this is necessary.

Histological evidence of reparative activity in chorioamniotic membrane following open fetal surgery for myelomeningocele

An increased understanding of the reparative process in fetal membrane following surgical techniques may be helpful to decrease the risks to mother and fetus and avoid adverse pregnancy outcomes. The present study discusses histological evaluation of the fetal membrane following open fetal surgery. Chorioamniotic membranes (n=10) were obtained following birth from pregnancies that underwent open fetal surgery for myelomeningocele. The collagen distribution was quantified using picrosirius-polarization method comparing the suture site with non-suture site. The differences between the collagen fiber percentages at the two sites was evaluated by the paired t-test with P<0.05. The mean gestational age of fetal surgery was 26.09±0.3 and 33.81±0.82 weeks at birth. The picrosirius red sign was more intense at the suture site, primarily associated with collagen type 1. Collagen observed in the surgical area was significantly increased (13.22±2.84%) compared with the non-surgical area (6.16±1.09%; P<0.0001). It was observed that the reparative activity at the suture site of the fetal membrane was characterized by a significant increase in collagen fibers. The findings suggest nascent collagen synthesis, tissue remodeling and repair of suture site, a mechanism likely to prevent the amniotic fluid leakage and maintain pregnancy following open fetal surgery.

Contraceptive practices in women with sickle-cell disease

Abstract This was a cross-sectional study of sexually active women with sickle-cell disease (SCD) managed at São Paulo Federal University during a one-year period. A total of 54 women were included. Mean age was 32.0 (11.2, standard deviation) years and almost 95% were black or of mixed racial ancestry. Almost 80% reported a history of multiple blood transfusions, 50% had kidney disease and 17% had a history of thrombosis. Over 80% of them had used some form of contraception, mostly combined hormonal contraceptive (52%) or progestin-only contraceptives (46%). Although most women had multiple comorbidities which would contraindicate the use of combined hormonal contraceptives, this was the most popular method used by them. We did not identify an association between the use of combined hormonal contraceptives and major complications. Larger, prospective studies are needed to evaluate the use and the effects of contraceptive methods in women with SCD.

Postnatal outcomes of infants with gastroschisis: a 5-year follow-up in a tertiary referral center in Brazil.

Abstract Objective: The aim of this study was to evaluate postnatal outcomes in fetuses with gastroschisis. Methods: This is a retrospective study (2009–2013) of patients with gastroschisis at the Hospital São Paulo (Federal University of São Paulo, Brazil). Results: A total of 44 infants with gastroschisis were examined. The mean maternal age was 21.1 years and mean gestational age at delivery was 36.1 weeks. Delivery occurred before 34 weeks in 13.6%, between 34 and 36 weeks and 6 d in 40.9%, and after 37 weeks in 45.5%. The mean birth weight was 2349 g, with 37.2% small-for-gestational age infants. The mean umbilical cord blood pH was 7.32. Bowel resection and delayed fascial closure was performed in 14.6% and 19.5%, respectively. The mean hospitalization time in the neonatal intensive care unit was 52.7 d. Neonatal infection was detected in 52.4%, with a positive blood culture; 77.3% of those cases were coagulase negative staphylococci. The overall rate of mortality was 25%; 18.2% before birth, 45.4% during the neonatal period, and 36.4% in infants. The main cause of postnatal death was septicemia (55.5%). Conclusions: Despite advances in perinatal care and surgical techniques, infants with gastroschisis still present high rates of complications and death.