Universidade Estadual De Campinas Research Articles

Silent Destruction: Fulminant Hepatitis and the Hidden Danger of Weight Loss Drugs

The use of natural products for therapeutic purposes is a common practice throughout the world, in part, due to the global obesity epidemic and the search for products with appetite suppression and weight loss properties, which include nutritional supplements, vitamins and minerals to herbal products. It is known that such products may be associated with various adverse health effects. Thus, the objective of this study is to report a series of cases of patients, who presented fulminant liver failure (HFI) requiring liver transplantation (LT), related to the consumption of products used for weight loss. This is a retrospective cohort based on the evaluation of patients listed for LT due to IHF at the Hospital das Clínicas of the Universidade Estadual de Campinas, between 1991 and 2022, with patients who had confirmed consumption of products with the aim of loss being selected. During the studied period, 92 patients were listed for HT due to IHF according to the Kings College criteria, with 5 cases being selected with proven consumption of herbal products for weight loss, and other causes that could explain the IHF were excluded. Four (80%) of the patients were female, with a mean age of 40.5 years, and 40% of the cases died. Unlike traditional pharmaceutical medicines, in most countries, the commercialization of these products is not conditioned on clinical and safety evidence or prior approval by regulatory bodies. Hepatoxicity can be related to several factors, such as the presence of toxins naturally found in plants, the presence of heavy metals, contamination during obtaining or processing and the addition of substances omitted from the labels. The use of weight loss products can evolve with IHF, a fact that deserves attention, due to ease of access and growing demand, and it is important to regulate the trade of these products and raise public awareness about the risks of use without professional supervision and guidance.

Improving breastfeeding among adolescent mothers: a prospective cohort.

Exclusive breastfeeding is recommended for the first six months, and mother's age impact early weaning. Educational support and relevant information can increase breastfeeding rates. To determine whether antenatal education enhances the maintenance, intention, and confidence in breastfeeding among adolescents. A prospective cohort study involving primiparous adolescents who gave birth at the Woman's Hospital (CAISM), Universidade Estadual de Campinas, Brazil. Adolescent mothers were categorized into two groups based on the location of prenatal care: those at the Woman's Hospital (WH) who received antenatal education, and at the Primary Care (PC) who did not receive antenatal education. All adolescents received breastfeeding orientation during their postpartum hospital stay. The groups were compared using the Student's t-test, Mann-Whitney U test, and chi-squared test. Log-binomial models were used to compare the groups at different time intervals. The study included 132 adolescents: 59 in the WH group and 73 in the PC group. Six months postpartum, adolescents in the WH group demonstrated higher engagement in breastfeeding (P < 0.005) and exclusive breastfeeding (P = 0.04) than PC group. PC group showed greater lack of confidence in breastfeeding (P = 0.02) and felt less prepared (P = 0.01). Notably, all WH adolescents reported a stronger desire to breastfeed after antenatal education. Antenatal education significantly improves the maintenance, intention, and confidence of breastfeeding among adolescents. This education approach can be implemented across all healthcare levels and should be made accessible to all women throughout the pregnancy and postpartum period.

The Analysis of 607 Volunteers Shows a Reduction of Workability in Individuals With LONG-COVID Syndrome Associated With Neuropsychiatric Symptoms (P5-10.004)

<h3>Objective:</h3> To investigate symptoms associated with reducing of workability in individuals with LONG-COVID syndrome. <h3>Background:</h3> Few studies evaluated the impact of neuropsychiatric symptoms (fatigue, depression, anxiety and excessive sleepiness) on workability in a homogeneous group of workers. <h3>Design/Methods:</h3> We evaluated 607 bank workers (mean age 42 years, 54% woman) after 200 days (on average) from confirmation of diagnosis of COVID19 (17% hospitalized and 83% non-hospitalized). Volunteers answered online forms including the “Chalder Fatigue Scale (CFQ)”, “Epworth Sleepiness Scale (ESS)”, “Hospital Anxiety and Depression scale (HADS)” and “Work Ability Index (WAI)”. We used SPSS22 for statistical evaluation with Chi-Square tests for analyses of proportions. <h3>Results:</h3> Approximately 85% completed higher education, and most (74.6%) worked in contact with the public. Overall, we identified 37.5% with normal WAI and 62.5% with reduced WAI in a group of 429 volunteers who answered the WAI questionnaire. Volunteers self-reported several symptoms, including fatigue (37%), anxiety (36%), cognitive dysfunction (29%) and depression (17%). Almost 20% were asymptomatic at the interview. However, the quantification of symptoms with formal questionnaires revealed excessive somnolence in 45%, fatigue in 79%, anxiety in 61% and symptoms of depression 66%. The comparisons of presence of these symptoms between groups with REDUCED-WAI and NORMAL-WAI revealed excessive sleepiness (25% versus 56% respectively; p&lt;0.001), fatigue (93.2% versus 54% respectively; p&lt;0.001), symptoms of depression (68.2% versus 18%; respectively, p&lt;0.001) and anxiety (76.8% versus 30%, respectively p&lt;0. 001). In a longitudinal evaluation with 180 responders (average of 1 year after first interview), they self-reported fatigue (48%), anxiety (38%) and memory problems (52%). <h3>Conclusions:</h3> Neuropsychiatric symptoms of LONG-COVID syndrome negatively affect work ability months after infection. These findings point to the urgence of specific and multidisciplinary treatments for patients to minimize the individual burden and the global economic loss. <b>Disclosure:</b> Mr. Salvador has received research support from The Research Support Foundation of the State of São Paulo. Mateus Nogueira has nothing to disclose. Lucas Silva has nothing to disclose. Dr. Karmann Aventurato has received research support from Coordenadoria de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES). Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Biopharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for United Medical – Brazil. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Zodiac Pharma . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eurofarma – Brazil . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology - Epilepsy. The institution of Dr. Cendes has received research support from São Paulo Research Foundation - FAPESP. The institution of Dr. Cendes has received research support from Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil . The institution of Dr. Cendes has received research support from NIH. Marcia Bandini has nothing to disclose. Mr. De Cesare Del Nero has received research support from Universidade Estadual de Campinas. Clarissa Yasuda has nothing to disclose.

Pesticide makes cockroaches slow down and forget

Farmers have been waging war against pests since humans first started planting crops. More recently, advances in pesticides have curbed many of the crop losses that farmers have been experiencing, which has helped the planet's population to grow to 8 billion people. However, some of the pesticides come with a cost; they inadvertently kill pollinator species which the agriculture industry relies upon to fertilize their crops. Not only do many pesticides have unintentional victims but they also can remain in the groundwater for some time, thereby affecting insects that don't come into direct contact with the treated plants. Though the amount of pesticide that makes its way into the water supply is much less than the amount that is sprayed onto a plant, these smaller doses could still have dire consequences for other insects. With this in mind, Maria Rosa of the Universidade Federal do Pampa (UNIPAMPA), Brazil, and Cháriston Dal Belo of the Universidade Federal de São Paulo, Brazil, turned to the speckled cockroach (Nauphoeta cinerea) to help them answer whether smaller doses of the pesticide fipronil affected these non-target insects.Working with other scientists from UNIPAMPA, the Universidade Estadual de Campinas, Brazil, and the University of Oslo, Norway, Rosa and Dal Belo first gave the cockroaches different amounts of fipronil before measuring how many times they cleaned their legs and antennae in 30 minutes. The cockroaches didn't groom their legs as much when they were given fipronil. According to Rosa, ‘grooming in insects is associated with body cleanliness and courtship’, among other behaviours, and not spending time grooming could lead to a shorter lifespan and fewer offspring. In addition, the researchers measured how far the insects walked versus how much time they spent stationary in a 10 minute video. When given the pesticide, the cockroaches didn't explore as much and spent more time stationary, even at the lowest doses of fipronil. Not spending time moving or exploring could cause these insects to be unable to find food or escape from predators. As the cockroaches weren't moving as much, Rosa and Dal Belo wondered what was causing this lack of locomotion.To get to the root of this, the duo measured how hard the muscles of the cockroach's legs contracted. With the highest dose of fipronil, the legs had trouble contracting, therefore reducing the animal's mobility and potentially hampering their ability to find a meal. But it isn't just movement that fipronil affects. Because of the way that fipronil interacts with the insect's brain, the duo were also interested in how the pesticide might affect how well the cockroaches remembered certain smells. Normally, cockroaches are repulsed by the smell of citronella, but they can learn to associate this odour with the reward of a sugar solution, causing them to move towards the smell. However, if the insects were given fipronil beforehand, they couldn't learn to associate citronella with the sugary reward. Being unable to learn to associate smells with a reward could have devastating effects on an animal's ability to find food or mates.While Rosa and colleagues utilized the nearly indestructible cockroach to study the effects of this particular pesticide, they are quick to point out that their findings are likely true for other insect species as well. While using pesticides definitely helps our crop yields, it could also have the unintended yet devastating side-effect of decimating the number of pollinator species such as bees and butterflies, which could be even more disastrous for humans than allowing a few crops to be eaten by pests.

The Impact of the COVID-19 Pandemic on the Care of Women Experiencing Abortion in a University Hospital in Brazil.

To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with miscarriage and legal termination of pregnancy in a university hospital in Brazil. A cross-sectional study of women admitted for abortion due to any cause at Hospital da Mulher Prof. Dr. J. A. Pinotti of Universidade Estadual de Campinas (UNICAMP), Brazil, between July 2017 and September 2021. Dependent variables were abortion-related complications and legal interruption of pregnancy. Independent variables were prepandemic period (until February 2020) and pandemic period (from March 2020). The Cochran-Armitage test, Chi-squared test, Mann-Whitney test, and multiple logistic regression were used for statistical analysis. Five-hundred sixty-one women were included, 376 during the prepandemic period and 185 in the pandemic period. Most patients during pandemic were single, without comorbidities, had unplanned pregnancy, and chose to initiate contraceptive method after hospital discharge. There was no significant tendency toward changes in the number of legal interruptions or complications. Complications were associated to failure of the contraceptive method (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.23-4.84), gestational age (OR 1.126; 95% CI 1.039-1.219), and preparation of the uterine cervix with misoprostol (OR 1.99; 95% CI 1.01-3.96). There were no significant differences in duration of symptoms, transportation to the hospital, or tendency of reducing the number of legal abortions and increasing complications. The patients' profile probably reflects the impact of the pandemic on family planning.

Happy 25th Anniversary, EurJOC!

Happy 25th Anniversary, EurJOC!

Perinatal Outcomes in Women with Chronic Kidney Diseases

To assess maternal and neonatal outcomes in women with chronic kidney disease (CKD) at a referral center for high-risk pregnancy. A retrospective cohort of pregnant women with CKD was followed at the Women's Hospital of Universidade Estadual de Campinas, Brazil, between 2012 and 2020. Variables related to disease etiology, treatment duration, sociodemographic variables, lifestyle, other associated diseases, obstetric history, and perinatal outcomes were assessed. The causes of CKD were grouped into 10 subgroups. Subsequently, we divided the sample according to gestational age at childbirth, as preterm and term births, comparing maternal and neonatal outcomes, and baseline characteristics as well as outcomes among such groups. A total of 84 pregnancies were included, in 67 women with CKD. Among them, six pregnancies evolved to fetal death, five to miscarriage, and one was a twin pregnancy. We further analyzed 72 single pregnancies with live births; the mean gestational age at birth was 35 weeks and 3 days, with a mean birth weight of 2,444 g. Around half of the sample (51.39%) presented previous hypertension, and 27.7% developed preeclampsia. Among the preterm births, we observed a higher frequency of hypertensive syndromes, longer maternal intensive care unit (ICU) stay in the postpartum period, higher incidence of admission to the neonatal ICU, higher neonatal death, lower 5-minute Apgar score, and lower birth weight. This study demonstrates increased adverse outcomes among pregnancies complicated by CKD and expands the knowledge on obstetric care among such women in an attempt to reduce maternal risks and identify factors related to prematurity in this population.

Technology Focus: Flow Assurance (November 2021)

I sincerely hope that all JPT readers and your families, peers, and employers remain safe and healthy and have work as they read this year’s Flow Assurance feature. Flow-assurance effects from slug-flow engineering, design, maintenance, and operations technical concerns still create and sustain challenging technical issues requiring safe, economical solutions for both onshore unconventional and offshore conventional production facilities. The recurring long-term mitigation of slugging and various flow-assurance phenomena—along with the prevention of wax, erosion, asphaltenes, corrosion, and salt deposition—and gas hydrate prediction and handling still demand attention and considerable project technical effort. Slug-flow assessments present opportunities for significant optimization in work flows to target governing operating scenarios. Paper OTC 30172 describes an integrated iterative approach between the flow-assurance and pipeline-engineering disciplines to streamline the work flow based on the value or cost associated with changes in input parameters that affect pipeline fatigue-assessment outcomes. Case studies on two multiphase pipelines are presented to illustrate this design approach. The results show that early identification of the key pipeline profile features and dominating spans for pipeline slugging fatigue assessments facilitated the optimization of slug-flow modeling and reduced computational time. The second paper, SPE 203448, presents decision trees that are considered as nonparametric machine-learning models. The data sets used in training and testing the predictive model are experimental and were collected from literature. Air/kerosene and air/water mixtures were used in obtaining the experimental data points. Results show that the proposed boosted decision tree regression (BDTR) model outperforms the best empirical correlations and the fuzzy-logic model used in estimating liquid holdup in gas/liquid multiphase flows. For the built model, the most important input feature in estimating liquid holdup is the superficial gas velocity. The empirical correlations developed in the past for identifying liquid holdup in multiphase flow can be applied only under the flow conditions by which they were originally developed. However, this machine-learning model does not suffer from this limitation. The third paper, OTC 31298, describes a slugging-control solution that was rejected because of the use of a pseudovariable as the principal control point. A novel control scheme, therefore, was developed and tested on simulations for both hydrodynamic slugging and severe riser-induced slugging in an Angolan field. The project implemented the novel active slugging control using a topsides control valve and topsides instrumentation. While a pseudovariable, a pseudoflow controller, was used, it was part of a cascade scheme such that the principal control variable was a real top-side pressure measurement. Upon com-missioning, slugging at the facility was found to be more severe than anticipated during design, but the novel active slug-control scheme was effective in controlling incoming slugs. The desire to understand better how to describe and improve flow assurance and multiphase flow for both offshore and onshore facilities drives new production technology research, applications, and approaches. The three papers listed for additional reading focus on developing further new analytical tools while providing safe, cost-effective, and reliable operations for flow assurance. I hope you find them as interesting as I did. In addition, I invite you to join the Flow Assurance Technical Section to augment your learning. Recommended additional reading at OnePetro: www.onepetro.org. OTC 30177 - Real-Time Online Hydrate Monitoring and Prevention in Offshore Fields by Syahida Husna Azman, Petronas, et al. SPE 201316 - Modeling Dynamic Loads Induced by Slug Flows Considering Gas Expansion Caused by the Pressure Gradient in a Free Span Horizontal Hanging Pipeline by Gabriel Meneses Santos, Universidade Estadual de Campinas, et al. OTC 31238 - Taylor Bubbles of Viscous Slug Flow in Inclined Pipes by Longtong Abednego Dafyak, University of Nottingham, et al.

Anesthesia technique and postpartum hemorrhage: a prospective cohort study

Background and objectiveDuring the past few years, an increased number of postpartum hemorrhages have been noticed, even in high-income countries. It has been suggested that this escalation could be associated with increased obstetric interventions. Among such interventions, anesthesia is one of the most prevalent. The present study aimed to investigate the influence of peripartum anesthesia on total blood loss during the 24 hours after delivery. MethodsWe performed a complementary analysis from a prospective cohort study that evaluated postpartum bleeding within 24 hours after birth. The study was performed between February 1st, 2015 and March 31st, 2016 at the Women’s Hospital at the Universidade Estadual de Campinas, Brazil. Postpartum bleeding was measured using a calibrated drape and summing the blood contained in the compresses and pads used for 24 hours. We calculated means, percentages, and standard deviation and performed Mann-Whitney analysis for the relation of anesthesia with Postpartum Hemorrhage (PPH) and logistic regression for drugs used in the anesthesia with PPH, using SAS 9.4 software. ResultsWe included 270 women in the study; of these, 168 received anesthesia for delivery and almost 50% of them had spinal and epidural anesthesia. The mean blood loss within 24 hours after delivery did not show differences between those who did and those who did not receive obstetrical anesthesia (579.0 ± 361.6 vs. 556.6 ± 360.6; p = 0.57). Logistic regression showed that anesthesia, the type of anesthesia, and the drug used did not influence the PPH above 500 mL and above 1000 mL within 2 hours (p > 0.05). ConclusionAnesthesia did not influence postpartum bleeding after vaginal delivery.

Apnea Test Safety in Brain Death: A Single-Center Retrospective Cohort Analysis

Background: The apnea test, which is considered positive when no spontaneous breathing movements are observed following maximal hypercapnia (PaCO 2 &gt; 55 mm Hg) respiratory center stimulation, was critically evaluated in this study by assessment of blood gas analyses performed during brain death protocols from 2010 to 2017, in the intensive care units of the Universidade Estadual de Campinas (UNICAMP). Methods: A retrospective cohort analysis based on the intensive care unit and Transplant Organ Search Organization data banks. Blood gas analyses before (pre-first and -second apnea tests) as after (after-first and -second apnea tests) were assessed. Descriptive statistical analyses of the numerical variables (such as pH, PaO 2 , PaCO 2 , HCO 3, SatO 2 ) with mean values and standard deviation, medians, and quartiles were performed. The Student’s t -test was used for pairwise group comparisons. A P &lt; 0.05 level was adopted for significance. Results: Eighty-seven protocols were evaluated. The mean apnea test duration was 11 min. All of the patients were under vasoactive drugs. Only five apnea tests were interrupted before the end at 10 min due to rapid desaturation (SatO 2 &lt; 90%), with no invalidated apnea test. Mean and standard deviation of blood gas tests assessed before the first apnea test were: pH 7.35(± 0.10), PaO 2 252.15 mm Hg (± 114.11), PaCO 2 42.78 mm Hg (± 10.84); after the first apnea test: pH 7.11(± 0.08), PaO 2 208.39 mm Hg (± 112), PaCO 2 82.43 mm Hg (± 16.91); before the second test: pH 7.33 (± 0.09), PaO 2 253.56 mm Hg (± 105.36), PaCO 2 43.76 mm Hg (± 9.67); following the second apnea test: pH 7.11 (± 0.10), PaO 2 200.1 mm Hg (± 116.45), PaCO 2 84.98 mm Hg (± 20.21). The pH, PaO 2 , and PaCO 2 values before and after the first and second apnea tests have shown statistically significant differences (P &lt; 0.0001). Conclusions: The apnea test was safe, blood gas test results are similar to those described in the literature, severe hypoxemias were prevented by a quick reconnection to the mechanical ventilation; and marked hypercapnia and acidemia following the apnea test were found, but no test was invalidated. J Neurol Res. 2021;11(1-2):14-19 doi: https://doi.org/10.14740/jnr646

Potential Impact of the Z0011 Trial on the Omission of Axillary Dissection: A Retrospective Cohort Study.

To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded from the study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes and met the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). The ACOSOG Z0011 trial criteria can be applied to a select group of SLN-positive patients, reducing the costs and morbidities of breast cancer surgery.

Apnea Test Safety in Brain Death: A Single-Center Retrospective Cohort Analysis

Background: The apnea test, which is considered positive when no spontaneous breathing movements are observed following maximal hypercapnia (PaCO 2 > 55 mm Hg) respiratory center stimulation, was critically evaluated in this study by assessment of blood gas analyses performed during brain death protocols from 2010 to 2017, in the intensive care units of the Universidade Estadual de Campinas (UNICAMP). Methods: A retrospective cohort analysis based on the intensive care unit and Transplant Organ Search Organization data banks. Blood gas analyses before (pre-first and -second apnea tests) as after (after-first and -second apnea tests) were assessed. Descriptive statistical analyses of the numerical variables (such as pH, PaO 2 , PaCO 2 , HCO 3, SatO 2 ) with mean values and standard deviation, medians, and quartiles were performed. The Student’s t -test was used for pairwise group comparisons. A P < 0.05 level was adopted for significance. Results: Eighty-seven protocols were evaluated. The mean apnea test duration was 11 min. All of the patients were under vasoactive drugs. Only five apnea tests were interrupted before the end at 10 min due to rapid desaturation (SatO 2 < 90%), with no invalidated apnea test. Mean and standard deviation of blood gas tests assessed before the first apnea test were: pH 7.35(± 0.10), PaO 2 252.15 mm Hg (± 114.11), PaCO 2 42.78 mm Hg (± 10.84); after the first apnea test: pH 7.11(± 0.08), PaO 2 208.39 mm Hg (± 112), PaCO 2 82.43 mm Hg (± 16.91); before the second test: pH 7.33 (± 0.09), PaO 2 253.56 mm Hg (± 105.36), PaCO 2 43.76 mm Hg (± 9.67); following the second apnea test: pH 7.11 (± 0.10), PaO 2 200.1 mm Hg (± 116.45), PaCO 2 84.98 mm Hg (± 20.21). The pH, PaO 2 , and PaCO 2 values before and after the first and second apnea tests have shown statistically significant differences (P < 0.0001). Conclusions: The apnea test was safe, blood gas test results are similar to those described in the literature, severe hypoxemias were prevented by a quick reconnection to the mechanical ventilation; and marked hypercapnia and acidemia following the apnea test were found, but no test was invalidated. J Neurol Res. 2021;11(1-2):14-19 doi: https://doi.org/10.14740/jnr646

Prevalence of depressive and anxiety disorders in patients with glaucoma: a cross-sectional study.

Our goal was to analyze the prevalence of depression and anxiety among patients with glaucoma and to identify risk factors related to these disorders. A cross-sectional study was carried out between August 2016 and August 2017 at the Hospital das Clínicas of Universidade Estadual de Campinas and at the Hospital Oftalmológico de Brasília to evaluate the prevalence of depressive and anxiety disorders among patients diagnosed with glaucoma. All patients underwent a complete ophthalmologic examination with standard automated perimetry to confirm the diagnosis of glaucoma. All participants were asked to complete the Hospital Anxiety and Depression Scale questionnaire. One hundred and twenty-nine patients were included in the study. Seventy-four were men (57.36%) and 55 (42.64%) were women. The mean age of the patients was 70.14 ± 15.8 years. Ninety participants were white (69.77%) and 38 (29.46%) were black. The study demonstrated a prevalence of depression and/or anxiety at 10.08%. Logistic regression revealed that women were at higher risk for anxiety and/or depression (OR: 5.25, p=0.015) and patients with a larger number of comorbidities also were at higher risk for anxiety and/or depressive disorders (OR: 2.82, p=0.038). A significant proportion of patients with glaucoma present with depression and/or anxiety. Females and patients with comorbidities are at greater risk for these disorders.

Laboratorial Aspects of Cytolytic Vaginosis and Vulvovaginal Candidiasis as a Key for Accurate Diagnosis: A Pilot Study

To identify clinical, microscopic, and biochemical characteristics that differentiate cytolytic vaginosis (CV) from vulvovaginal candidiasis (VVC). The present cross-sectional study analyzed the vaginal contents of 24 non-pregnant women aged 18 to 42 years who were attended at the Genital Infections Clinic at Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-UNICAMP). They were diagnosed either with (CV = 8, VVC = 8) or without vulvovaginitis or vaginal dysbiosis (controls). The socio-demographic, clinical, and gynecological data were obtained from a detailed patient interview. Samples of the vaginal contents were collected for analysis of vaginal pH, gram stain, and specific fungal culture. The Kruskal-Wallis and Fisher exact tests were used to compare the differences between the groups. Odds ratios were used to compare the categorical variables. The significance level was considered at p < 0.05. Both women with CV and VVC had a lumpy vaginal discharge (p = 0,002) and vaginal hyperemia (p = 0.001), compared with controls. The inflammatory process was more intense in the VVC group (p = 0.001). In the CV group, there was statistical significance for the lactobacillus amount (p = 0.006), vaginal epithelium lysis (p = 0.001), and vaginal pH (p = 0.0002). Cytolytic vaginosis and VVC diagnoses rarely differ on clinical characteristics but have different laboratorial findings. The present study highlights the importance of conducting an accurate investigation through laboratory tests rather than clinical criteria to avoid misdiagnosis.

Dispositivos de Treino Muscular Inspiratório em idosos com desmame da ventilação mecânica e com traqueostomia

Objetivo: investigar os efeitos de dois dispositivos de treino muscular inspiratório em idosos com desmame prolongado da ventilação mecânica invasiva e com traqueostomia. Materiais e Métodos: O estudo foi realizado com 12 idosos em desmame prolongado da ventilação mecânica e traqueostomia, nas Unidades de Terapia Intensiva do Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP). Seis idosos foram submetidos ao uso do dispositivo Powerbreathe plus medic® (PPM), e seis idosos ao Powerbreathe K5® (PK5). Foram avaliados os seguintes parâmetros respiratórios antes e depois da intervenção: índice de respiração rápida e superficial (IRRS) e pressão inspiratória máxima (PImáx). A análise dos dados foi conduzida por meio da estatística descritiva e inferencial (p&lt;0,05). Resultados: os resultados evidenciaram diferença significativa na PImáx (p = 0,014), onde média do grupo PPM foi superior a do grupo PK5. Houve efeito do tempo (F = 7,756) no IRRS, com variações negativas após o período de intervenção no grupo PK5. Foi encontrado efeito do grupo (F = 8,394) e do tempo (F = 8,141) na PImáx, sugerindo que os grupos eram diferentes e que apresentaram variação positiva ao longo do tempo. Houve efeito do tempo (F = 43,808) e da interação (F = 12,020) na carga de treinamento, indicando maior incremento de carga no grupo PPM, com tamanho do efeito grande (d=1,261). Conclusão: Concluiu-se que o PK5 se mostrou mais efetivo para a melhora do IRRS, PImáx e frequência respiratória.

Self-care and Health Care in Postpartum Women with Obesity: A Qualitative Study.

To explore the experiences of women with obesity regarding self-care and the care provided by their families and health team after childbirth. A clinical qualitative study performed at the Postnatal Outpatient Clinic of Hospital da Mulher, Universidade Estadual de Campinas, Brazil. The sample was selected using the saturation criteria, with 16 women with obesity up to 6 months after childbirth. The analysis comprised three categories: 1) postnatal self-care; 2) family support for woman after childbirth; and 3) postnatal health care service for women with obesity. Women with obesity need support from the health team and from their families after childbirth, when they are overwhelmed by the exhausting care for the newborn. The present study reveals how important it is for health care professionals to broaden their perception and care provided after childbirth for women with obesity so they may experience an improvement in their quality of health and of life.

WITHDRAWN

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Letters to Language

Letters to Language Cilene Rodrigues Language accepts letters from readers that briefly and succinctly respond to or comment upon either material published previously in the journal or issues deemed of importance to the field. The editor reserves the right to edit letters as needed. Brief replies from relevant parties are included as warranted. Response to a book review April 5, 2020 To the Editor: In their review of the book Recursion across domains (ed. by Luiz Amaral, Marcus Maia, Andrew Nevins, and Tom Roeper, Cambridge University Press, 2018), Daniel Everett and Edward Gibson (E&G; Language 95(4).777–90, 2019) concluded that the chapters devoted to Pirahã do not meet ‘high scientific standards’ (p. 780). Their review is unusual in criticizing not only the argumentation and claims of these chapters, but also the very competence of the authors to conduct their research, as well as the competence of a local assistant thanked by the authors, mistakenly described as the ‘primary Pirahã consultant’ (p. 781). I coauthored two of the chapters criticized in their review, Chs. 6 and 15. For space reasons, I focus on their criticism of the first of those papers. There is much to be said about the rest of their review, but I believe that the failings of their response to Ch. 6 satisfactorily exemplify issues that pervade the review. I am writing this communication not because their review was negative, but because it contains misrepresentations and falsehoods, which should be corrected. I first briefly summarize the evidence and argument that Ch. 6 presents in favor of structural embedding. I then consider E&G’s critique, ending with a brief response to their comments concerning our competence, the competence of our sources, and their criticism of our data. ________ Word order and control: Our argument for syntactic embedding was straightforward, based on fieldwork data that showed obligatory control, a phenomenon found internal to complex sentences in the world’s languages, and not found across discourse. The canonical word order of Pirahã is SOV (Everett 1983:201, ex. 3; A lingua Pirahã e a teoria da sintaxe, Universidade Estadual de Campinas dissertation). However, in constructions that one might take to show a clause embedded as a complement of a higher verb, Pirahã generally places that clause after the verb, yielding a structure that one might analyze as SVO (Everett 2005:629, ex. 24; ‘Cultural constraints on grammar and cognition in Pirahã: Another look at the design features of human language’, Current Anthropology 46(4).621–46). Everett 2005, however, took this as evidence that such structures do not actually involve clausal complementation, but paratactic conjunction, the putative clausal object actually constituting an independent sentence. We presented the following arguments against E’s (2005) claim: a. The Pirahã counterpart of sentences like ‘I want to study’ shows the phenomenon of obligatory control (OC). When the subject of ‘study’ is unpronounced, it must be understood as controlled by the subject of ‘want’. Our consultant permitted no other interpretation. b. In such structures, both SOV and SVO are acceptable (Everett 2005:117, ex. 13, 14). The first of these orders is clearly not amenable to reanalysis as paratactic conjunction. c. Main-clause material may follow the complement clause in control structures with SVO order. A temporal adverb following a complement clause in an SVO OC structure can only modify the main clause (Everett 2005: 119, ex. 17) (possibly because the embedded clause is too small to support ad verbial modification). If the putative complement clause were actually an independent sentence, we would not expect that it could be followed by an adverb modifying an earlier independent sentence. d. SOV order is not restricted to environments of control. The desiderative verb sogabagai may also take a full clausal complement with an overt subject. In this case, SOV order is restricted; only the embedded predicate can precede the desiderative verb. The subject of the embedded clause follows the higher verb, resulting in a subject-predicate split. Once again, we would not expect an independent sentence to be followed by the subject of the sentence that preceded it. ________ E&G’s critique: According to E&G, Rodrigues et al. ‘missed some crucial...

Empowering Adolescent Mothers in the Choice of Contraceptive Methods at the Postpartum Period: Avoiding a Subsequent Pregnancy

Almost 80% of adolescent pregnancies are unplanned, and between 28 and 63% of adolescent mothers had a repeated pregnancy within 18 months. Among girls with repeated pregnancies, two-thirds reported that the pregnancy was unplanned. We aim to assess contraceptive use by adolescent mothers with increasing choice for long-acting reversible contraception (LARC) methods in postpartum consultation after a semistructured group intervention involving adolescent mothers. Retrospective observational study conducted at the Universidade Estadual de Campinas, Campinas, state of São Paulo, Brazil, involving new antenatal and postpartum education groups for adolescents. At postpartum consultations, the adolescents chose their contraceptive. The data was compared with previous series followed in a period before the implementation of the education group - a historical control group. We included 129 adolescent after childbirth from January 1st, 2015 through July 31st, 2017. Out of this total, 63% had ever used contraceptive methods before pregnancy, and the most frequent method was combined oral contraceptives (33%) followed by condoms (21%). At the first postpartum consultation, the most common contraceptive chosen was intrauterine contraception (IUC) (37.2%) and depot-medroxyprogesterone acetate (DMPA) (34.1%). When comparing the rates before and after the education interventions, there was a 3-fold increase in the use of IUCs. Antenatal and postpartum education have shown a significant increase in the choice for LARC methods among adolescent mothers, with very high acceptability after a period using the method. The educational groups performed during the antenatal care and beyond the gestational period are easy to be applied worldwide with low dependence on funding.

Pregnancy Among Women with Kidney Transplantation: A 20-Years Single-Center Registry.

To assess maternal and perinatal outcomes in pregnancies after kidney transplantation in a tertiary center in Brazil. Retrospective cohort of pregnancies in women with kidney transplantation at the Universidade Estadual de Campinas, from January 1995 until December 2017. Medical charts were reviewed, and maternal and perinatal outcomes were described as means and frequencies. Renal function and blood pressure were evaluated during pregnancy and postpartum. A total of 22 women had at least 1 pregnancy during the considered time interval, and 3 of them had > 1 pregnancy, totalizing 25 pregnancies. The mean age at transplantation was of 24.6 ± 4.2 years old, and the mean time interval until pregnancy was of 67.8 ± 46.3 months. The most frequent complication during pregnancy was hypertension, which affected 11 (64.7%) women. The gestational age at delivery was 34.7 ± 4 weeks, and 47% of these pregnancies were preterm (< 37 weeks). A total of 88.2% of the women delivered by cesarean section. Renal function, measured by serum creatinine, remained stable during pregnancy, and the systolic blood pressure increased significantly, while the diastolic blood pressure did not differ during pregnancy. Pregnancy after kidney transplantation is a rare event. Pre-eclampsia and prematurity were frequent complications, and cesarean section rates were very high. A specialized antenatal and postpartum care with a multiprofessional approach and continuous monitoring of graft function are essential for the early diagnosis of complications and improved outcomes.