Heat shock proteins increase their gene expression after exposure of cells or organisms to some forms of stress, which may be high temperature, infection, inflammation, hypoxia, lack of nutrients and water. Stressful situations for the body are also pregnancy-related complications associated with placental insufficiency - preeclampsia and IUGR, as well as other pregnancy-related complications such as fetal growth restriction and gestational hypertension. Therefore, I examined whether the occurrence of pregnancy-related complications (preeclampsia, fetal growth retardation, gestational hypertension) affect the gene expression of heat shock proteins. Five hsp systems was detected, namely Hsp27, Hsp60, Hsp70, Hsp90 and HspBP1 in placental tissue samples and whole maternal peripheral blood. Samples came from women with physiological pregnancy and from women with certain pregnancy-related complications (PE, FGR, GH). RNA was isolated from the samples. Detection of hsp expression was performed by using real-time RT-PCR and the comparative Ct method. Changes in gene expression between the test samples and reference sample were examined. To assess the difference between physiological pregnancies and pregnancies with selected pregnancy- related complications, an analysis of variance (ANOVA) was used....

The aim of this study was to investigate gene expression of cardiovascular miRNAs in peripheral blood of mothers after delivery. MiRNAs are small non-coding RNAs, which significantly modulate posttranscriptional adjustments of mRNA and thus regulate gene expression across biological processess. Dysregulation of miRNAs is associated with many pathological phenomena, thanks that we can use them for diagnosis and potentionaly we can treat these diseases by the manipulation of miRNA gene expression. We examined gene expression of circulating miRNAs associated with cardiovascular diseases, and we investigated, how the expression profile depends on pregnancy course and manifestation of pregnancy-related complications. For this purpose we examined material from 221 mothers 3-10 years after delivery. A group with identical pregnancy-related complication was always compared with a group of mothers after physiological pregnancy. Gene expression of 29 cardiovascular miRNAs in peripheral blood was studied using reverse transcription and quantitative real-time PCR. It was confirmed, that the expression profile of miRNAs differed between pregnancy-related complications and physiological controls. We also confirmed, that the profile of gene expression discovered at mothers 3-10 years after delivery was different...

Children descending from pregnancy complicated by gestational hypertension, preeclampsia or fetal growth restriction have a lifelong increased risk of development of cardiovascular disease. This study investigates the expression profile of 29 cardiovascular and cerebrovascular microRNAs in children at the age of 3 to 11 years. MicroRNAs are short non-coding RNA molecules affecting gene expression by posttranscriptional modifications of mRNA, which affects biological processes. Abnormal microRNA levels can lead to pathological conditions of the individual. This study explores the relationship between dysregulated microRNA levels in whole peripheral venous blood of children and the presence of complications during pregnancy. Furthermore, this study looks at expression profile specificities depending on the presence of pathology in the child's cardiovascular system, as found in a clinical examination consisting of BMI assessment and evaluation, blood pressure testing and ultrasound examination of the heart. Dysregulated profile was present in children with gestational hypertension in miR-1-3p, miR-17-5p, miR-20a-5p, miR-21-5p, miR-26a-5p, miR-29a-3p, miR-126-3p, miR-133a-3p, miR-181a-5p, miR-199a-5p, miR-342-3p and miR-499-5p. In children with preeclampsia, dysregulation was found with miR-1-3p and...

The aim of this study was to investigate gene expression of cardiovascular miRNAs in peripheral blood of mothers after delivery. MiRNAs are small non-coding RNAs, which significantly modulate posttranscriptional adjustments of mRNA and thus regulate gene expression across biological processess. Dysregulation of miRNAs is associated with many pathological phenomena, thanks that we can use them for diagnosis and potentionaly we can treat these diseases by the manipulation of miRNA gene expression. We examined gene expression of circulating miRNAs associated with cardiovascular diseases, and we investigated, how the expression profile depends on pregnancy course and manifestation of pregnancy-related complications. For this purpose we examined material from 221 mothers 3-10 years after delivery. A group with identical pregnancy-related complication was always compared with a group of mothers after physiological pregnancy. Gene expression of 29 cardiovascular miRNAs in peripheral blood was studied using reverse transcription and quantitative real-time PCR. It was confirmed, that the expression profile of miRNAs differed between pregnancy-related complications and physiological controls. We also confirmed, that the profile of gene expression discovered at mothers 3-10 years after delivery was different...

Cette thèse aborde dans la première partie une revue panoramique des controverses historico-juridiques autour de l’avortement dans le monde, suivi par une analyse du contexte socioculturel des attitudes et des pratiques liées aux rapports sociaux de sexe, aux grossesses non désirées et à l’avortement non sécurisé. Enfin, nous examinons les articulations entre la médecine traditionnelle, coloniale et moderne au Gabon. Tout cela nous amène à notre étude sur les barrières à l’accès aux soins modernes chez les femmes en situation d’urgence médicale.L’objectif de cette thèse doctorale est d’élaborer et d’appliquer, dans sa deuxième partie, une méthodologie pour étudier le réseau des acteurs impliqués dans les pratiques liées aux avortements afin de mieux comprendre les résistances aux changements socio-cliniques et juridiques. Quel est le système de soins formel et informel chez les prestataires médicaux de soins en matière d'avortement et quels sont les obstacles que les praticiens et les femmes doivent franchir pour fournir (les praticiens) et obtenir (les femmes) ce service ? Spécifiquement une investigation des interactions sociales et institutionnelles en milieu hospitalier de Lambaréné et dans les zones rurales environnantes a été réalisée. Elle nous a conduit à déceler différentes barrières extra médicales et intra médicales à l’accès aux soins d’urgence suite aux complications des avortements non sécurisés. Ainsi, nous nous sommes concentrés, d’une part, sur les discours des professionnels de la santé, leurs pratiques et les contextes de soins ; et d’autre part, nous avons privilégié les récits des femmes sur les stratégies à interrompre les grossesses avec ou sans l'aide médicale et sur leurs stratégies d’accès aux soins modernes malgré les obstacles.Les résultats obtenus à partir des entretiens, après l’analyse de contenus, montrent qu’en pratique, il existe d'importantes barrières à l'accès aux soins d’urgences. Ces difficultés débutent dans leur environnement social avec la recherche des produits abortifs et les premiers traitements (automédication, aller en pharmacie ou chez le tradithérapeute). En cas de complications aggravées, les obstacles extra médicaux s’amplifient avec la distance géographique, les problèmes de transport et des moyens financiers. Par ailleurs, une fois ces obstacles plus ou moins franchis, les femmes doivent encore affronter les obstacles intra médicaux dans la prise en charge des urgences. Fournir un accès aux services d’avortement sans risque pour les Gabonaises est l’un des grands défis auquel nous devons faire face actuellement. Cette thèse contribue à dénoncer tout haut ce qui se passe de manière informelle dans la société gabonaise. Les femmes vivent des situations tragiques. / This dissertation begins with a broad overview of juridical and historical controversies surrounding abortion in the world followed by an analysis of attitudes and practices in diverse socio-cultural contexts linked to gender relations, unwanted pregnancy and unsafe abortion. We then examine articulations between traditional, colonial and modern medicine in Gabon. That panorama brings us to our study of the obstacles women with medical emergencies face in accessing modern health care.The objective of this doctoral research is to elaborate and apply a methodology for studying the network of actors involved in practices connected to abortion in order to better understand resistance to socio-clinical and juridical change. What is the formal and informal health care system of medical providers in matters related to abortion and what are the obstacles that providers and women must transverse to offer (providers) and obtain (women) this service? Specifically, an investigation of social and institutional interactions was conducted in urban hospital settings and in surrounding rural areas. That led us to detect different extra-medical and intra-medical barriers to emergency care access following unsafe abortion complications. In this way, we focused, on one side, upon the discourse, practices and medical contexts of health professionals while, on the other side, privileging the accounts women recited of their strategies for terminating pregnancies with or without medical help and for accessing modern care despite the obstacles.Content analysis of interviews revealed major barriers to emergency care access. Those difficulties start in the social environment with the search for abortion products and for initial treatments (self-medication and visits to the pharmacy or to traditional practitioners). In cases of advanced complications, extra-medical obstacles intensify with greater geographic distance, transportation problems and insufficient financial means. Moreover, once those obstacles are more or less overcome, women must then confront intra-medical obstacles within emergency care hospital units. Providing access to safe abortion for Gabonese women in current times is one of the great challenges we must confront. This dissertation contributes to a loud vocal denunciation of informal happenings in the society of Gabon. Women live tragic circumstances.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-05-19T11:00:27Z No. of bitstreams: 1 mariadaconsolacaomagalhaes.pdf: 3358023 bytes, checksum: 11bd3472d372f91b765a67807ee928ff (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-05-19T14:32:48Z (GMT) No. of bitstreams: 1 mariadaconsolacaomagalhaes.pdf: 3358023 bytes, checksum: 11bd3472d372f91b765a67807ee928ff (MD5) / Made available in DSpace on 2017-05-19T14:32:48Z (GMT). No. of bitstreams: 1 mariadaconsolacaomagalhaes.pdf: 3358023 bytes, checksum: 11bd3472d372f91b765a67807ee928ff (MD5) Previous issue date: 2011-08-26 / É considerado um caso de morbidade materna extremante grave (MMEG) ou near miss uma mulher que quase foi a óbito, mas sobreviveu a complicação que ocorreu durante a gravidez, parto ou até 42 dias do término da gestação. Os critérios para identificação de casos de MMEG têm sido discutidos por diversos autores que levam em consideração as condições clínicas, laboratoriais e/ou manejo dos casos. Os sistemas de informação em saúde disponíveis atualmente no Brasil, tais como o SIH-SUS (Sistema de Informações Hospitalares do SUS), Sistema de informação sobre Nascidos vivos (SINASC) e Sistema de Informação sobre Mortalidade (SIM) contam com grande número de dados que poderiam contribuir para estudos da morbidade materna. Este trabalho tem como objetivos analisar a situação da morbimortalidade materna e infantil a partir dos Sistemas de Informações em Saúde; adequar os critérios de MMEG; identificar e analisar os casos de MMEG na base de dados do SIH-SUS visando subsidiar o planejamento das ações de saúde materna. Entre as 8620 mulheres residentes em Juiz de Fora, MG, no período de 2006 e 2007, internadas com causas codificadas dentro do Capítulo XV da CID-10 ou que receberam procedimentos obstétricos, 326 apresentaram alguma condição clínica e/ou procedimento selecionado como MMEG e uma foi a óbito. A taxa de mortalidade materna foi 12,0 por 100.000 mulheres. A letalidade 3,1 por mil mulheres e a prevalência de MMEG, 39,0 por 1000 mulheres. A média de tempo de internação foi de 3,5 e 10,5 dias para as mulheres sem e com morbidade, respectivamente. O tempo de internação maior que quatro dias foi 13 vezes mais alto entre as mulheres que apresentaram MMEG. A razão de prevalência para permanência do recém-nascido após alta da mãe, ter filhos nascidos mortos e óbito da criança antes da alta da mãe foi mais elevada entre as mulheres com MMEG, respectivamente 2,52, 4,86 e 4,41. As variáveis tempo de internação, número de internações e filhos nascidos mortos mostraram-se como fatores preditores para a MMEG na análise de regressão logística (p < 0,001). Entre os procedimentos/condições selecionados os mais frequentes foram a transfusão de hemoderivados, “permanência a maior” e pré-eclampsia grave/eclampsia, com prevalências de morbidades específicas de 15,7/1000, 9,5/1000 e 8,2/1000, respectivamente. A razão de prevalência de MMEG encontrada e as prevalências específicas de transfusão de hemoderivados e pré-eclampsia grave/eclampsia são achados consistentes com a literatura existente e demonstram que o uso de associação de algumas tabelas do SIH-SUS tem grande potencial para identificação dos casos de MMEG. O critério utilizado para identificação dos casos é factível e pode contribuir para a vigilância da morbimortalidade materna e para ampliar o conhecimento sobre os aspectos que a envolve, contribuindo assim para a melhoria na qualidade da assistência à mulher no período gravídico-puerperal. / An extremely severe maternal morbidity (ESMM) case, or near miss, is one in which the woman almost died due to gestation/delivery-related problems, or any problem occurring up to 42 days after the end of gestation, but survived because of the care received or sheer chance. The criteria for identification of ESMM cases have been discussed by several authors, who take into account clinical and laboratory features and/or case management. Health information systems available in Brazil, such as the Hospital Information System (Sistema de Informações Hospitalares – SIH-SUS), Live-birth Information System (Sistema de Informações sobre Nascidos Vivos – SINASC) and Mortality Information System (Sistema de Informações sobre Mortalidade – SIM) comprise a large number of data, which could contribute to studies on maternal morbidity. This study aimed to: assess maternal and childhood morbimortality from the SIH-SUS, adequate the ESMM criteria, and identify and analyze the ESMM cases within the SIH-SUS database, with a focus on the planning of maternal health interventions. Of the 8620 women living in Juiz de Fora, MG, Brazil, admitted to hospital with a diagnosis belonging to chapter XV of the ICD-10, or who underwent an obstetric procedure, in the period 2006-2007, 326 had a clinical condition and/or procedure selected as ESMM, with 1 death. Maternal mortality rate was 12.0/100,000 women. Case-fatality rate was 3.1/1,000 women, and ESMM rate was 39.0/1,000 women. Mean hospital stay length ranged from 10.5 to 3.5 days, for women with and without ESMM, respectively. Hospital stay length over 4 days was 13 more likely for ESMM women. Prevalence ratios of newborn hospital stay after the mother`s discharge, stillbirth, and child`s death before the mother`s discharge were higher for ESMM women, being 2.52, 4.86, and 4.41, respectively. The variables hospital stay length, number of admissions, and number of stillbirths were predictors of ESMM on logistic regression analysis (p < 0.001). Of the selected procedures/conditions, the most frequent ones were blood derivatives transfusion, longer hospital stay, and severe pre-eclampsia/eclampsia, with specific morbidity prevalence rates of 15.7/1,000, 9.5/1,000 and 8.2/1,000, respectively. The ESMM prevalence ratio found and the specific prevalence rates of blood derivatives transfusion and severe pre-eclampsia/eclampsia are consistent with literature data, and show that the association use of the SIH-SS tables has significant potential to identify ESMM cases. The criterion used for case identification is feasible and may contribute to maternal morbimortality surveillance, increasing our knowledge about its associated features and contributing to better prenatal/puerperal care.