Resumo Objetivo Investigar a expressão da endotelina-1 (ET-1) e da óxido nítrico sintase endotelial (endothelial nitric oxide synthase, eNOS, em inglês) em placentas normais e com pré-eclâmpsia (PE). Métodos Este estudo transversal e analítico foi realizado em primigestas normais e com PE (n=10 em cada grupo) internadas no Hospital Geral e das Clínicas de North Okkalapa entre fevereiro de 2019 e fevereiro de 2020. Amostras de soro foram coletadas imediatamente antes do parto, e os tecidos placentários foram coletados imediatamente após cesariana de emergência ou eletiva. A expressão da eNOS da placenta foi medida por western blot, e os níveis de ET-1 nos homogenatos de tecidos placentários ET-1 e no soro foram medidos por ensaio de imunoabsorção enzimática. Resultados O grupo comPE apresentou níveis séricos de ET-1 significativamentemais altos (mediana: 116,56 pg/mL; IIQ: 89,14-159,62 pg/mL) do que o grupo normal (mediana: 60,02 pg/mL; IIQ: 50,89-94,37 pg/mL) (p<0,05). No entanto, não foi observada diferença significativa no nível ET-1 dos homogenatos de tecidos placentários entre placentas normais e com PE (mediana: 0,007 pg/μg de proteína total; IIQ: 0,002-0,0123 pg/μg de proteína total; e mediana: 0,005 pg/μg de proteína total; IIQ: 0,003-0,016 pg/μg de proteína total, respectivamente). Os valores da mediana e do IIQ da expressão relativa da eNOS placentária foram significativamente maiores no grupo com PE do que no grupo normal (p<0,05). O nível sérico de ET-1 não estava significativamente correlacionado com a expressão placentária de ET-1, e tampouco houve correlação significativa entre as expressões placentária de ET-1 e de eNOS em nenhum dos grupos. Conclusão Os níveis séricos de ET-1 foram significativamente maiores em gestantes com PE em comparação com gestantes normais, ao passo que os níveis de ET-1 dos homogenatos de tecidos placentários não foram significativamente diferentes. A ET-1 sérica, em vez da ET-1 placentária, pode desempenhar um papel importante na patogênese da EP.

Abstract Objective To investigate the expression of endothelin-1 (ET-1) and endothelial nitric oxide (NO) synthase (eNOS) in normal and preeclamptic (PE) placentae. Methods The present cross-sectional analytical study was performed in normal and PE primigravidae (n=10 in each group) who were admitted to the North Okkalapa General and Teaching Hospital from February 2019 to February 2020. Serum samples were collected immediately before delivery, and placental tissues were collected immediately after emergency or elective cesarean section. The expression of placental eNOS was measured by western blot, and the levels of ET-1 in placental tissue homogenates and in the serum were measured by enzyme-linked immunosorbent assay (ELISA). Results The PEgrouphadsignificantly higher serumlevelsof ET-1(median: 116.56 pg/mL; IQR: 89.14-159.62 pg/mL) than the normal group (median: 60.02 pg/mL; IQR: 50.89-94.37 pg/mL) (p<0.05). However, statistically significant differences were not observed in the levels of ET-1 in placental tissue homogenates between normal and PE placentae (median: 0.007 pg/μg of total protein; IQR: 0.002-0.0123 pg/μg of total protein; andmedian: 0.005 pg/μg of total protein; IQR: 0.003-0.016 pg/μg of total protein respectively). The median and IQR values of relative placental eNOS expression were significantly higher in the PE group than in the normal group (p<0.05). The serum levels of ET-1 level were not significantly correlated with placental ET-1 expression, and neither there was a significant correlation between placental ET-1 and eNOS expression in any of the groups. Conclusion The serum levels of ET-1 were significantly higher in PE pregnant women compared with normal pregnant women, while the ET-1 levels of placental tissue homogenates were not significantly different. Serum ET-1 rather than placental ET-1 might play a major role in the pathogenesis of PE.

The door-to-door distribution of contraceptives and information on maternal and child health and family planning (MCH-FP) services, through bimonthly visits to eligible couples by trained fieldworkers, has been instrumental in increasing the contraceptive prevalence rate and immunization coverage in Bangladesh. The doorstep delivery strategy, however, is labour- intensive and costly. More cost-effective service delivery strategies are needed, not only for family planning services but also for a broader package of reproductive and other essential health services. Against this backdrop, operations research was conducted by the Centre for Health and Population Research at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) from January 1996 to May 1997, in collaboration with government agencies and a leading national nongovernmental organization, with a view to developing and field-testing alternative approaches to the delivery of MCH-FP services in urban areas. Two alternative strategies featuring the withdrawal of home-based distribution and the delivery of basic health care from fixed-site facilities were tested in two areas of Dhaka. The clinic-based service delivery strategy was found to be a feasible alternative to the resource-intensive doorstep system in urban Dhaka. It did not adversely affect programme performance and it allowed the needs of clients to be addressed holistically through a package of essential health and family planning services.

En Bangladesh, un factor que ha contribuido a aumentar la prevalencia del uso de anticonceptivos y la cobertura inmunitaria son las visitas bimensuales casa por casa efectuadas por trabajadores sobre el terreno a las parejas que reúnen los requisitos establecidos para distribuirles anticonceptivos y suministrarles información sobre los servicios de saludmaternoinfantil y planificación familiar. Esa estrategia de visitas domiciliarias, sin embargo, es costosa y requiere abundante personal. Es preciso disponer de estrategias asistenciales más eficaces con relación al costo, no sólo para los servicios de planificación familiar, sino también para un más amplio conjunto de servicios de salud reproductiva y otros servicios de salud básicos. Ante esta situación, entre enero de 1996 y mayo de 1997, ICDDR,B - Centro para la Investigación en materia de Salud y Población, en colaboración con organismos gubernamentales y con una destacada organización no gubernamental nacional, llevóa cabo una investigación operativa a fin de desarrollar y ensayar sobre el terreno formas alternativas de prestación de servicios de salud maternoinfantil y planificación familiar en zonas urbanas. En dos áreas de la ciudad de Dhaka se ensayaron dos estrategias alternativas caracterizadas por la suspensión de la distribución domiciliaria y la prestación de atención sanitaria básica a partir de centros de salud fijos. Se comprobó que esa estrategia de prestación de servicios ambulatorios constituía una alternativa viable al costoso sistema de visitas en las zonas urbanas de Dhaka. No menoscabó la eficacia de los programas, y permitió abordar de forma global las necesidades de los usuarios mediante un paquete de servicios básicos de salud y planificación familiar.

La distribution à domicile de contraceptifs et d’informations sur les services de santé de la mère et de l’enfant et les services de planification familiale, dans le cadre de visites bimestrielles aux couples concernés effectuées par des agents de terrain spécialement formés, a joué un rôle utile en augmentant la prévalence de l’utilisation des contraceptifs et la couverture vaccinale au Bangladesh. Cette stratégie est toutefois coûteuse en temps et en argent. Il est nécessaire de disposer de stratégies ayant un meilleur rapport coût-efficacité pour la prestation non seulement des services de planification familiale mais aussi d’un ensemble plus vaste de services de santé génésique et autres services essentiels en matière de santé. Compte tenu de cette situation, le Centre de recherche sur la santé et la population de l’ICDDR,B (Centre international de recherche sur les maladies diarrhéiques, Bangladesh) a conduit une recherche opérationnelle de janvier 1996 à mai 1997 en collaboration avec des organismes officiels et une grande organisation non gouvernementale nationale, dans le but d’élaborer et d’expérimenter sur le terrain de nouvelles approches de la prestation de services de santé de la mère et de l’enfant et de services de planification familiale en zone urbaine. Deux stratégies de rechange comportant la suppression de la distribution à domicile et assurant la prestation des soins de santé de base en un lieu fixe ont été testées dans deux secteurs de la ville de Dhaka. La stratégie avec prestation de services en dispensaire s’est révélée une alternative réalisable au coûteux système de distribution à domicile en usage en ville de Dhaka. Elle n’a pas entraîné de perte de performance du programme et a permis de répondre de façon holistique aux besoins des clients grâce à un ensemble de services de santé essentiels et de services de planification familiale.