Application Of Continuous Positive Airway Pressure In The Delivery Room: A Multicenter Randomized Clinical Trial.

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.47259-6

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Boron and calcium sprayed on 'Fuyu' persimmon tree prevent skin cracks, groove and browning of fruit during cold storage Boro e cálcio pulverizado em árvores de caqui "Fuyu" previnem fissuras, estrias e escurecimento do fruto durante o armazenamento refrigerado

Flesh softening, skin browning and rotting are chief problems during cold storage (CS) of 'Fuyu' Persimmon. We studied the effects of boron (B) and calcium (Ca) sprayed on the trees during three consecutive years, on the development of skin cracks, grooves and browning in persimmon fruit under CS in Farroupilha, RS, Brazil (29&deg;31' south, 51&deg;21' west, about 750 m altitude). A homogeneous orchard area of 0.5 ha was delimitated and three sets of five plants for each treatment were randomly selected. The persimmon trees were sprayed at a 20 day interval, from 15th January until harvest, for three consecutive years, with: T1) water; T2) calcium nitrate at 0.5% (m/v); T3) calcium chloride at 0.5% (m/v); and T4) boron at 0.3% (m/v). The fruit were harvest with orange-reddish colour; 18-20&deg;Brix, pulp firmness of 45 to 60N, and kept under CS at 0&plusmn;1&deg;C for 45 days. The fruits were evaluated immediately before CS, after six hours at 23&plusmn;2&deg;C after removal from CS, and after four days at 23&plusmn;2&deg;C after removal from CS. Equally boron and calcium sprayed on the trees prevented skin cracks, skin grooves and skin browning. Besides, when boron was sprayed on the trees, the mentioned effects were additive in the following year.<br>As principais alterações indesejáveis observadas no período pós-colheita de caquis em armazenamento refrigerado (AR) são a perda de firmeza de polpa, e a ocorrência de escurecimento epidérmico e de podridões. Este trabalho teve por objetivo principal estudar as respostas da aplicação de boro (B) e cálcio (Ca), em três safras sucessivas, na prevenção da ocorrência de fissuras, estrias e escurecimento epidérmico de caquis "Fuyu". No pomar (Farroupilha-RS-Brasil, 29&deg;31' Sul, 51&deg;21' Oeste, aproximadamente 750m altitude) delimitou-se uma área homogênea de 0,5ha., marcando-se, ao acaso, três repetições de cinco plantas para cada tratamento: T1 - controle, caquizeiros não-pulverizados com B e Ca; T2 - pulverizações com Nitrato de Ca 0,5% (m/v); T3 - pulverizações com Cloreto de Ca 0,5% (m/v); e T4 - pulverizações com B 0,3% (m/v). As aplicações foram realizadas em três anos sucessivos a partir de 15 de janeiro a intervalos de 20 dias. Foram colhidos os caquis na coloração alaranjado-avermelhada, com 18-20&deg;Brix e 45 a 60N, que posteriormente foram armazenados em AR a 0&plusmn;1&deg;C por 45 dias. As avaliações foram realizadas no dia do armazenamento, após seis horas a 23&plusmn;2&deg;C a partir da retirada AR, e após quatro dias a 23&plusmn;2&deg;C a partir da retirada do AR. Foi avaliada a ocorrência de frutas com fissuras, estrias e escurecimento epidérmico. Comprovou-se o efeito benéfico da aplicação de B ou Ca na prevenção de fissuras, estrias e escurecimento epidérmico. Adicionalmente, foi detectado o incremento da resposta à aplicação de B, que, além de prevenir (à semelhança das aplicações com Ca), apresentou efeito aditivo no segundo ano. O resultado sugere que as respostas às aplicações com B são progressivas

Born into an isolating world: family-centred care for babies born to mothers with COVID-19

Background: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. Methods: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the ‘EsPnIC Covid paEdiatric NeonaTal REgistry’ (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. Findings: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March–June 2020 to 74% in January–March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March–June 2020 and January–March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. Interpretation: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed. Funding: The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children's Hospital Foundation: Grant ID 2019–1155 (EJP), Victorian Government Operational Infrastructure Support Program

Análise morfológica de sementes, germinação e plântulas de jatobá (Hymenaea intermedia Ducke var. adenotricha (Ducke) Lee & Lang.) (Leguminosae-caesalpinioideae) Morphologycal analysis of seeds, germination, and seedlings of jatobá (Hymenaea intermedia Ducke var. adenotricha (Ducke) Lee & Lang.) (Leguminosae-caesalpinioideae)

As leguminosas são usadas para compor Sistemas Agroflorestais, cujo sucesso de implantação depende de informações básicas sobre as espécies que compõem os diferentes extratos. Hymenaea intermedia var. adenotricha é uma leguminosa com potencial para aproveitamento agroflorestal na região. As sementes foram coletadas de matrizes na área de floresta natural da Província Petrolífera de Porto Urucu - Amazonas. O estudo foi realizado em condições de viveiro e laboratório da Faculdade de Ciências Agrárias (UFAM). A semente de Hymenaea intermedia var. adenotricha é eurispérmica, com testa de consistência pétrea (desidratada) e cartácea (hidratada). O tegumento apresenta quatro estratos celulares com o primeiro formado por células finas e longas em paliçada, sendo visível a "linha lúcida". O embrião é axial, total, de cor amarelo-esverdeado. Os cotilédones são carnosos, inteiro com radícula escondida. A plúmula é rudimentar. A germinação é epígea fanerocotiledonar, com emergência curvada. A plântula apresenta sistema radicular pivotante com raiz primária axial, sub-lenhosa, estriada, glabra. As raízes secundárias são curtas, pouco ramificadas, porém entrelaçadas, resinosas e sem nódulos. O protófilo é composto, com folíolos opostos, sésseis. O primeiro metáfilo apresenta-se composto, bifoliolado, com folíolos assimétricos levemente falcado-oblongo.<br>Species from the Leguminosae family are used in Agroforestry Systems. Their successful implementation depends on basic information about the species that constitute each extract. Hymenaea intermedia var. adenotricha is a specie from the leguminosae family with potential to be used in agroforestry in the Amazon region. The seeds were harvested from plants found in the natural forest of Petroleum Province Urucu Harbor. The studies were carried out under laboratory and nursery conditions at the Agrarian Sciences College the Amazonas University. H. intermedia var. adenotricha seeds are eurispermic, the tegument showed stone consistency when dehydrated and soft consistency when hydrated. The seed tegument showed four cellular strata, the first layer was formed by thin cells organized in a palissade. The embryon axis was yellow green. The cotyledons were fleshy with a hidden radicle. The plumule is rudimentary. The seed germination is phanero-epigeal, showing curved body during its emergency. The seedling showed tap-root root system, the axial primary root was woody grooved and glabrous. The secondary roots were resinous, short, slightly ramified but interlaced and showed no nodules. The protophyll exhibited compound asymmetric leaflets which were slightly falcade and oblonge. The first metaphyll presented compound asymmetric leaflets with slightly falcade-oblonge shape

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P &lt; 0.01), had lower American Society of Anesthesiology score (ASA) grade (P &lt; 0.01) and less comorbidity (P &lt; 0.01), but were more likely to be current smokers (P &lt; 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P &lt; 0.01) and frequently underwent ileocecal resection (P &lt; 0.01) with higher rate of de-functioning/primary stoma construction (P &lt; 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P &lt; 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups