Atualização sobre o tratamento multidisciplinar das fissuras labiais e palatinas

O artigo aborda as fissuras labiopalatais (FLP), sua epidemiologia, anomalias associadas, o diagnóstico pré-natal, prognóstico, fatores de risco, tratamentos, orientações e prevenção. Chama-se atenção para essas anomalias, pois elas estão entre as congênitas mais comuns e causam custos em termos de morbidade, cuidados de saúde, distúrbios emocionais, sociais e exclusão do trabalho tanto para o indivíduo afetado, quanto para a sua família e a sociedade

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. Methods The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODErn), to generate cause fractions and cause specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Findings At the broadest grouping of causes of death (Level 1), non-communicable diseases (NC Ds) comprised the greatest fraction of deaths, contributing to 73.4% (95% uncertainty interval [UI] 72.5-74.1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 186% (17.9-19.6), and injuries 8.0% (7.7-8.2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22.7% (21.5-23.9), representing an additional 7.61 million (7. 20-8.01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7.9% (7.08.8). The number of deaths for CMNN causes decreased by 222% (20.0-24.0) and the death rate by 31.8% (30.1-33.3). Total deaths from injuries increased by 2.3% (0-5-4-0) between 2007 and 2017, and the death rate from injuries decreased by 13.7% (12.2-15.1) to 57.9 deaths (55.9-59.2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118.0% (88.8-148.6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36.4% (32.2-40.6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33.6% (31.2-36.1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respirator}, infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990 neonatal disorders, lower respiratory infections, and diarrhoeal diseases were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. Interpretation Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

Atualização sobre o tratamento multidisciplinar das fissuras labiais e palatinas - doi:10.5020/18061230.2005.p31

Cleft of the lip and palate (CLP) are included among the more common congenital anomalies.Knowing about the importance of the disease, the objective of this study is to inform and to help the health professionals to establish the correct diagnosis and treatment. This review is based on the relevant literature published. The source of data was MEDLINE, LILACS database and textbooks. The key words used for searching were cleft lip and palate. The CLP occurs in approximately 1/600 newborn babies worldwide. The prevalence varies considerably across geographic areas and ethinic groupings. The genetic of CLP is highly complex and include single-gene causes, chromosomal disorders, polygeneic interactions, environmental risks and gene/environmental risks There is a considerable variation in the proportion of cases of CLP with congenital anomalies and syndromes. Ultrasonography has been used to detect CLP prenatally. The patients with CLP need multidisciplinary surgical and non-surgical treatment with pediatrician, geneticist, psychologist, nutritionist, odontologist. The adequate treatment of CLP is important because their impact on speech, hearing, appearance and cognition has a prolonged and adverse influence on health and social integration. The costs incurred from CLP in terms of morbidity, health care, emotional disturbance, social and employment exclusion are considerable for affected individuals, their families and society. Researches may increase in the understanding of the cause of CLP, improve the treatment for it and lead ultimately to its prevention.As fissuras labiopalatais (FLP) estão incluídas entre as anomalias congênitas mais comuns. Conhecendo a importância das FLP, o objetivo desse trabalho é informar e ajudar a profissionais de saúde a estabelecer um diagnóstico e tratamento adequado. Essa revisão é baseada em relevante literatura. A fonte de dados foi MEDLINE, LILACS e livrostexto. As palavras chave utilizadas na pesquisa foram fissura de lábio e palato. As FLP ocorrem em aproximadamente 1/600 nascimentos em todo o mundo. A prevalência varia consideravelmente com regiões geográficas e grupos étnicos. A genética das FLP é extremamente complexa e inclue causas monogênicas, doenças cromossômicas, interações poligênicas, riscos ambientais e entre gene e ambiente. Há uma considerável variação na proporção de casos com FLP associados a anomalias congênitas e síndromes. A ultrassonografia tem sido utilizada para detectar FLP no pré-natal. Os pacientes com FLP necessitam de tratamento multidisciplinar cirúrgico e não-cirúrgico com pediatra, geneticista, psicólogo, nutricionista, odontologista. O tratamento das FLP é importante devido ao seu impacto na fala, audição, aparência e cognição tem uma influência prolongada e adversa na saúde e integração social. O custo causado pelas fissuras labiais e palatinas em termos de morbidade, cuidados de saúde, distúrbios emocionais, sociais e exclusão do trabalho são consideráveis para o indivíduo afetado, sua família e a sociedade. As pesquisas podem aumentar a compreensão das causas de fissuras labiais e palatinas, melhoria do tratamento e principalmente na prevenção