Brazilian multicenter study on prevalence of preterm birth and associated factors

<p>Abstract</p> <p>Background</p> <p>The occurrence of preterm birth remains a complex public health condition. It is considered the main cause of neonatal morbidity and mortality, resulting in a high likelihood of sequelae in surviving children. With variable incidence in several countries, it has grown markedly in the last decades. In Brazil, however, there are still difficulties to estimate its real occurrence. Therefore, it is essential to establish the prevalence and causes of this condition in order to propose prevention actions. This study intend to collect information from hospitals nationwide on the prevalence of preterm births, their associated socioeconomic and environmental factors, diagnostic and treatment methods resulting from causes such as spontaneous preterm labor, prelabor rupture of membranes, and therapeutic preterm birth, as well as neonatal results.</p> <p>Methods/Design</p> <p>This proposal is a multicenter cross-sectional study plus a nested case-control study, to be implemented in 27 reference obstetric centers in several regions of Brazil (North: 1; Northeast: 10; Central-west: 1; Southeast: 13; South: 2). For the cross sectional component, the participating centers should perform, during a period of six months, a prospective surveillance of all patients hospitalized to give birth, in order to identify preterm birth cases and their main causes. In the first three months of the study, an analysis of the factors associated with preterm birth will also be carried out, comparing women who have preterm birth with those who deliver at term. For the prevalence study, 37,000 births will be evaluated (at term and preterm), corresponding to approximately half the deliveries of all participating centers in 12 months. For the case-control study component, the estimated sample size is 1,055 women in each group (cases and controls). The total number of preterm births estimated to be followed in both components of the study is around 3,600. Data will be collected through a questionnaire all patients will answer after delivery. The data will then be encoded in an electronic form and sent online by internet to a central database. The data analysis will be carried out by subgroups according to gestational age at preterm birth, its probable causes, therapeutic management, and neonatal outcomes. Then, the respective rates, ratios and relative risks will be estimated for the possible predictors.</p> <p>Discussion</p> <p>These findings will provide information on preterm births in Brazil and their main social and biological risk factors, supporting health policies and the implementation of clinical trials on preterm birth prevention and treatment strategies, a condition with many physical and emotional consequences to children and their families.</p

Hanseni?ase: uma revisa?o de literatura / Leprosy: a literature review

INTRODUC?A?O: A Hanseni?ase, doenc?a infecciosa cro?nica granulomatosa, e? causada pelo bacilo a?lcool-acido resistente, Mycobaterium leprae, e afeta a humanidade desde os tempos antigos; pore?m, seu tratamento so? foi descoberto em 1940. Esta doenc?a e? conhecida, principalmente, por ser um fardo moral e social, sendo, portanto, muito estigmatizada. OBJETIVO: Este trabalho foi realizado com a finalidade de reunir dados da literatura para tentar elucidar a doenc?a com o intuito de auxiliar na melhor compreensa?o como um todo da hanseni?ase. DISCUSSA?O: A hanseni?ase e? uma doenc?a que inflige sumariamente os nervos e a derme, podendo provocar danos severos e irreversi?veis.

Escleroderma diabeticorum: rara mas frequentemente na?o reconhecida complicac?a?o da diabetes mellitus / Scleroderma diabeticorum: rare but often not recognized complication of diabetes mellitus

INTRODUC?A?O: O scleroderma adultorum (SA) e? uma doenc?a rara do tecido conjuntivo, caracterizada por endurecimento da pele, geralmente em pescoc?o, ombros e tronco. De etiologia desconhecida e ini?cio insidioso, pode diminuir a mobilidade dos tecidos afetados. Por ser raro e causa de morbidade significativa, e? muito importante seu reconhecimento. METODOLOGIA: O relato do caso consistiu nas informac?o?es obtidas por meio de revisa?o do prontua?rio e entrevista com paciente, bem como na revisa?o de literatura com busca no PubMed/MEDLINE e Scielo acerca do tema. Foram utilizados os termos: “Dermatology” e “Scleroderma, Systemic”. RELATO DO CASO: paciente homem, 60 anos, com quadro insidioso ha? 4 anos de placas eritemato-infiltradas em pescoc?o e dorso. Diabe?tico ha? 20 anos, mal- controlado. Trigliceri?deos de 600, Hemoglobina glicada de 9; micologico direto e cultura para fungos negativos; histopatolo?gico com edema de?rmico e infiltrado de mononucleares perivasculares. Diagno?stico de esclerederma diabeticorum. Paciente evoluiu com melhora do controle glice?mico e amolecimento das placas. DISCUSSA?O: O reconhecimento dessa condic?a?o cuta?nea pode permitir o diagno?stico e tratamento precoce de DM, melhorando o progno?stico e qualidade de vida dos pacientes.1.                  Sattar MA, Diab S, Sugathan TN et al. Scleroedema diabeticorum: a minor but often unrecognized complication of diabetes mellitus. Diabet Med 1988;5:465-8. 2.                  Knobler, R., Moinzadeh, P., Hunzelmann, N., Kreuter, A., Cozzio, A., Mouthon, Krieg, T, et al. European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis. Journal of the European Academy of Dermatology and Venereology. 2017;31(10),1581–1594. 3. Tran K, Boyd KP, Robinson MR, Whitlow M. Scleredema diabeticorum. Dermatol Online J. 2013;19:207–18

Necro?lise Epide?rmica To?xica desencadeada por fenitoi?na: Um Relato de caso / Toxic Epidermal Necrolysis Triggered by Phenytoin: A Case Report

INTRODUC?A?O:A necro?lise epide?rmica to?xicae? desencadeada na maior parte das vezes por medicac?o?es, sendo caracterizada por necrose extensiva da epiderme acometendo mais de 30% da superfi?cie corpo?rea, levando o paciente a apresentar aspecto de grande queimado. As medicac?o?es mais comumente associadas sa?o o alopurinol, lamotrigina, sulfassalazina, anti-inflamato?rios na?o esteroidais e fa?rmacos oncolo?gicos. OBJETIVO: Neste estudo, discutimos os principais aspectos da necro?lise epide?rmica to?xica atrave?s de uma revisa?o de literatura ilustrada por um caso cli?nico. METODOLOGIA: Foi realizada uma revisa?o bibliogra?fica tomando-se por refere?ncia informac?o?es obtidas nas bases de dados online PubMed e SciELO. Artigos em ingle?s, portugue?s, france?s e espanhol foram inclui?dos e ilustrados com um caso cli?nico. RELATO DO CASO: O paciente analisado foi admitido no servic?o com leso?es descamativo bolhosas em 40% da superfi?cie corporal, hematu?ria macrosco?pica e taquicardia 48 horas apo?s uso de fenitoi?na. O paciente foi tratado na unidade de queimados, com suspensa?o da medicac?a?o e curativos seriados e teve um curso favora?vel da doenc?a sem sequelas. DISCUSSA?O: Apresentamos dados para orientar o tratamento de pacientes com necro?lise epide?rmica to?xica para cirurgio?es pla?sticos, pediatras, intensivistas, dermatologistas e me?dicos de emerge?ncia. Um alto ni?vel de suspeita e? necessa?rio para um diagno?stico e estratificac?a?o de risco adequados, e medidas e tratamento precoces de apoio devem ser realizados por uma equipe multidisciplinar treinada para minimizar os danos e a mortalidade. 

Airway Microbiota and Pathogen Abundance in Age-Stratified Cystic Fibrosis Patients

Bacterial communities in the airways of cystic fibrosis (CF) patients are, as in other ecological niches, influenced by autogenic and allogenic factors. However, our understanding of microbial colonization in younger versus older CF airways and the association with pulmonary function is rudimentary at best. Using a phylogenetic microarray, we examine the airway microbiota in age stratified CF patients ranging from neonates (9 months) to adults (72 years). From a cohort of clinically stable patients, we demonstrate that older CF patients who exhibit poorer pulmonary function possess more uneven, phylogenetically-clustered airway communities, compared to younger patients. Using longitudinal samples collected form a subset of these patients a pattern of initial bacterial community diversification was observed in younger patients compared with a progressive loss of diversity over time in older patients. We describe in detail the distinct bacterial community profiles associated with young and old CF patients with a particular focus on the differences between respective “early” and “late” colonizing organisms. Finally we assess the influence of Cystic Fibrosis Transmembrane Regulator (CFTR) mutation on bacterial abundance and identify genotype-specific communities involving members of the Pseudomonadaceae, Xanthomonadaceae, Moraxellaceae and Enterobacteriaceae amongst others. Data presented here provides insights into the CF airway microbiota, including initial diversification events in younger patients and establishment of specialized communities of pathogens associated with poor pulmonary function in older patient populations

An overview of treatment approaches for chronic pain management

Pain which persists after healing is expected to have taken place, or which exists in the absence of tissue damage, is termed chronic pain. By definition chronic pain cannot be treated and cured in the conventional biomedical sense; rather, the patient who is suffering from the pain must be given the tools with which their long-term pain can be managed to an acceptable level. This article will provide an overview of treatment approaches available for the management of persistent non-malignant pain. As well as attempting to provide relief from the physical aspects of pain through the judicious use of analgesics, interventions, stimulations, and irritations, it is important to pay equal attention to the psychosocial complaints which almost always accompany long-term pain. The pain clinic offers a biopsychosocial approach to treatment with the multidisciplinary pain management programme; encouraging patients to take control of their pain problem and lead a fulfilling life in spite of the pain. © 2016 Springer-Verlag Berlin Heidelber

Estudo comparativo entre marcadores ultra-sonográficos morfológicos preditores de parto pré-termo: sinal do afunilamento do colo e ausência do eco glandular endocervical A comparative study between morphologic ultrasonographic markers for preterm delivery: funneling sign and absence of cervical gland area

OBJETIVO: Avaliar o risco de parto pré-termo (PPT) espontâneo na população geral a partir do estudo comparativo dos marcadores ultra-sonográficos morfológicos do colo uterino, como o sinal do afunilamento e a ausência da área glandular endocervical. MATERIAIS E MÉTODOS: Foram arroladas 361 gestantes na população geral, submetidas a exame ultra-sonográfico transvaginal entre a 21ª e 24ª semana, e verificados os resultados perinatais. RESULTADOS: A incidência de PPT espontâneo foi de 5,0%. O sinal do afunilamento foi observado em 4,2% da população estudada e em 22,2% das pacientes que evoluíram para PPT espontâneo. Tal parâmetro mostrou associação significante com PPT (p < 0,001; risco relativo de 6,68). A ausência do eco glandular endocervical (EGE) foi detectada em 2,8% das pacientes estudadas e em 44,4% das pacientes que evoluíram para PPT espontâneo. Este parâmetro demonstrou forte associação com PPT espontâneo (p < 0,001; risco relativo de 28,57). A análise de regressão logística multivariada apontou a ausência do EGE como a única variável morfológica associada ao PPT espontâneo. CONCLUSÃO: A predição do PPT espontâneo a partir de sinais ultra-sonográficos deve ser realizada contemplando marcadores biométricos e morfológicos, entre estes, a ausência do EGE. Este estudo indica uma tendência clara da marcante importância da ausência do EGE como indicador do risco para PPT espontâneo, a ser confirmada futuramente em pesquisas multicêntricas.<br>OBJECTIVE: To verify if different morphological ultrasonographic markers such as the funneling sign and the cervical gland area can be predictors of spontaneous premature delivery in pregnant women between 21 and 24 weeks of gestation. MATERIALS AND METHODS: This was a prospective cross-sectional study in which 361 women with 21 to 24 weeks of gestation were examined by transvaginal ultrasonography. The gestational age at delivery was later checked by telephone or mail. RESULTS: Spontaneous preterm delivery (SPD) occurred in 5% of the patients. Cervical funneling occurred in 4.2% of the women and in 22.2% of those who had SPD. This finding was correlated to preterm delivery (p < 0.001; relative risk of 6.68). Absence of a hypoechoic area peripheral to the cervical canal consistent with endocervical epithelium glands, namely endocervical glandular echo (EGE) feature, was detected in 2.8% of all patients and in 44.4% of those who developed spontaneous preterm labor. There was a statistically significant association of this feature to SPD (p < 0.001; relative risk of 28.57). Multivariance logistic regression analysis showed that this was the feature with strongest correlation with SPD, when compared to cervical funneling. CONCLUSION: Prediction of SPD through ultrasound features should observe biometrical and morphological signs such as absence of EGE. This is a new and important ultrasound finding that can be considered a predictor of risk for SPD, and should be confirmed in future multicentric trials