Mortalidade por gastrosquise no estado do Rio de Janeiro: uma série de 10 anos

OBJETIVO: Analisar a mortalidade e fatores associados em uma série de nascimentos com gastrosquise no estado do Rio de Janeiro em 10 anos (2005 a 2014). MÉTODO: Estudo de coorte retrospectiva, no qual foram relacionadas as bases de dados do Sistema de Informação sobre Nascidos Vivos e do Sistema de Informação sobre Mortalidade por linkage probabilístico. A base de dados final foi construída em duas etapas, que consistiram em: preparo das duas bases de dados iniciais e estabelecimento de relações entre elas. RESULTADOS: Os recém-nascidos pré-termo e os com baixo peso ao nascer tiveram maior chance de óbito, com significância estatística (p = 0,03 e p = 0,006, respectivamente). Em relação ao local de nascimento, embora a frequência de óbito tenha sido maior nas maternidades do que em hospitais gerais (p = 0,04; OR = 0,5; IC95% 0,3–1,0), foi observado que uma unidade caracterizada como hospital geral apresentou uma frequência alta de nascimentos (61,2%) e, na análise comparativa da chance de óbito dessa unidade com as demais, encontrou-se uma chance de morrer 7,5 maior em hospitais gerais e 3,2 maior em maternidades, com significância estatística (p < 0,001). Além disso, nascer em unidades de terapia intensiva tipo II aumentou a chance de óbito em 3,9 vezes em comparação com as do tipo III (p < 0,001). CONCLUSÃO: Este estudo dá subsídios para a discussão de duas possíveis estratégias no tratamento de recém-nascidos com gastrosquise. A primeira seria a centralização do cuidado em unidades terciárias, possibilitando que o cuidado à malformação seja analisado de forma mais minuciosa e padronizada. A segunda, e talvez mais factível, seria a elaboração de diretrizes clínicas que padronizem o cuidado imediato aos bebês com gastrosquise nascidos fora de centros terciários, bem como a padronização do transporte deles até a chegada ao centro terciário.OBJECTIVE: To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD: A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS: Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3–1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION: This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center

Identificação dos conceitos de medidas de desfechos de ensaios clínicos em osteogênese imperfeita utilizando a Classificação Internacional de Funcionalidade, Incapacidade e Saúde - versão crianças e jovens

The biopsychosocial model from the International Classification of Functioning, Disability, and Health (ICF) has been used as a reference in clinical practice to identify and analyze the functioning components in outcome measures. Objective: The objectives of this study were to identify the concepts contained in outcome measures of clinical trials on Osteogenesis Imperfecta, to analyze how these concepts are linked with the ICF - Children and Youth version (ICF-CY) and describe what the functioning components are that are assessed in these studies. Method: Randomized controlled trials on children with diagnoses of Osteogenesis Imperfecta carried out between 2000 and 2013 were selected using MedLine and Cochrane. The outcome measures were extracted and the concepts contained in the outcome measures were linked to the ICF-CY. Results: Fourteen trials were included. The concepts of clinical and technical measures and of one health assessment instrument (Pediatric Evaluation of Disability Inventory - PEDI) were identified. The concepts of clinical and technical measures were linked to the ICF-CY Body Functions and Structures component. The PEDI concepts were linked to the Body Functions and especially to Activity and Participation. Conclusion: Using the linking of the concepts of outcome measures to the ICF-CY it was possible to verify that clinical trials on Osteogenesis Imperfecta assessed mainly the Body Functions and Body Structures component. Assessments of Activity and Participation and contextual factors are scarce on these studies. More research is necessary on the effects of interventions on these components.O modelo biopsicossocial da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) tem sido utilizado como referência na prática clínica para identificação e análise dos componentes da funcionalidade presentes em medidas de desfechos. Objetivo: Este estudo tem como objetivos identificar os conceitos de medidas de desfecho de ensaios clínicos em Osteogênese Imperfeita, analisar como estes conceitos se relacionam com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde versão crianças e jovens (CIF-CJ) e descrever quais componentes da funcionalidade mais avaliados. Método: Ensaios clínicos realizados entre 2000 e 2013 em crianças com diagnóstico de Osteogênese Imperfeita foram selecionados a partir de uma revisão nas bases de dados MedLine e Cochrane. As medidas de desfecho foram extraídas e os conceitos significativos de cada medida foram relacionados à CIF-CJ. Resultados: Foram incluídos para o estudo 14 artigos. Os conceitos de medidas clínicas e técnicas e de um instrumento de avaliação padronizado (Pediatric Evaluation of Disability Inventory - PEDI) foram identificados. Os conceitos das medidas clínicas e técnicas relacionaram-se ao componente da CIF-CJ Funções e Estruturas do Corpo. Os conceitos do PEDI relacionaram-se aos componentes Funções do Corpo e principalmente Atividade e Participação. Conclusão: Através do link dos conceitos das medidas de desfecho com a CIF-CJ foi verificado que os ensaios clínicos em OI avaliam principalmente o componente Funções e Estruturas do Corpo. As avaliações da Atividade e Participação e os fatores contextuais ainda são pouco contempladas nestes estudos havendo necessidade de novas pesquisas sobre o efeito das intervenções nestes componentes

Nutritional profile of newborns with microcephaly and factors associated with worse outcomes

OBJECTIVE: To describe the nutritional profile of newborns with microcephaly and factors associated with worse outcomes during the first 14 days of life. METHODS: This investigation is a longitudinal, descriptive study carried out in 21 full-term neonates exposed vertically to the Zika virus and hospitalized in a neonatal intensive care unit from February to September 2016. Patients receiving parenteral nutrition were excluded. Data analysis was performed using a generalized estimating equation model and Student’s t-test to evaluate the association between worsening weight-for-age z-scores and independent clinical, sociodemographic and nutritional variables during hospitalization, with po0.05 indicating significance. RESULTS: During hospitalization, there was a decrease in the mean values of the weight-for-age z-scores. The factors associated with worse nutritional outcomes were symptomatic exposure to the Zika virus, low maternal schooling, absence of maternal income and consumption of infant formula (po0.05). Calcification and severe microcephaly were also associated with poor nutritional outcomes. Energy and macronutrient consumption remained below the recommendations and had an upward trend during hospitalization. CONCLUSION: The presence of cerebral calcification, the severity of microcephaly and symptomatic maternal exposure to Zika virus affected the nutritional status of newborns. In terms of nutritional factors, human milk intake had a positive impact, reducing weight loss in the first days of life. Other known factors, such as income and maternal schooling, were still associated with a poor nutritional status

Influence of Osteopathic Manipulative Treatment on the Quality of Life and the Intensity of Lumbopelvic Pain in Pregnant Women in the Third Trimester: A Prospective Observational Study

During pregnancy, the various changes women undergo can affect their health status. Manual therapies are important aids because they do not use medication. This study aimed to evaluate the influence of osteopathic manipulative treatment on the intensity of lumbar and pelvic pain and changes in quality of life. This prospective study included women over 18 years old and between 27 and 41 weeks pregnant, and excluded women with fetal malformations, multiple fetuses, premature rupture of membranes, and in labor. Forty-six pregnant women were selected and divided into two groups of ≤3 and ≥4 visits. Statistically significant improvements were observed in the intensity of maximum low back pain (7.54 ± 1.47 vs. 3.815 ± 1.73, p ≤ 0.01) and minimum low back pain (5.67 ± 2.03 vs. 3.111 ± 1.67, p ≤ 0.01), maximum pelvic pain (6.54 ± 2.22 vs. 2.77 ± 1.64, p = 0.01), and minimum pelvic pain (5.615 ± 2.21 vs. 2.615 ± 1.66, p = 0.01). Both groups achieved improvements in quality of life indices, with the improvements achieved by the ≥4-visits group being statistically significant. Osteopathic treatment was effective in reducing the intensity of lumbar and pelvic pain and in improving the quality of life of pregnant women in the third trimester

Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis

CONTEXT AND OBJECTIVE: Even if precursor lesions of cervical cancer are properly treated, there is a risk of persistence or recurrence. The aim here was to quantify the risks of persistence of high-grade intraepithelial squamous lesions, one and two years after cervical electrosurgical excisional treatment with positive margins. DESIGN AND SETTING: Systematic review of the literature and meta-analysis at Instituto Fernandes Figueira. METHODS: This meta-analysis was on studies published between January 1989 and July 2009 that were identified in Medline, Scopus, Embase, Cochrane, SciELO, Lilacs, Adolec, Medcarib, Paho, Wholis, Popline, ISI Web of Science and Sigle. Articles were selected if they were cohort studies on electrosurgical excisional treatment of high-grade squamous intraepithelial lesions with a minimum follow-up of one year, a histopathological outcome of persistence of these lesions and a small risk of bias. RESULTS: The search identified 7,066 articles and another 21 in the reference lists of these papers. After applying the selection and exclusion criteria, only four articles were found to have extractable data. The risk of persistence of high-grade intraepithelial lesions after one year was 11.36 times greater (95% confidence interval, CI: 5.529-23.379, P < 0.0001) in patients with positive margins and after two years, was four times greater (95% CI: 0.996-16.164), although without statistical significance. CONCLUSION: This meta-analysis confirms the importance of positive margins as an indicator of incomplete treatment after the first year of follow-up and highlights the need for appropriately chosen electrosurgical techniques based on disease location and extent, with close surveillance of these patients

ANÁLISE DAS INFECÇÕES DE SÍTIO CIRÚRGICO EM PACIENTES PEDIÁTRICOS APÓS CIRURGIA ORTOPÉDICA: UM ESTUDO CASO-CONTROLE

RESUMO Objetivos: Descrever taxa de infecção no sítio cirúrgico em crianças submetidas à cirurgia ortopédica em centro de referência e analisar o perfil desses pacientes. Métodos: Verificados prontuários de pacientes pediátricos submetidos à cirurgia ortopédica de janeiro de 2012 a dezembro de 2013 no Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad com um ano de seguimento. Pacientes com diagnóstico de infecção de sítio cirúrgico foram pareados com pacientes sem esse diagnóstico com base na idade, na data de internação, na área de atuação ortopédica e no tipo de procedimento cirúrgico. Averiguadas variáveis do paciente, da cirurgia e do seguimento. Realizadas análises descritivas, bivariadas e de correspondência para avaliação do perfil dos pacientes. Resultados: Identificadas 347 cirurgias e 10 infecções de sítio cirúrgico (2,88%). Houve associação de infecção com idade Odds Ratio (OR) 11,5 (intervalo de confiança - IC95% 1,41-94,9), implante OR 7,3 (IC95% 1,46-36,3), tempo pré-operatório OR 9,8 (IC95% 1,83-53,0) e tempo de internação OR 20,6 (IC95% 3,7-114,2). A análise de correspondência correlacionou a infecção com tempo pré-operatório, peso, escore Z de peso, idade, implante, tipo de procedimento e tempo de internação. O tempo médio de diagnóstico da infecção foi de 26,5±111,46 dias após cirurgia. Conclusões: A taxa de infecção no sítio cirúrgico foi de 2,88%, maior em crianças acima de 24 meses, que realizaram implante, tiveram mais tempo pré-operatório e de internação. Este estudo identificou variáveis de vigilância epidemiológica desses eventos em crianças. Bancos de dados e métodos de análises adequados são fundamentais para o acompanhamento e o aprimoramento do cuidado ofertado à população pediátrica

Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis

CONTEXT AND OBJECTIVE: Even if precursor lesions of cervical cancer are properly treated, there is a risk of persistence or recurrence. The aim here was to quantify the risks of persistence of high-grade intraepithelial squamous lesions, one and two years after cervical electrosurgical excisional treatment with positive margins. DESIGN AND SETTING: Systematic review of the literature and meta-analysis at Instituto Fernandes Figueira. METHODS: This meta-analysis was on studies published between January 1989 and July 2009 that were identified in Medline, Scopus, Embase, Cochrane, SciELO, Lilacs, Adolec, Medcarib, Paho, Wholis, Popline, ISI Web of Science and Sigle. Articles were selected if they were cohort studies on electrosurgical excisional treatment of high-grade squamous intraepithelial lesions with a minimum follow-up of one year, a histopathological outcome of persistence of these lesions and a small risk of bias. RESULTS: The search identified 7,066 articles and another 21 in the reference lists of these papers. After applying the selection and exclusion criteria, only four articles were found to have extractable data. The risk of persistence of high-grade intraepithelial lesions after one year was 11.36 times greater (95% confidence interval, CI: 5.529-23.379, P < 0.0001) in patients with positive margins and after two years, was four times greater (95% CI: 0.996-16.164), although without statistical significance. CONCLUSION: This meta-analysis confirms the importance of positive margins as an indicator of incomplete treatment after the first year of follow-up and highlights the need for appropriately chosen electrosurgical techniques based on disease location and extent, with close surveillance of these patients