Bacterial Meningitis in Newborn Babies

Objectivo — Conhecer a epidemiologia da meningite bacteriana em recém-nascidos admitidos na Unidade de Cuidados Intensivos Neonatais do Hospital de Dona Estefânia. Doentes e métodos — Foi feita a revisão dos processos de recém-nascidos admitidos na Unidade de Cuidados Intensivos Neonatais do Hospital de Dona Estefânia de Janeiro de 1985 a Dezembro de 1996 — 12 anos, provenientes da maternidade do Hospital ou do exterior. Foram excluídas as infecções congénitas e as crianças com idade superior a 28 dias. Definiu-se como precoce a infecção com início nas primeiras 72 horas de vida. Resultados — Houve 36 casos de meningite bacteriana correspondendo a 1,1% das admissões. A incidência de meningite bacteriana precoce na Maternidade do Hospital foi 0,13 por mil nados-vivos. Vinte e quatro crianças eram do sexo masculino (66,7%), 7 eram pré-termo, 4 de baixo peso e 1 de muito baixo peso. Dez recém-nascidos tiveram meningite precoce (27,8%) e 26 (72,2%) meningite tardia. Houve isolamento do agente bacteriano no líquido cefalorraquidiano em 27 crianças (77,1%): E. coli (n=7); Streptococcus do grupo B(SGB) (n=6); Klebsiella pneumoniae (n=3); Proteus mirabilis (n=2), Listeria monocytogenes (n=1), Streptococcus bovis (n=1), Staphylococcus aureus (n=1), Neisseria meningitidis (n=2) e Salmonella tiphy (n=1). Houve ainda o isolamento de 3 Gram negativos não identificados. A hemocultura foi positiva em 19 de 32 colheitas (59,4%). Na ausência de terapêutica antibiótica, em 6 casos a cultura do líquor foi positiva e a hemocultura negativa e noutros 2 ambas as culturas foram negativas. Durante o internamento faleceram 9 recém-nascidos — mortalidade de 25% e em 11 foram detectadas sequelas. Conclusão — Houve um predomínio de casos de meningite tardia, em recém-nascidos de termo e do sexo masculino. Os agentes mais frequentemente encontrados foram a E. coli e a Streptococcus do grupo B

Repercussão das Colheitas de Sangue sobre os Valores de Hemoglobina em Recém-Nascidos de Muito Baixo Peso (RNMBP) Submetidos a Terapia Intensiva

A perda iatrogénica de sangue constitui um problema comum nas unidades de cuidados intensivos neonatais. O objectivo deste trabalho foi quantificaras espoliações de sangue para estudos analíticos em 22 RNMBP durante as primeiras três semanas de hospitalização. O número médio de colheitas por criança e por dia foi IA e o número médio de colheitas por criança no período estudado foi 29.7. O valor cumulativo médio de sangue espoliado pelo 21." dia foi 18,7 ml/kg. Os valores médios de hemoglobina nas primeiras 12 horas de tida e no 21." dia foram respectivamente 16.4 e 12.9 gr/d1. Verificou-se uma relação estreita entre o volume de sangue extraído e o volume de sangue transfundido. sugerindo este facto que. em geral. as transfusões são efectuadas por necessidade de compensar as perdas sanguíneas relacionadas com as colheitas de sangue. Conclui-se que as espoliações repetidas de sangue para análises laboratoriais se repercutem significativamente nos valores de hemoglobina dos recém-nascidos pretermo e de MBP sendo portanto desejável que tais espoliações sejam rigorosamente quantificadas e reduzidas ao mínimo tendo em conta os riscos das transfusões de sangue

Melhor Suporte Nutricional — «Melhor» Composição Corporal? Uma Análise em Recém-Nascidos de Baixo Peso

Objectivo: Avaliar o impacto de diferentes estratégias de suporte nutricional na composição corporal de recém-nascidos de baixo peso (RNBP), por intermédio não só do peso, mas também das áreas muscular braquial (AMB) e adiposa braquial (AAB). Indivíduos e métodos: Comparou-se a média do dia de recuperação do peso, da AMB e da AAB entre dois grupos de RNBP assistidos em períodos distintos, com suportes nutricionais diferentes — grupo I (n=10): 1991 versus grupo II (n=24): 1995/96. Os recém-nascidos foram incluidos de modo consecutivo e avaliados prospectivamente sob o ponto de vista antropométrico. Resultados: Não houve diferenças significativas da média das idades gestacionais e dos pesos de nascimento entre os dois grupos. Os recém-nascidos do grupo II, comparativamente com os do grupo I, receberam provisões mais precoces de energia, lípidos e proteínas através da alimentação parentérica. Não se observaram diferenças significativas no dia de recuperação do peso e da AMB entre os grupos. No entanto, os RN do grupo II recuperaram mais precocemente a AAB (dia 6,9 ± 2,5 vs dia 12,6 ± 5,1) (p<0,01), após um período inicial de declínio dos respectivos valores. Conclusões: O atraso na adequada provisão de energia e proteínas pode ter um impacto negativo na reserva lipídica, não detectada pela observação isolada da evolução ponderai. A medição das áreas braquiais representa um método simples e não invasivo de avaliação indirecta da composição corporal dos RNBP

Upper Arm Anthropometry Is Not a Valid Predictor of Regional Body Composition in Preterm Infants

Background: Upper arm anthropometry has been used in the nutritional assessment of small infants, but it has not yet been validated as a predictor of regional body composition in this population. Objective: Validation of measured and derived upper arm anthropometry as a predictor of arm fat and fat-free compartments in preterm infants. Methods: Upper arm anthropometry, including the upper arm cross-sectional areas, was compared individually or in combination with other anthropometric measurements, with the cross-sectional arm areas measured by magnetic resonance imaging, in a cohort of consecutive preterm appropriate-for-gestationalage neonates, just before discharge. Results: Thirty infants born with (mean 8 SD) a gestational age of 30.7 8 1.9 weeks and birth weight of 1,380 8 325 g, were assessed at 35.4 8 1.1 weeks of corrected gestational age, weighing 1,785 8 93 g. None of the anthropometric measurements are reliable predictors (r 2 ! 0.56) of the measurements obtained by magnetic resonance imaging, individually or in combination with other anthropometric measurements. Conclusion: Both measured anthropometry and derived upper arm anthropometry are inaccurate predictors of regional body composition in preterm appropriate-for-gestational-age infants

HIV-Associated Facial Lipodystrophy: Experience of a Tertiary Referral Center With Fat and Dermis-Fat Compound Graft Transfer

Objectives: HIV-associated lipodystrophy is a common comorbidity in HIV-infected patients, having a profound impact on every aspect of patients' lives, particularly when involving the face. Hence, it is of the utmost importance to evaluate the result of any potential therapies that may help solve HIV-associated facial lipodystrophy. The aim of this article was to evaluate the outcome of patients undergoing facial lipodystrophy correction surgery within our institution. Methods: A retrospective analysis of the clinical charts and iconographic information of patients regarding demographics, morphologic changes, surgical option, postoperative complications, results, and patient satisfaction assessed by a 1- to 10-point scale and by the Assessment of Body Change and Distress questionnaire. Results: Twenty-three patients were operated on from March 2011 to April 2015. Seventy-five percent of cases were treated with fat graft injection, whereas dermis-fat grafts were applied in 25% of patients. The former had their fat harvested more commonly from the abdomen, whereas in the latter case, the graft was harvested mostly from the inner aspect of arms. The mean volume of fat injected on each side of the face was 28.5 ± 22.7 mL. On a scale from 1 to 10, mean patient satisfaction was 7.7 ± 2.8. The Assessment of Body Change and Distress questionnaire revealed statistically significant improvements. Complications occurred in 25% of cases, the most frequent being significant reabsorption. No major complications occurred. Conclusions: Treatment of HIV-associated facial lipodystrophy with autologous fat or dermis-fat compound graft is a safe procedure with long-lasting results and unquestionable aesthetic and social benefits.info:eu-repo/semantics/publishedVersio

‘Sorry we do not deliver to your area’: geographical inequalities in online groceries provision

The British grocery retail sector is experiencing rapid growth in online ordering for home delivery, resulting in considerable supply side investment in delivery and fulfilment infrastructure. For retailers with a physical store network, investments typically utilise larger format stores as delivery and fulfilment hubs. Proximity to the store network and delivery infrastructure capacity thus drive the availability and choice of online groceries provider at the neighbourhood level. We aim to assess the geographical extent of online groceries coverage at a small-area level in Great Britain (GB). We carry out a nationwide assessment of the provision of online groceries, revealing generally excellent coverage within urban and suburban areas, including those neighbourhoods that may have once been considered urban food deserts. However, rural–urban inequalities are evident, with the most remote and rural catchments experiencing comparatively poor online groceries provision. We argue that these inequalities give rise to a new form of food desert: remote and rural neighbourhoods with the compounded effects of poor access to physical retail provision (akin to ‘traditional’ food deserts) and the additional disadvantage of poor coverage by online groceries providers. Many of these neighbourhoods are already the most remote from physical store provision and may also be faced with withdrawal of physical (retail) services. We make a number of recommendations that could support the provision of online groceries services in these areas and reflect on the tremendous potential for ongoing research into widening inequalities in access to grocery retailing driven by the geography of online groceries

Reducing Discomfort While Measuring Crown-Heel Length in Neonates

To assess the degree of discomfort caused by length measurement in neonates, performed with one or both lower limbs extended, on the first and second day after birth, with either one or both lower limbs extended. METHODS: Healthy full-term neonates were systematically sampled during the months of February and March 2004. Crown-heel length was measured, using a 1-mm precision neonatometer, at approximately 8 h and 32 h after birth, with one and both lower limbs extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analysed by parametric and non-parametric tests as appropriate. RESULTS: Whatever the measurement technique, discomfort scores are significantly higher during the length measurement than at baseline. Whenever length measurements are performed, discomfort scores are significantly higher when extending both lower limbs rather than one lower limb (p < 0.006). The measured length is greater with one lower limb extended; however, the difference decreases over time, being 0.19 cm (95% CI 0.1-0.3; p < 0.001) at approximately 32 h of age. No significant differences in length were found between measurements at approximately 8 or 32 h, regardless of the technique used. The best correlation between length measurements with one or both lower limbs extended was observed at approximately 32 h after birth (r = 0.98). CONCLUSION: Measuring crown-heel length is a distressful procedure for the neonate. Measurements with one lower limb extended result in less discomfort than when both lower limbs are extended, without decreasing the accuracy

Genetic diversity and plant growth promoting traits of diazotrophic bacteria isolated two Pennisetum purpureum Schum. Genotypes grown in the field.

Background and aims Some elephant grass (Pennisetum purpureum) genotypes are able to produce large amounts of biomass and accumulate N derived from BNF when growing in soil with low N levels. However, information about the diazotrophic bacteria colonizing this C4 plant is still very scarce. This study aimed to characterize the plant growth promoting traits of a fraction of culturable diazotrophs colonizing the genotypes CNPGL F06-3 and Cameroon. Methods A total of 204 isolates were obtained from surface sterilized leaves, stems and roots after culturing on five different N-free semisolid media. These were then analyzed by BOX-PCR, and the 16S rRNA and nifH sequences of representative isolates were obtained. The functional ability of the isolates to reduce acetylene, produce indole and to solubilize phosphate was also determined. Results The diazotrophic bacterial population varied from 102 up to 106 bacteria g?1 fresh tissues of both genotypes. The BOX-PCR analysis suggested a trend in the genetic diversity among the 204 diazotrophic strains colonizing the different genotypes and plant tissues. Sequencing of 16S rRNA fragments confirmed the presence of Azospirillum brasilense and Gluconacetobacter diazotrophicus and revealed for the first time the occurrence of G. liquefaciens, G. sacchari, Burkholderia silvatlantica, Klebsiella sp., Enterobacter cloacae and E. oryzae in elephant grass. Interestingly, several nifH sequences from isolates identified as G. liquefaciens and G. sacchari showed homologies with nifH sequences of Enterobacter species. The majority of the isolates (97%) produced indole compounds, 22% solubilized phosphate and 6.4% possessed both characteristics