Effects of Age, Period, and Cohort on the Incidence of Psoriasis in Spain: A 30-year Review (1990­2019).

AIM: This study aimed to investigate the effects of age, period, and cohort on the incidence of psoriasis in Spain from 1990 through 2019 using the Global Burden of Disease (GBD) database and age-period-cohort (A-P-C) analysis. METHODS: We conducted an ecological trend study to analyze the incidence rates of psoriasis in Spain from 1990 through 2019. Joinpoint software and National Cancer Institute A-P-C tools were used to identify trends and assess the effects of age, period, and cohort. RESULTS: From 1990 through 2019, an estimated 2.99 million cases of psoriasis were diagnosed in Spain, with a mean annual increase of 0.49%. Significant decreases in age-standardized incidence rates (ASIR) were reported for both sexes, with women consistently maintaining a slightly higher ASIR. Joinpoint analysis revealed multiple turning points in the downward trend, indicating periods of stabilization. A-P-C analysis demonstrated significant declines in both net (overall trend) and local drift (age-specific trends), indicating a broad decrease in the incidence of psoriasis across most age groups. While the risk of psoriasis increased with age, peaking in the 50-54 age group, it declined thereafter. Furthermore, the analysis revealed a continuous decline in risk from 1990 through 2019 for both sexes, with individuals born in the early 21st century exhibiting a significantly lower risk vs those born in the early 20th century. CONCLUSION: This study observed a slight decline in the reported psoriasis ASIR in Spain, potentially due to reduced exposure to risk factors. However, limitations in data and the complexity of factors influencing the incidence of psoriasis require further research.

Effects of Age, Period, and Cohort on the Incidence of Psoriasis in Spain: A 30-year Review (1990-2019).

AIM: This study aimed to investigate the effects of age, period, and cohort on the incidence of psoriasis in Spain from 1990 through 2019 using the Global Burden of Disease (GBD) database and age-period-cohort (A-P-C) analysis. METHODS: We conducted an ecological trend study to analyze the incidence rates of psoriasis in Spain from 1990 through 2019. Joinpoint Regression Program, Version 5.0.2 - May 2023; Surveillance Research Program, National Cancer Institute and National Cancer Institute A-P-C tools were used to identify trends and assess the effects of age, period, and cohort. RESULTS: From 1990 through 2019, an estimated 2.99 million cases of psoriasis were diagnosed in Spain, with a mean annual increase of 0.49%. Significant decreases in age-standardized incidence rates (ASIR) were reported for both sexes, with women consistently maintaining a slightly higher ASIR. Joinpoint analysis revealed multiple turning points in the downward trend, indicating periods of stabilization. A-P-C analysis demonstrated significant declines in both net (overall trend) and local drift (age-specific trends), indicating a broad decrease in the incidence of psoriasis across most age groups. While the risk of psoriasis increased with age, peaking in the 50-54 age group, it declined thereafter. Furthermore, the analysis revealed a continuous decline in risk from 1990 through 2019 for both sexes, with individuals born in the early 21st century exhibiting a significantly lower risk vs those born in the early 20th century. CONCLUSION: This study observed a slight decline in the reported psoriasis ASIR in Spain, potentially due to reduced exposure to risk factors. However, limitations in data and the complexity of factors influencing the incidence of psoriasis require further research.

Effect of Drug Compounding on Quality of Life in Patients With Genodermatoses: A Cross-Sectional Study. / Formulación magistral en pacientes con genodermatosis. Impacto en la calidad de vida: un estudio transversal.

BACKGROUND: Cutaneous manifestations are complicated to treat in rare diseases. The main aim of this study was to analyze the impact of compounded drugs prepared by hospital pharmacists on the quality of life of patients with genodermatoses. MATERIAL AND METHODS: We undertook a cross-sectional study of patients with genodermatoses treated with topical medications compounded and dispensed by the pharmacy at Complejo Hospitalario Universitario in Pontevedra, Spain. We collected demographic data and answers to questionnaires examining generic and disease-specific quality of life, treatment satisfaction, and treatment adherence. RESULTS: Nine patients were included. We observed a significant improvement in health-related quality of life following treatment with compounded drugs. Satisfaction with the topical medications was 2.8 on a scale of 0 (greatest satisfaction) to 25. Treatment adherence was 59%. CONCLUSIONS: Drug compounding facilitates access to orphan drugs that are not available for many rare diseases. Few studies, however, have analyzed impact on quality of life in this setting. In this series of patients with genodermatoses, topical medications compounded and dispensed by a hospital pharmacy improved health-related quality of life. This preliminary study has given rise to a multicenter study of compounding for ichthyosis. We expect that analysis of a larger sample will confirm our findings.

Impact of untreated dental caries and dental pain on sadness related to oral health of Brazilian children.

PURPOSE: Children should feel sad when they believe that a negative outcome is permanent. The sadness that an oral problem might bring tends to contribute to children's loneliness and increase the social stress levels. The aim of this study was to evaluate the impact of untreated dental caries, dental pain, malocclusion, and traumatic dental injury on prevalence of sadness related to oral health among Brazilian children. METHODS: This cross-sectional study was carried out with 397 children aged 8-10 years randomly selected from public and private schools in Diamantina, Brazil. The Brazilian version of the CPQ8-10 was applied. Sadness was collected through the question, "In the last month how often did you feel sad because of your teeth or mouth?" and dental pain through the question, "In the last month, how many times have you had pain in your teeth?" One calibrated examiner (Kappa value intra examiner: 0.77-0.91; Kappa value inter examiner: 0.80-1.00) performed the exam for dental caries (DMFT), malocclusion (DAI), and dental trauma (O'Brien). Parents answered questions addressing socioeconomic issues. Descriptive analyses, Chi-square test, and hierarchical Poisson regression models were performed (IC 95%; p < 0.05)." RESULTS: The prevalence of sadness related to oral health was 30.5% (n = 121). Sadness related to oral health was associated with untreated dental caries (PR: 1.46; 95% CI 1.32-2.46; p = 0.001 ) and dental pain (PR: 2.91; 95% CI 2.00-4.22; p < 0.001). Other clinical variables analyzed (traumatic dental injury and malocclusion) were not significantly associated with sadness related to oral health. CONCLUSIONS: Children with untreated dental caries and dental pain presented a higher report of sadness related to oral health.

Critically ill COVID-19 patients attended by anesthesiologists in northwestern Spain: a multicenter prospective observational study. / Pacientes críticos COVID-19 atendidos por anestesiólogos en el Noroeste de España: estudio multicéntrico, prospectivo, observacional.

BACKGROUND AND OBJECTIVES: There are limited information on outcome, complications and treatments of critically ill COVID-19 patients requiring admission to an intensive care unit (ICU). The aim of this study is to describe the clinical ICU course, treatments used, complications and outcomes, of critically ill COVID-19 patients admitted in seven ICU in Galicia region during the 2020 March-April pandemic peak. METHODS: Between March 21 and April 19, 2020, we evaluated critically ill COVID-19 patients admitted to the ICU of Anesthesia of seven hospitals in Galicia, northwestern Spain. Outcome, complications, and treatments were monitored until May 6, 2020, the final date of follow-up. RESULTS: A total of 97 critically ill COVID-19 patients were included. During ICU stay, mechanical ventilation became necessary in 80 (82.5%) patients, and tracheostomy in 22 (22.7%) patients. Prone position was used frequently in both intubated (67.5%) and awake (27.8%) patients. Medications consisted of antivirals agents (92.7%), corticosteroids (93.8%), tocilizumab (57.7%), and intermediate or high doses of anticoagulants (83.5%). The most frequent complications were ICU-acquired infection (52.6%), thrombosis events (16.5%), and reintubation (9.3%). After a median follow-up of 42 (34-45) days, 15 patients (15.5%) deceased, 73 patients (75.2%) had been discharged from ICU, and nine patients (9.3%) were still in the ICU. CONCLUSIONS: A high proportion of our critically ill COVID-19 patients required mechanical ventilation, prone positioning, antiviral medication, corticosteroids, and anticoagulants. ICU complications were frequent, mainly infections and thrombotic events. We had a relatively low mortality of 15,5%.

Secukinumab: Drug Survival in Clinical Practice Settings. / Secukinumab: supervivencia en práctica clínica real.

Secukinumab, an immunoglobulin G1/κ monoclonal antibody that selectively targets interleukin 17a, is used to treat moderate to severe plaque psoriasis in adults who are eligible for systemic treatment. Indirect comparisons of the efficacy of secukinumab, ustekinumab, and anti-tumor necrosis factor agents have found lower drug survival rates for patients on secukinumab, in spite of that biologic's rapid onset of action and efficacy as demonstrated by the large number of patients reaching a Psoriasis Area and Severity Index of 90 or 100. We present data from a retrospective study of 171 patients treated with doses of 300mg or 150mg of secukinumab every 4 weeks in 5 hospitals in the Spanish autonomous community of Andalusia. Eighty-seven percent continued on treatment at 132 weeks, contrasting with reports from previously published case series.

Nonlinear regression analysis of length growth in cultured rainbow trout / [Análise não linear do crescimento em comprimento de truta-arco-íris de aquicultura ]

Length growth as a function of time has a non-linear relationship, so nonlinear equations are recommended to represent this kind of curve. We used six nonlinear models to calculate the length gain of rainbow trout (Oncorhynchus mykiss) during the final grow-out phase of 98 days under three different feed types in triplicate groups. We fitted the von Bertalanffy, Gompertz, Logistic, Brody, Power Function, and Exponential equations to individual length-at-age data of 900 fish. Equations were fitted to the data based on the least square method using the Marquardt iterative algorithm. Accuracy of the fitted models was evaluated using a model performance metrics combining mean squared residuals (MSR), mean absolute error (MAE) and Akaike's Information Criterion corrected for small sample sizes (AICc). All models converged in all cases tested. Evaluation criteria for the Logistic model indicated the best overall fit (0.67 of combined metric MSR, MAE and AICc) under all different feeding types, followed by the Exponential model (0.185), and the von Bertalanffy and Brody model (0.074, respectively). Additionally, ∆AICc results identify the Logistic and Gompertz models as being substantially supported by the data in 100% of cases. The logistic model can be suggested for length growth prediction in aquaculture of rainbow trout.(AU)

O crescimento em comprimento em função do tempo tem uma relação não linear; por isso, funções não lineares são recomendáveis para descrever essa relação. Seis modelos não lineares foram usados para calcular o ganho em comprimento de truta-arco-íris (Oncorhynchus mykiss) durante 98 dias, na fase final da engorda, submetidas a três dietas diferentes em grupos triplicados. Foram ajustadas as equações de von Bertalanffy, Gompertz, logístico, Brody, função potencial e exponencial a dados individuais de comprimento-idade de 900 peixes. O ajuste foi feito pelo método dos mínimos quadrados, usando-se o algoritmo iterativo de Marquardt. A precisão do ajuste foi avaliada pelo uso de critérios combinados de ajuste: quadrado médio do resíduo (QMR), erro médio absoluto (EMA) e o critério de informação de Akaike corrigido para tamanhos amostrais pequenos (AICc). Todos os modelos atingiram a convergência para cada caso avaliado. Os critérios de avaliação do modelo logístico indicaram o melhor ajuste geral (0,67 vez dos critérios combinados MSR, MAE e AICc) para cada grupo de peixe avaliado, seguido pelo modelo exponencial (0,185) e os modelos von Bertalanffy e Brody, com 0,074, respectivamente. Similarmente, os resultados de ΔAICc identificaram-se ao modelo logístico e ao de Gompertz, com grande suporte das informações em 100% dos casos. Por fim, o modelo logístico pode ser sugerido na predição do crescimento em comprimento de truta-arco-íris cultivada.(AU)

Micro-computed tomographic evaluation of the shaping ability of four instrumentation systems in curved root canals.

AIM: To compare the shaping ability of four instrumentation systems in curved molar root canals, using computerized microtomography (micro-CT). METHODOLOGY: Forty mesial roots of mandibular molars were submitted first to radiographic examination to determine their curvature and then to a micro-CT scan to analyse other initial morphological characteristics. The specimens were distributed into four experimental groups, according to the endodontic instrumentation system used (n = 10): Group R, Reciproc; Group PTN, ProTaper Next; Group WOG, WaveOne Gold; Group PDL, ProDesign Logic. After root canal instrumentation, the specimens were submitted to a second micro-CT scan, and the pre- and postoperative data were examined to evaluate the following parameters: volume of dentine removed (DR), increase in root canal volume (VI), untouched root canal surface area (UA), volume of accumulated hard tissue debris (AD) and structure model index (SMI). The data observed for these parameters after instrumentation were analysed using generalized linear models. R software was used for the analyses, and the level of significance adopted was 5%. RESULTS: There were no significant differences among the instrumentation systems regarding the DR, VI, UA and AD parameters (P > 0.05). PTN and WOG systems were associated with greater increases in SMI than the PDL system (P < 0.05). CONCLUSIONS: The four systems evaluated were similar regarding the parameters analysed, with the exception of the SMI, with the rate of variation of this parameter being greater after using the PTN and WOG systems than after using the PDL system. These results indicate that the four systems perform similarly in terms of their shaping ability, but that the PTN and WOG systems produced more rounded preparations than the PDL system.

Counterclockwise or clockwise reciprocating motion for oval root canal preparation: a micro-CT analysis.

AIM: To evaluate oval root canal preparation using one or two instruments in counterclockwise or clockwise reciprocating motion. METHODOLOGY: The radiographic diameter of mandibular human incisors was evaluated, and oval canals were selected (2 ≤ Diameter Ratio ≤ 4). Fifty-seven teeth were assigned to root canal preparation (n = 19): Reciproc 40 (R40) in a counterclockwise reciprocating motion; Mtwo size 40, .06 taper (M 40.06) in a clockwise reciprocating motion or Mtwo size 20, .06 taper and size 40, .06 taper (M 20/40.06) in a clockwise reciprocating motion. Mtwo instruments were coupled to an ENDO DUAL motor, turning 150° clockwise and 30° counterclockwise. Scanning was performed before and after root canal preparation using a SkyScan 1176 micro-computed tomography. Volume, percentage of debris and percentage of uninstrumented surface were analysed in the entire root canal and in each third of the canal. Data were compared using anova and Tukey's tests or Kruskal-Wallis and Dunn tests. RESULTS: The Reciproc and Mtwo systems using different kinematics were associated with a similar increase in root canal volume. Additionally, both system had similar percentage of uninstrumented surface (P > 0.05). Mtwo size 20, .06 taper and size 40, .06 taper was associated with significantly lower debris (P < 0.05) in the middle third (0.56%) when compared to R40 (1.31%) and M size 40, .06 taper (1.54%). CONCLUSIONS: The conventional reciprocation motion for R40 and the clockwise reciprocation motion for Mtwo resulted in similar root canal preparations. Less remaining debris was present in the middle third when two instruments with different diameters were used.

Effect of finishing instrumentation using NiTi hand files on volume, surface area and uninstrumented surfaces in C-shaped root canal systems.

AIM: To assess the effect of 90°-oscillatory instrumentation with hand files on several morphological parameters (volume, surface area and uninstrumented surface) in C-shaped root canals after instrumentation using a single-file reciprocation system (Reciproc; VDW, Munich, Germany) and a Self-Adjusting File System (SAF; ReDent Nova, Ra'anana, Israel). METHODOLOGY: Twenty mandibular second molars with C-shaped canals and C1 canal configurations were divided into two groups (n = 10) and instrumented with Reciproc and SAF instruments. A size 30 NiTi hand K-file attached to a 90°-oscillatory motion handpiece was used as final instrumentation in both groups. The specimens were scanned using micro-computed tomography after all procedures. Volume, surface area increase and uninstrumented root canal surface were analysed using CTAn software (Bruker-microCT, Kontich, Belgium). Also, the uninstrumented root canal surface was calculated for each canal third. All values were compared between groups using the Mann-Whitney test and within groups using the Wilcoxon's signed-rank test. RESULTS: Instrumentation with Reciproc significantly increased canal volume compared with instrumentation with SAF. Additionally, the canal volumes were significantly increased after 90°-oscillatory instrumentation (between and within group comparison; (P < 0.05)). Regarding the increase in surface area after all instrumentation protocols, statistical analysis only revealed significant differences in the within groups comparison (P < 0.05). Reciproc and SAF instrumentation yielded an uninstrumented root canal surface of 28% and 34%, respectively, which was not significantly different (P > 0.05). Final oscillatory instrumentation significantly reduced the uninstrumented root canal surface from 28% to 9% (Reciproc) and from 34% to 15% (SAF; P < 0.05). The apical and middle thirds exhibited larger uninstrumented root canal surfaces after the first instrumentation that was significantly reduced after oscillatory instrumentation (P < 0.05). CONCLUSIONS: The Reciproc and SAF system were associated with similar morphological parameters after instrumentation of mandibular second molars with C-shaped canals except for a higher canal volume increase in the Reciproc group compared to the SAF. Furthermore, the final use of 90°-oscillatory instrumentation using NiTi hand files significantly decreased the uninstrumented canal walls that remained after Reciproc and SAF instrumentation.

A micro-computed tomography evaluation of long-oval canal preparation using reciprocating or rotary systems.

AIM: To evaluate, using micro-computed tomography, the preparation of long-oval root canals using a single reciprocating system versus a multiple-file rotary system. METHODOLOGY: Distal canals of thirty mandibular molars were selected and randomly assigned to one of two instrument groups (n = 15): Reciproc 40 (VDW, Munich, Germany) or BioRaCe system (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The teeth were scanned before and after preparation of the canal by a SkyScan 1172 micro-computed tomography scanner at 11-µm resolution. Morphometric variations were measured by volume increases and by the remaining untreated canal surface area in the entire canal and as well as in each third of the canal. Data were compared using the Mann-Whitney test. RESULTS: The Reciproc system left significantly more areas untouched (P < 0.001) in the cervical and middle thirds (18.14% and 21.82%) as compared to BioRaCe (8.14% and 11.35%). The Reciproc system had the greatest increase in volume of both the entire canal and the apical third (P < 0.5). CONCLUSIONS: Neither technique was able to completely prepare the outline of long-oval canals. The Reciproc system removed more tooth structure. The BioRaCe left fewer untouched dentine walls in the more coronal thirds of the canal, whilst Reciproc left fewer in the apical third.

The oral administration of trans-caryophyllene attenuates acute and chronic pain in mice.

Trans-caryophyllene is a sesquiterpene present in many medicinal plants' essential oils, such as Ocimum gratissimum and Cannabis sativa. In this study, we evaluated the antinociceptive activity of trans-caryophyllene in murine models of acute and chronic pain and the involvement of trans-caryophyllene in the opioid and endocannabinoid systems. Acute pain was determined using the hot plate test (thermal nociception) and the formalin test (inflammatory pain). The chronic constriction injury (CCI) of the sciatic nerve induced hypernociception was measured by the hot plate and von Frey tests. To elucidate the mechanism of action, mice were pre-treated with naloxone or AM630 30 min before the trans-caryophyllene treatment. Afterwards, thermal nociception was evaluated. The levels of IL-1ß were measured in CCI-mice by ELISA. Trans-caryophyllene administration significantly minimized the pain in both the acute and chronic pain models. The antinociceptive effect observed during the hot plate test was reversed by naloxone and AM630, indicating the participation of both the opioid and endocannabinoid system. Trans-caryophyllene treatment also decreased the IL-1ß levels. These results demonstrate that trans-caryophyllene reduced both acute and chronic pain in mice, which may be mediated through the opioid and endocannabinoid systems.

Evaluation of the antinociceptive activity of Ocimum gratissimum L. (Lamiaceae) essential oil and its isolated active principles in mice.

Ocimum gratissimum is used in popular medicine to treat painful diseases. The antinociceptive properties of O. gratissimum essential oil (OgEO) and two of its active principles (eugenol and myrcene) were tested in classic models of pain (hot plate test and formalin test). Adult male C57BL/6 J mice acutely received corn oil (control group, p.o.), morphine (positive control group, 5 mg/kg, i.p.), OgEO (10, 20, or 40 mg/kg, p.o.), eugenol or myrcene (both at 1, 5, or 10 mg/kg, p.o.). The highest doses of all tested drugs significantly increased the latency to lick the paw(s) in the hot plate test compared with the control group. OgEO at a dose of 40 mg/kg and eugenol and myrcene at a dose of 10 mg/kg were effective in minimizing animal pain in the first and second phases of the formalin test. The antinociceptive effect shown by all drugs tested in hot plate test was reverted by naloxone administration (1 mg/kg), indicating opiod system participation. These results demonstrate the beneficial effects of OgEO and its active principles against neurogenic and inflammatory pain. Our findings demonstrate that OgEO and its isolated active principles exhibited antinociceptive activity in murine pain models.

Pelvic differences between brachycephalic and mesaticephalic cats and indirect pelvimetry assessment.

Pelvic measurements were carried out in cats with various cranial conformations to (1) determine pelvic morphometry, (2) compare any pelvic differences with cranial conformation and gender and (3) determine whether body biometrics can be used to predict pelvic measurements. Thirteen brachycephalic and 14 mesaticephalic female cats and 17 brachycephalic and nine mesaticephalic male cats were used. Body and external pelvic measurements, as well as pelvic radiographs, were performed. Brachycephalic females all had external pelvic and radiographic measurements that were significantly smaller than those of the mesaticephalic females, including smaller pelvic inlet and outlet areas and a smaller pelvic canal shape. Brachycephalic females had wider and flatter heads than do mesaticephalic females. Similarly, brachycephalic males all have radiographic pelvic measurements that are smaller than those of mesaticephalic males. Males had larger pelvis measurements than did their female counterparts for both cranial types, and indirect pelvimetry did not demonstrate good predictive value in determining the internal pelvic measurements. Thus, we conclude that pelvic differences exist between genders and between brachycephalic and mesaticephalic cats. Furthermore, body biometric measurements do not have good predictive value for determining internal pelvic measurements.

Triplex Doppler evaluation of uterine arteries in cyclic and pregnant domestic cats.

The aims were to determine resistance index (RI) and pulsatility index (PI) in the uterine arteries of cyclic and pregnant domestic cats comparing the left and right uterine horns, as well as the majority or minority uterine horns, based on fetus number per horn; to determine the presence or absence of an early diastolic notch (EDN) in the uterine artery of pregnant queens. Ten domestic cats were followed during one cycle and one pregnancy until 63rd days after mating. The estrous cycle length was 16 ± 9.57 days. The uterine horn with the highest number of fetuses (majority uterine horn - MUH) presented 2.0 ± 1.0 fetus and the lower (minority uterine horn - miUH) presentes 0.78 ± 0.67 fetus. There were no differences in indexes between uterine arteries during the cycles and pregnancies. The RI and PI of MUH were lower than miUH (P<0.05). Uterine artery of the MUH presented lower indexes than miUH during the acceptance period (P<0.05). On D14 of pregnancy, uterine artery presented reductions in both indexes for the miUH. On D56, the PI was reduced in the miUH. The indexes depended on the week of pregnancy. EDN was present on the uterine arteries of all cats until D35, but disappeared by D49. The blood flow varied according to the category of horn.

Avaliação da promoção do aleitamento materno em Hospitais Amigos da Criança / Evaluation of breastfeeding promotion in Baby-Friendly Hospitals

OBJETIVO:Avaliar o cumprimento dos Passos 4 a 10 dentre os Dez Passos para o Sucesso do Aleitamento Materno, preconizados pela Iniciativa Hospital Amigo da Criança (IHAC), criada pela Organização Mundial da Saúde (OMS). MÉTODOS: Estudo descritivo de corte transversal. Foram realizadas entrevistas com 100 puérperas nos dois hospitais credenciados pela IHAC em Salvador. Não foram incluídas mães ou recém-nascidos que não poderiam oferecer ou receber aleitamento materno exclusivo, respectivamente.Questionou-se sobre história obstétrica, aleitamento materno anterior, atendimento pré-natal e aspectos relacionados aos Passos Para o Sucesso do Aleitamento Materno. As questões foram elaboradas de acordo com os Critérios Globais para a IHAC. No mínimo 80 por cento das mães deveriam responder de forma satisfatória às perguntas correspondentes a cada passo para que ele fosse considerado como cumprido. Foi feita descrição de frequências para avaliar as respostas. RESULTADOS: O cumprimento foi insatisfatório para o Passo 4 (suporte ao aleitamento materno após o parto - 58 por cento), Passo 5 (aleitamento exclusivo durante a internação - 77 por cento) e Passo 10 (encaminhamento para grupo de suporte ao aleitamento materno - 5 por cento). Outros passos demonstraram bons resultados: Passo 6 (oferta de substitutos do leite materno - 19 por cento), Passo 7 (prática do alojamento conjunto - 91 por cento) e Passo 9 (não uso de chupetas e mamadeiras - 100 por cento). CONCLUSÕES: Houve boa aderência a alguns aspectos dos Critérios Globais da IHAC. Evidencia-se, no entanto, a necessidade de se ampliarem as discussões sobre os critérios para manter o título de "Hospital Amigo da Criança", uma vez que os resultados foram insatisfatórios em relação aos Passos 4, 5 e 10.

OBJECTIVE:To evaluate the compliance to steps 4 to 10 of the Ten Steps Program to Successful Breastfeeding recommended by the Baby-Friendly Hospital Initiative (BFHI), created by World Health Organization (WHO). METHODS: Cross-sectional descriptive study of 100 mothers in the immediate post-partum period admitted to both BFHI accredited hospitals in Salvador (Northeast Brazil). Newborns that could not be exclusively breastfed were not included. The mothers were questioned about obstetric history, previous breastfeeding, prenatal care, and aspects related to The Ten Steps to Successful Breastfeeding. Interviewers used a questionnaire based on the BFHI Global Criteria. At least 80 percent of the mothers had to satisfactorily answer the questions related to each step in order to consider them complied. Descriptive statistics was used to evaluate the answers. RESULTS: The compliance was unsatisfactory for Step 4 (support to breastfeeding initiation immediately after birth - 58 percent), Step 5 (exclusive breastfeeding during hospitalization - 77 percent), and Step 10 (referral of mothers to a breastfeeding support group following discharge from hospital - 5 percent). Other steps showed a satisfactory result: Step 6 (offer of formula - 19 percent), Step 7 (practice of rooming-in - 91 percent) and Step 9 (no pacifiers and bottles use - 100 percent). CONCLUSIONS: A satisfactory compliance with some aspects of the BFHI Global Criteria was noted, but more discussions about strategies to keep the title of "Baby Friendly Hospital" are needed, since the compliance was poor regarding Steps 4, 5 and 10.

Migraine and hypercoagulable states in ischemic stroke.

BACKGROUND: Whether migraine is associated with a higher prevalence of hypercoagulable states (HS) in ischemic stroke patients is unknown. METHODS: This was a prospective study of patients under 55 years of age with brain ischemia. A systematic questionnaire addressed the antecedent of migraine with aura (MA) or without aura (MO). We investigated the presence of HS by an extensive battery of haematological tests. The presence of patent foramen ovale (PFO) was assessed by trans-oesophageal echocardiography. RESULTS: A total of 154 patients (95 men; mean ± SD age, 44.12 ± 8.4 years) were included; 44 had migraine, 15 had MA. HS were more frequent in the migraine than non-migraine group (38.6% vs. 16.4%, p < 0.01). The multivariate analysis showed that MO was associated with a 2.88-fold (95% CI, 1.14 to 7.28) increased risk of HS diagnosis. However, in the group of patients with brain infarction under 50 years old, MA, but not MO, was independently associated with HS (OR 6.81; 95% CI, 1.01 to 45.79). CONCLUSION: In young patients with ischemic stroke, migraine may be associated with a higher frequency of HS.