Attainment of LDL-Cholesterol Goals in Patients with Previous Myocardial Infarction: A Real-World Cross-Sectional Analysis. / Atingimento das Metas de Colesterol LDL em Pacientes com Histórico de Infarto Agudo do Miocárdio: Estudo Transversal do Mundo Real.

BACKGROUND: The European Society of Cardiology guidelines recommend an LDL-cholesterol (LDL-C) < 55 mg/dL for patients with established cardiovascular disease. While the Friedewald equation to estimate LDL-C is still widely used, the newer Martin-Hopkins equation has shown greater accuracy. OBJECTIVES: We aimed to assess: A) the proportion of patients reaching LDL-C goal and the therapies used in a tertiary center; B) the impact of using the Martin-Hopkins method instead of Friedewald's on the proportion of controlled patients. METHODS: A single-center cross-sectional study including consecutive post-myocardial infarction patients followed by 20 cardiologists in a tertiary hospital. Data was collected retrospectively from clinical appointments that took place after April 2022. For each patient, the LDL-C levels and attainment of goals were estimated from an ambulatory lipid profile using both Friedewald and Martin-Hopkins equations. A two-tailed p-value of < 0.05 was considered statistically significant for all tests. RESULTS: Overall, 400 patients were included (aged 67 ± 13 years, 77% male). Using Friedewald's equation, the median LDL-C under therapy was 64 (50-81) mg/dL, and 31% had LDL-C within goals. High-intensity statins were used in 64% of patients, 37% were on ezetimibe, and 0.5% were under PCSK9 inhibitors. Combination therapy of high-intensity statin + ezetimibe was used in 102 patients (26%). Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8%). Among those deemed controlled by Friedewald's equation, 27 (21.6%) would have a Martin-Hopkins' LDL-C above goals. CONCLUSIONS: Less than one-third of post-myocardial infarction patients had LDL-C within the goal. Applying the Martin-Hopkins equation would reclassify one-fifth of presumably controlled patients into the non-controlled group.

FUNDAMENTO: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. OBJETIVOS: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. MÉTODOS: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. RESULTADOS: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. CONCLUSÕES: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados.

Use of combination therapy is associated with improved LDL-cholesterol management: 1-year follow-up results from the European observational SANTORINI study.

AIM: To assess whether implementation of the 2019 ESC/EAS dyslipidaemia guidelines observed between 2020-2021 improved between 2021-2022 in the SANTORINI study. METHODS: High- or very-high cardiovascular (CV) risk patients were recruited across 14 European countries from March 2020-February 2021, with 1-year prospective follow-up until May 2022. Lipid-lowering therapy (LLT) and 2019 ESC/EAS risk-based low-density lipoprotein cholesterol (LDL-C) goal attainment (defined as <1.4 mmol/L for patients at very high CV risk and <1.8 mmol/L for patients at high CV risk) at 1-year follow-up were compared with baseline. . RESULTS: Of 9559 patients enrolled, 9136 (2626 high risk, 6504 very high risk) had any follow-up data, and 7210 (2033 high risk, 5173 very high risk) had baseline and follow-up LDL-C data. LLT was escalated in one-third of patients and unchanged in two-thirds. Monotherapy and combination therapy usage rose from 53.6% and 25.6% to 57.1% and 37.9%, respectively. Mean LDL-C levels decreased from 2.4 mmol/L to 2.0 mmol/L. Goal attainment improved from 21.2% to 30.9%, largely driven by LLT use among those not on LLT at baseline. Goal attainment was greater with combination therapy compared with monotherapy at follow-up (39.4 vs 25.5%). CONCLUSIONS: LLT use and achievement of risk-based lipid goals increased over 1-year follow-up particularly when combination LLT was used. Nonetheless, most patients remained above goal, hence strategies are needed to improve implementation of combination LLT.

Cardiovascular diseases, a group of disorders of the heart and blood vessels, are the most common cause of death worldwide. Lowering low-density lipoprotein (LDL) cholesterol in the bloodstream reduces the risk of developing cardiovascular diseases, such as heart attacks and strokes. Guidelines recommend that those at highest risk of cardiovascular disease should achieve the lowest levels of LDL cholesterol. Several medications are available that help lower LDL cholesterol levels and prevent cardiovascular events, however, recent studies have shown that the majority of patients continue to have LDL cholesterol levels above optimal value in part due to suboptimal use of these medications. Here we report the results after 1 year of follow-up of the SANTORINI study (started in 2020) which aimed to document the management of LDL cholesterol in clinical practice across 14 countries in Europe. We found that better control of LDL cholesterol occurred when more than one drug was used (combination therapy). Use of combination therapy was low at the start of the study 25.6% but increased over 1 year to 37.9%, resulting in better control of LDL cholesterol at 1 year than observed at the start of the study. Nonetheless, only 31% of patients achieved their LDL cholesterol target levels based on the European guidelines. Greater use of combination therapies is needed in order to improve the overall population level control of LDL cholesterol.

Inventory of tiger- and ground-beetles (Coleoptera, Caraboidea, Cicindelidae and Carabidae) in two sampling seasons of the Gorongosa National Park, Mozambique.

Background: The Gorongosa National Park (Mozambique) is one of the most emblematic protected areas in Africa, well known for its vertebrate biodiversity and restoration ecology efforts following the Mozambican civil war in 1992. The invertebrate biodiversity of Gorongosa National Park is still poorly studied, although the scarce information available indicates the existence of a rich number of species, namely in the case of tiger- and ground-beetles (Coleoptera, Caraboidea). Moreover, the study of arthropod assemblages is key for designing conservation practices since they are potentially accurate biodiversity and ecological indicators. Hence, the diversity assessment of Caraboidea beetles using standardised methodologies is likely to provide a new insight for future conservation planning and help to quantify the effects of climate change in areas identified as vulnerable to anthropogenic pressures, such as the Gorongosa National Park. New information: We report the occurrence of five tiger beetles (Cicindelidae) and 93 ground-beetles (Carabidae) species/morphospecies in Gorongosa National Park from a field survey funded by the ECOASSESS project. Sampling was performed in the four main habitat types present in the Park (miombo tropical forest, mixed dry forest, transitional forest and grasslands) between 25 October and 25 November 2019. In this sampling window, the turnover of Caraboidea species from the dry season to the wet season was recorded for the first time. Twenty-eight species of ground-beetles are new records to Mozambique, including three new subgenera and three new genera. Additional information on species phenology and habitat preferences is also provided.

Atingimento das Metas de Colesterol LDL em Pacientes com Histórico de Infarto Agudo do Miocárdio: Estudo Transversal do Mundo Real / Attainment of LDL-Cholesterol Goals in Patients with Previous Myocardial Infarction: A Real-World Cross-Sectional Analysis

Resumo Fundamento: As diretrizes da Sociedade Europeia de Cardiologia recomendam um nível de colesterol LDL (LDL-C) < 55 mg/dL para pacientes com doença cardiovascular estabelecida. Embora a fórmula de Friedewald ainda seja amplamente utilizada para estimar o LDL-C, a fórmula mais recente de Martin-Hopkins mostrou maior precisão. Objetivos: Nosso objetivo foi avaliar: A) a proporção de pacientes que atingiram a meta de LDL-C e as terapias utilizadas em um centro terciário; B) o impacto da utilização do método de Martin-Hopkins em vez do método de Friedewald na proporção de pacientes controlados. Métodos: Estudo transversal monocêntrico, incluindo pacientes consecutivos pós-infarto do miocárdio, acompanhados por 20 cardiologistas, em um hospital terciário. Os dados foram coletados retrospectivamente de consultas clínicas realizadas após abril de 2022. Para cada paciente, os níveis de LDL-C e o atingimento das metas foram estimados a partir de um perfil lipídico ambulatorial, utilizando as fórmulas de Friedewald e Martin-Hopkins. Um valor-p bicaudal < 0,05 foi considerado estatisticamente significativo para todos os testes. Resultados: Foram incluídos 400 pacientes (com 67 ± 13 anos, 77% do sexo masculino). Utilizando a fórmula de Friedewald, a mediana de LDL-C sob terapia foi de 64 (50-81) mg/dL, e 31% tinham LDL-C dentro da meta. Estatinas de alta intensidade foram usadas em 64% dos pacientes, 37% estavam em uso de ezetimiba e 0,5% estavam em uso de inibidores de PCSK9. A terapia combinada de estatina de alta intensidade + ezetimiba foi utilizada em 102 pacientes (26%). A aplicação do método de Martin-Hopkins reclassificaria um total de 31 pacientes (7,8%). Entre aqueles considerados controlados pela fórmula de Friedewald, 27 (21,6%) teriam LDL-C estimado por Martin-Hopkins acima da meta. Conclusões: Menos de um terço dos pacientes pós-infarto do miocárdio apresentaram LDL-C dentro da meta. A aplicação da fórmula de Martin-Hopkins reclassificaria um quinto dos pacientes presumivelmente controlados no grupo de pacientes não controlados.

Abstract Background: The European Society of Cardiology guidelines recommend an LDL-cholesterol (LDL-C) < 55 mg/dL for patients with established cardiovascular disease. While the Friedewald equation to estimate LDL-C is still widely used, the newer Martin-Hopkins equation has shown greater accuracy. Objectives: We aimed to assess: A) the proportion of patients reaching LDL-C goal and the therapies used in a tertiary center; B) the impact of using the Martin-Hopkins method instead of Friedewald's on the proportion of controlled patients. Methods: A single-center cross-sectional study including consecutive post-myocardial infarction patients followed by 20 cardiologists in a tertiary hospital. Data was collected retrospectively from clinical appointments that took place after April 2022. For each patient, the LDL-C levels and attainment of goals were estimated from an ambulatory lipid profile using both Friedewald and Martin-Hopkins equations. A two-tailed p-value of < 0.05 was considered statistically significant for all tests. Results: Overall, 400 patients were included (aged 67 ± 13 years, 77% male). Using Friedewald's equation, the median LDL-C under therapy was 64 (50-81) mg/dL, and 31% had LDL-C within goals. High-intensity statins were used in 64% of patients, 37% were on ezetimibe, and 0.5% were under PCSK9 inhibitors. Combination therapy of high-intensity statin + ezetimibe was used in 102 patients (26%). Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8%). Among those deemed controlled by Friedewald's equation, 27 (21.6%) would have a Martin-Hopkins' LDL-C above goals. Conclusions: Less than one-third of post-myocardial infarction patients had LDL-C within the goal. Applying the Martin-Hopkins equation would reclassify one-fifth of presumably controlled patients into the non-controlled group.

Características clínicas y laboratoriales de la infección por el virus Chikungunya en pacientes en edad pediátrica del Instituto de Medicina Tropical

Introducción: La fiebre chikungunya (FCHIK) es una enfermedad febril transmitida por mosquitos, que en el niño tiene manifestaciones clínicas diferentes, dependiendo del grupo de edad. Objetivo: el presente trabajo tiene el propósito de identificar las características clínicas y evolutivas de la FCHIK en pacientes ≤15 años, que acudieron al Instituto de Medicina Tropical (IMT). Materiales y método: estudio observacional, descriptivo retrospectivo, basado en revisión de historias clínicas de pacientes de 0 y 15 años, que consultaron al IMT, entre noviembre/2022 y marzo/ 2023, con diagnóstico de FCHIK. Resultados: de 2050 pacientes febriles que consultaron al IMT entre noviembre/2022 y marzo/2023, 301 fueron casos de FCHIK, 10,6% (32/301) requirió hospitalización, de estos el 62,5% (20/32) era ≤1 año. La presencia de vómitos (p<0.0001.OR= 5,5 IC95% 2.2-13.2), dolor abdominal (p<0.0001.OR=40.5,5 IC95% 4.5-364.3); erupción maculo-papular-ampollar p<0.008. OR=3.5, IC95% 1.3 - 9.1), fue significativamente más frecuente en los hospitalizados. El 37.5% (12/32) fue hospitalizado en UCI y 15,6% (5/32) requirió ARM, 18.7%(6/32) presentó miocarditis; 15.6%(5/32) encefalitis, y 3.1%(1/32) encefalitis y miocarditis. No se registraron óbitos. Conclusiones: La décima parte de los pacientes con FCHIK requirieron hospitalización, de estos más de la mitad fueron <1 año. Las manifestaciones clínicas más frecuentes fueron fiebre, exantema, vómitos, irritabilidad, artralgias, lesiones ampollares. La leucopenia fue significativamente más frecuente en ≤1 año. La edad <3 meses, así como vómitos, exantema vesículo-ampollar, presencia de choque, irritabilidad, convulsiones, dolor abdominal y dificultad respiratoria se asociaron significativamente al requerimiento de hospitalización. Las complicaciones más frecuentes fueron el choque, la miocarditis y la encefalitis.

Introduction: Chikungunya fever (CHKF) is a febrile disease transmitted by mosquitoes, which presentes different clinical manifestations in children, depending on their age group. Objective: to describe the clinical and outcome characteristics of CHKF in patients ≤15 years old, who presented to the Institute of Tropical Medicine (ITM). Materials and methods: this was a retrospective, descriptive and observational study, based on the review of medical records of patients between 0 and 15 years of age, who were evaluated at the ITM, between November/2022 and March/2023, who were diagnosed with CHKF. Results: of 2050 febrile patients who consulted at the ITM between November/2022 and March/2023, 301 were cases of CHKF, 10.6% (32/301) required hospitalization, of which 62.5% (20/32) were ≤ 1 year of age. The presence of vomiting (p<0.0001, OR= 5.5, 95% CI 2.2-13.2), abdominal pain (p<0.0001, OR=40.5.5, 95% CI 4.5-364.3); maculo-papular-bullous rash (p<0.008, OR=3.5, 95% CI 1.3 - 9.1), was significantly more frequent in hospitalized patients. 37.5% (12/32) were hospitalized in the ICU and 15.6% (5/32) required ARM, 18.7% (6/32) presented myocarditis; 15.6%(5/32) encephalitis, and 3.1%(1/32) had both encephalitis and myocarditis. No deaths were registered. Conclusions: One tenth of the patients with CHKF required hospitalization, of which more than half were <1 year of age. The most frequent clinical manifestations were fever, rash, vomiting, irritability, arthralgia, and bullous lesions. Leukopenia was significantly more frequent in those ≤1 year of age. Age <3 months, as well as vomiting, vesicular-bullous rash, shock, irritability, seizures, abdominal pain, and respiratory distress were significantly associated with the need for hospitalization. The most frequent complications were shock, myocarditis and encephalitis.

Pre- and postoperative comparative analysis of the spinopelvic and global sagittal parameters of patients with adolescent idiopathic scoliosis / Análise comparativa pré e pós-operatória dos parâmetros espino-pélvicos e sagital global dos pacientes com escoliose idiopática do adolescente / Análisis comparativo pre y postoperatorio de los parámetros espino-pélvicos y sagital global en pacientes con escoliosis idiopática del adolescente

ABSTRACT Objective: To analyze the pre- and postoperative spinopelvic parameters and global sagittal balance of patients with adolescent idiopathic scoliosis (AIS) divided into 3 groups (Group 1 - thoracic arthrodesis, Group 2 - thoracolumbar arthrodesis, and Group 3 - lumbar arthrodesis), observing differences in these two moments and whether the parameter values are maintained or not over a period of up to 2 years following surgery. Methods: We analyzed the radiographs from a single-center database of 99 patients who underwent arthrodesis with posterior instrumentation. Pelvic incidence, pelvic version, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis values were measured in the pre- and postoperative radiographies of each patient. Results: The parameters of pelvic incidence, pelvic version, sacral slope, and sagittal vertical axis did not show statistically significant differences among the 3 groups. There was a difference in preoperative lumbar lordosis between the 3 groups (p = 0.049). Thoracic kyphosis showed differences both in the pre- (p = 0.015) and postoperative (p = 0.042) values, in addition to demonstrating a relationship of dependence between the pre- and postoperative values in the final statistical analysis. Conclusion: The evaluation of the parameters analyzed shows that the study groups have similar values of individual balance, with the exception of thoracic kyphosis and lumbar lordosis, which are measurements that depend on the surgical technique and compensatory mechanisms, but remained within normal ranges. These factors allow the surgeon to be attentive to both the coronal and sagittal planes when planning the correction in order to achieve the equilibrium of the trunk in addition to correction of the deformity. Level of Evidence IIIA: Comparative retrospective study.

RESUMO Objetivo: Analisar parâmetros espino-pélvicos e equilíbrio sagital de pacientes com escoliose idiopática do adolescente (EIA) no pré e pós-operatório em três grupos (grupo 1 - artrodese torácica, grupo 2 toracolombar e grupo 3 - artrodese lombar), observando diferenças nesses dois momentos e se os parâmetros são mantidos ou não por um período de até dois anos de pós-operatório. Métodos: Foram avaliadas radiografias de 99 pacientes de um banco de dados de um único centro, que foram submetidos a artrodese por via posterior. Foram aferidos valores da incidência pélvica, versão pélvica, inclinação sacral, lordose lombar, cifose torácica e eixo vertical sagital nas radiografias pré e pós-operatória. Resultados: Os parâmetros de incidência pélvica, versão pélvica, inclinação sacral e do eixo vertical sagital não apresentaram diferenças estatisticamente significantes nos três grupos. A lordose lombar apresentou diferença entre os três grupos no pré-operatório (p = 0,049). A cifose torácica apresentou diferenças tanto no pré (p = 0,015) quanto no pós-operatório (p = 0,042), além de demonstrar relação de dependência nos valores do pré e pós na análise estatística final. Conclusões: A avaliação dos parâmetros analisados mostra que os grupos estudados apresentam valores semelhantes de equilíbrio do indivíduo, com exceção da cifose torácica e lordose lombar que são medidas dependendo da técnica cirúrgica e dos mecanismos compensatórios, porém mantendo-se dentro da faixa normal. Esses fatores permitem ao cirurgião ficar atento no planejamento da correção tanto no plano coronal quanto no plano sagital para conseguir, além da correção da deformidade, o equilíbrio do tronco. Nível de Evidência IIIA; Estudo retrospectivo comparativo.

RESUMEN Objetivo: Analizar los parámetros espino-pélvicos y el equilibrio sagital de pacientes con escoliosis idiopática del adolescente (EIA) en el pre y postoperatorio divididos en 3 grupos (grupo 1 - artrodesis torácica, grupo 2 - toracolumbar y grupo 3 - artrodesis lumbar), observando las diferencias en estos dos momentos y si los parámetros se mantienen o no durante un periodo de hasta 2 años en el postoperatorio. Métodos: Se evaluaron las radiografías de 99 pacientes de una base de datos de un solo centro, a quienes se les realizó artrodesis por vía posterior. Se midieron los valores de incidencia pélvica, versión pélvica, inclinación sacra, lordosis lumbar, cifosis torácica y eje vertical sagital en las radiografías pre y postoperatorias de cada paciente. Resultados: Los parámetros de incidencia pélvica, versión pélvica, inclinación sacra y eje vertical sagital no presentaron diferencias estadísticamente significativas en los 3 grupos. La lordosis lumbar presentó una diferencia entre los 3 grupos en el preoperatorio (p = 0,049). La cifosis torácica presentó diferencias tanto en el pre (p = 0,015) como en el postoperatorio (p = 0,042), además de presentar una relación de dependencia entre los valores del pre y postoperatorios en el análisis estadístico final. Conclusiones: La evaluación de los parámetros analizados muestra que los grupos estudiados presentan valores de equilibrio individual similares, con excepción de la cifosis torácica y la lordosis lumbar, que se miden en función de la técnica quirúrgica y de los mecanismos compensatorios, pero manteniéndose dentro del rango normal. Estos factores permiten al cirujano estar atento a la hora de planificar la corrección tanto en el plano coronal como en el sagital, para lograr, además de corregir la deformidad, el equilibrio del tronco. Nivel de evidencia IIIA; Estudio retrospectivo comparativo.

Complicaciones asociadas a trombocitopenia severa en pacientes con dengue

Resumen Introducción. La plaquetopenia severa representa un reconocido signo de alarma del dengue. Objetivo. Determinar la relación entre el recuento de plaquetas y severidad del dengue en niños. Metodología. Niños menores de 15 años hospitalizados con el diagnóstico de dengue entre los años 2007-2018 fueron evaluados en el recuento de plaquetas y severidad de la enfermedad. Los pacientes fueron divididos en 2 grupos, según que el recuento de plaquetas fuera mayor o menor de 100.000/mm3. Resultados. Ochocientos ochenta y dos pacientes hospitalizados con dengue fueron incluidos en el estudio, con una edad media 9,7 ± 4,6 años, e igual distribución de sexo: 437 (49,5%) del sexo femenino y 445 (50,5%) del sexo masculino. El 62,4% (550 pts) presentaron plaquetas ≤100.000/mm3. No hubo diferencias en la frecuencia de fiebre (99% vs 98%), cefalea (54% vs 62%), exantema (38% vs 34%) y mialgias (42% vs 47%) entre aquellos pacientes con plaquetas 100.000/mm3. Sin embargo, la frecuencia de sangrados (28% vs 26%, p3 veces lo normal) (10% vs 2%; p<0,0001; OR=7,41; 95% IC 2,93-18,70), la presencia de extravasación (49% vs 4%; p<0,0001; OR 27,7; 95% IC 14,86-51,57), e ingreso a UTI (11% vs 0,4%, p<0,0001; OR 41,29; 95% IC 5,69-299,33) fue mayor en los pacientes con plaquetas <100.000/mm3. Conclusiones. El presente estudio muestra que la severidad del dengue es mayor en pacientes con dengue con plaquetas <100.000/mm3 y que las complicaciones están influenciadas por la misma.

Abstract Introduction. Severe platelet disease is a recognized warning sign of dengue. Objective. To determine the relationship between platelet count and dengue severity in children. Methodology. Children younger than 15 years hospitalized with the diagnosis of dengue between 2007-2018 were evaluated for the platelet`s count and severity of the disease. The patients were divided into 2 groups, according to whether the count o platelets was greater or less than 100,000 / mm3. Results. Eight hundred eighty two hospitalized patients with dengue were included in the study, with a mean age of 9.7 ± 4.6 years, and the same sex distribution: (437 (49.5%) female and 445 (50.5%) male. Sixty-two % (550 pts) presented platelets ≤100,000 / mm3. There were no differences in the frequency of fever (99% vs. 98%), headache (54% vs. 62%), rash (38% vs. 34%) and myalgia (42% vs. 47%) among those patients with platelets 100,000 / mm3. However, the frequency of bleeding (28% vs 26%, p 3 times normal) (10% vs 2%; p <0.0001; OR = 7.41, 95% CI 2.93-18.70), the presence of extravasations (49% vs. 4%; p <0.0001; OR 27.7, 95% CI 14.86-51.57), and admission to ICU (11% vs. 0.4%, p <0.0001; OR 41.29, 95 % CI 5.69-299.33) it was higher in patients with platelets <100,000 / mm3. Conclusions. The present study shows that dengue severity is higher in dengue patients with platelets <100,000 / mm3 and those complications are influenced by it.

Use of alar-iliac s2 screw technique in scoliosis secondary to myelomeningocele / Utilização da técnica de parafuso s2 alar-ilíaco na escoliose secundária à mielomeningocele / Utilización de la técnica de tornillo s2 alar-iliaco en la escoliosis secundaria a mielomeningocele

ABSTRACT Objective: To evaluate retrospectively the results related to the use of pelvic fixation with alar-iliac S2 screw in individuals with myelomeningocele. Methods: Retrospective study of cases surgically treated with this technique, between January 2015 and March 2018 at the Pequeno Principe Children's Hospital. Radiographic images and clinical records were analyzed in search of complications. Results: Twelve patients with mean age of 13.3 years were treated at the time of surgery. The mean follow-up was 11.5 months. The mean of the highest magnitude curve measured by the Cobb angle in the preoperative period was 83.8°; while in the last postoperative follow-up was 29.5° (correction of 65%). The mean pelvic obliquity was 23.1° in the preoperative period and in the postoperative was 7.1° (correction of 69%). Only 2 cases (17%) with complications associated with material failure at the level of sacroiliac fixation, due to the unilateral release of the head of the polyaxial S2 iliac screw. Conclusions: The technique of pelvic fixation in the scoliosis secondary to myelomeningocele with the use of S2 alar-iliac screws has shown satisfactory results, with only two complications (17%) directly related to pelvic fixation in the operated cases. Level of Evidence IV; Series of Cases.

RESUMO Objetivo: Avaliar retrospectivamente os resultados do uso da fixação pélvica com o parafuso S2 alar-ilíaco em indivíduos portadores de mielomeningocele. Métodos: Estudo retrospectivo dos casos tratados cirurgicamente através desta técnica entre janeiro de 2015 e março de 2018 no Hospital Infantil Pequeno Príncipe. Foram analisados as imagens radiográficas e registro clínico no prontuário à procura de complicações. Resultados: Foram tratados 12 pacientes com média de idade de 13,3 anos no momento da cirurgia. A média de seguimento foi de 11,5 meses. A média da curva de maior magnitude medida pelo ângulo de Cobb no pré-operatório foi de 83,8°; enquanto que no último seguimento pós-operatório foi de 29,5° (correção de 65%). A média da obliquidade pélvica foi de 23,1° no pré-operatório e no pós-operatório de 7,1° (correção de 69%). Foram observados apenas dois casos (17%) com complicações associadas à falha do material ao nível da fixação sacroilíaca, devido soltura unilateral da cabeça do parafuso poliaxial de S2 alar-ilíaco. Conclusão: A técnica de fixação pélvica na escoliose secundária à mielomeningocele com uso de parafusos em S2 alar-ilíacos tem demonstrado resultados satisfatórios, havendo apenas duas complicações (17%) diretamente relacionada à fixação pélvica nos casos operados. Nível de Evidência IV; Série de Casos.

RESUMEN Objetivo: Evaluar retrospectivamente los resultados del uso de la fijación pélvica con el tornillo S2 alar-ilíaco en individuos con mielomeningocele. Métodos: Estudio retrospectivo de los casos tratados quirúrgicamente a través de esta técnica entre enero de 2015 y marzo de 2018 en el Hospital Infantil Pequeno Príncipe. Fueron analizadas las imágenes radiográficas y los prontuarios en busca de complicaciones. Resultados: Se trataron quirúrgicamente a 12 pacientes con promedio de edad de 13,3 años. El promedio de seguimiento fue de 11,5 meses. El promedio de la curva de mayor magnitud medida por el ángulo de Cobb en el preoperatorio fue de 83,8°, mientras que en el último seguimiento postoperatorio fue de 29,5° (corrección del 65%). El promedio de la oblicuidad pélvica fue de 23,1° en el preoperatorio y en el postoperatorio de 7,1° (corrección del 69%). Se observaron sólo 2 casos (17%) con complicaciones asociadas a la falla del material al nivel de la fijación sacroilíaca, debido a la soltura unilateral de la cabeza del tornillo poliaxial S2 alar-ilíaco. Conclusiones: La técnica de fijación pélvica en la escoliosis secundaria a la mielomeningocele con uso de tornillos en S2 alar-ilíacos ha demostrado resultados satisfactorios, habiendo apenas dos complicaciones (17%) directamente relacionada a la fijación pélvica en los casos operados. Conclusiones (17%) directamente relacionadas a la fijación pélvica en los casos operados. Nivel de Evidencia IV; Serie de Casos.

Alternative to the inverted "y" incision in scoliosis secondary to myelomeningocele / Alternativa à incisão em "y" invertido para escoliose secundária para mielomeningocele / Alternativa a la incisión en "y" invertido en escoliosis secundaria a mielomeningocele

ABSTRACT Objective: To evaluate the healing of the modified inverted "Y" incision in patients with scoliosis due to myelomeningocele. Methods: Retrospective study through medical records review of patients with myelomeningocele surgically treated with a modified inverted "Y" approach between January 2013 and December 2015. Results: We analyzed the medical records of six patients. Two patients progressed with skin complications in the immediate postoperative period and only one of them required surgical intervention for debridement and suturing. In another patient, it was necessary to perform two surgical reviews due to material failure without skin complications in these interventions. Conclusions: The modified inverted "Y" technique is a great alternative to traditional incision and inverted "Y" because it has good results in patients with spina bifida associated with poor skin conditions treated surgically for correction of spinal deformities. Level of Evidence IV; Case series.

RESUMO Objetivo: Avaliar a cicatrização da modificação da incisão em "Y" invertido em pacientes com escoliose decorrente de mielomeningocele. Métodos: Estudo retrospectivo, mediante revisão de prontuários dos pacientes portadores de mielomeningocele, tratados cirurgicamente por um acesso cirúrgico modificado do "Y" invertido, entre janeiro de 2013 e dezembro de 2015. Resultados: Foram analisados os prontuários de seis pacientes. Dois pacientes evoluíram com complicações de pele no pós-operatório imediato, apenas em um deles foi necessária intervenção cirúrgica para debridamento e sutura. Em outro paciente foi necessário realizar duas revisões cirúrgicas, devido a quebra do material, sem ocorrer complicações de pele em todas as abordagens. Conclusão: A variação da técnica em "Y" invertido é uma ótima alternativa à incisão tradicional e ao "Y" invertido, por apresentar bons resultados em pacientes com espinha bífida associada às condições de pele ruins, tratados cirurgicamente para correção de deformidades da coluna vertebral. Nível de evidência IV; Série de casos.

RESUMEN Objetivo: Evaluar la cicatrización de la incisión en "Y" invertida modificada en pacientes con escoliosis derivada de mielomeningocele. Métodos: Estudio retrospectivo mediante revisión de registros médicos de pacientes con mielomeningocele tratados quirúrgicamente por acceso quirúrgico en "Y" invertida modificada entre enero de 2013 y diciembre de 2015. Resultados: Se analizaron los registros médicos de seis pacientes. Dos pacientes desarrollaron complicaciones de piel en el postoperatorio inmediato y sólo en uno de ellos fue necesaria intervención quirúrgica para desbridamiento y sutura. En otro paciente fue necesario realizar dos revisiones quirúrgicas debido al quiebre del material, sin que ocurrieran complicaciones cutáneas en esas intervenciones. Conclusiones: La técnica en "Y" invertida modificada es una excelente alternativa a la incisión tradicional y la "Y" invertida por demostrar buenos resultados en pacientes con espina bífida asociada a malas condiciones cutáneas tratados quirúrgicamente para corrección de deformidades de la columna vertebral. Nivel de evidencia IV; Serie de casos.

Trastornos de la conducta alimentaria en adolescentes: una patología en auge?

Introducción: Los trastornos de la conducta alimentaria (TCA) son trastornos de salud mental caracterizados por un comportamiento patológico frente a la ingesta alimentaria y una obsesión por el control de peso, acompañado de distorsión de la percepción de la imagen corporal. Es de origen multifactorial, incluyendo causas de origen biológico, psicológico, familiar y sociocultural. Los TCA más conocidos son la anorexia nerviosa y la bulimia nerviosa, pero también existen otros, como el trastorno por atracón, la ortorexia (la obsesión por la comida sana) y la vigorexia (la obsesión por el ejercicio físico). Pueden ocasionar importante morbimortalidad. Se puede presentar en adolescentes. Objetivo: Analizar las prevalencias de los trastornos de la conducta alimentaria en adolescentes escolarizados en dos periodos de tiempo (2008 y 2012). Materiales y Métodos: Estudio observacional, descriptivo, retrospectivo de prevalencias, en adolescentes escolarizados en dos colegios de área urbana y tres de área rural, en los años 2008 y 2012 mediante encuesta estructurada de aplicación rápida para tamizaje de padecer riesgo de trastorno de conducta alimentaria de Unikel -Santorini. Resultados: Fueron incluidos 469 estudiantes en los dos años. En el año 2008, la prevalencia fue de 6%, en el 2012 fue de 9,5%. La prevalencia se mantuvo estable (p< 0,05), sin embargo se observó ruralización del trastorno (p< 0,05), y fue más frecuente en el sexo femenino en el año 2008 (p< 0,05). Conclusiones: La prevalencia de los TCA en la población fue de 6 y 9%, manteniendo una tendencia estable, con una llamativa ruralización del trastorno.

Introduction: Eating disorders (ED) are a group of mental health disorders characterized by a pathological behavior towards food intake and an obsession with weight control, accompanied by a distortion in the perception of body image. Its origin is multifactorial, and includes biological, psychological, family and sociocultural causes. The most well-known EDs are anorexia nervosa and bulimia nervosa, but there are also others, such as binge eating disorder, orthorexia (obsession with healthy food) and vigorexia (obsession with exercise). These disorders can cause significant morbidity and mortality. They occur commonly in adolescents. Objective: To analyze the prevalence of eating disorders in adolescents enrolled in school during two time periods (2008 and 2012). Materials and Methods: This was an observational, descriptive, and retrospective prevalence study in adolescents enrolled in two schools in two urban and three rural areas, in 2008 and 2012, using a rapid-application screening tool to evaluate the risk of eating disorders by Unikel -Santorini. Results: 469 students were included in the two time periods. In 2008, the prevalence was 6%, in 2012 it was 9.5%. The prevalence remained stable (p <0.05), but ruralization of the disorder was observed (p <0.05), and was more frequent in females in 2008 (p <0.05). Conclusions: The prevalence of ED in the population was 6 and 9%, respectively, maintaining a stable trend, with a striking ruralization of the disorder.

Effect of Reciprocating Systems and Working Lengths on Apical Microcrack Development: a micro-CT Study

Abstract The objective of this study was to evaluate the effect of root canal preparation with single-file reciprocating systems at different working lengths on the development of apical microcracks using micro-computed tomographic (micro-CT) imaging. Forty extracted human mandibular incisors were randomly assigned to 4 groups (n=10) according to the systems and working length used to prepare the root canals: Group A - WaveOne Gold at apical foramen (AF), Group B - WaveOne Gold 1 mm short of the AF (AF-1 mm), Group C - Unicone (AF) and Group D - Unicone (AF-1 mm). Micro-CT scanning was performed before and after root canal preparation at an isotropic resolution of 14 µm. Then, three examiners assessed the cross-sectional images generated to detect microcracks in the apical portion of the roots. Apical microcracks were visualized in 3, 1, 1, and 3 specimens in groups A, B, C, and D, respectively. All these microcracks observed after root canal preparation already existed prior to instrumentation, and no new apical microcrack was detected. For all groups, the number of slices presenting microcracks after root canal preparation was the same as before canal preparation. Root canal preparation with WaveOne Gold and Unicone, regardless of the working length, was not associated with apical microcrack formation.

Resumo O objetivo deste estudo foi avaliar o efeito da instrumentação de canais radiculares utilizando sistemas reciprocantes de lima única em diferentes comprimentos de trabalho sobre o desenvolvimento de microfissuras apicais utilizando imagens de microtomografia computadorizada (micro-CT). Quarenta incisivos inferiores humanos extraídos foram distribuídos aleatoriamente em 4 grupos (n=10) de acordo com os sistemas e comprimentos de trabalho utilizados para preparar os canais radiculares: Grupo A - WaveOne Gold no forame apical (FA), Grupo B - WaveOne Gold 1 mm aquém do FA (FA-1 mm), Grupo C - Unicone (FA) e grupo D - Unicone (FA-1 mm). Escaneamentos de micro-CT foram realizados antes e após o preparo dos canais a uma resolução isotrópica de 14 μm. Em seguida, três examinadores avaliaram as imagens de secção transversal geradas para detectar microfissuras na porção apical das raízes. Microfissuras apicais foram visualizadas em 3, 1, 1 e 3 espécimes nos grupos A, B, C e D, respectivamente. Todas essas microfissuras observadas após o preparo dos canais radiculares já existiam antes da instrumentação e não foi detectada nenhuma nova microfissura apical. Para todos os grupos, o número de cortes apresentando microfissuras após o preparo dos canais radiculares foi o mesmo verificado antes do preparo dos canais. A instrumentação de canais radiculares utilizando WaveOne Gold e Unicone, independentemente do comprimento de trabalho, não foi associada à formação de microfissuras apicais.

Prevalence of endodontic diseases: an epidemiological evaluation in a Brazilian subpopulation

Aim: To determine the prevalence of pulp and periradicular diseases in a Brazilian subpopulation, correlating the prevalence with sex, age and most affected teeth. Methods: Data collected from medical records of patients treated at the Clinic of Specialization in Endodontics of the Federal University of Pernambuco between 2003 and 2010. The following variables were recorded for each patient: sex, age, affected teeth and diagnosed endodontic disease. Using Pearson's chi-square and Fisher's exact tests, the collected data analysis was set at a 5% significance level. Results: From all the treated teeth, 57% were diagnosed with pulp diseases, with the symptomatic irreversible pulpitis being the most prevalent (46.3%), while among the diagnosed periradicular diseases (43%), chronic apical periodontitis was the most prevalent (81%). Pulp diseases were detected in men and women in an unequal mode (p=0.008). Subjects under 40 years old had higher prevalence of pulp disease (p=0.286), and patients over 50 years were most affected by periradicular diseases (p=0.439). Maxillary incisors and mandibular first molars were the most affected teeth by endodontic diseases. Conclusions: In the evaluated subpopulation, the endodontic diseases were more prevalente in the maxillary incisive, affected indiscriminately individuals of different age groups and chronic apical periodontitis was the most prevalent diagnosed disease (Au)

Síndrome neurológico asociado a Zika de adquisición post natal. A propósito del primer caso en Paraguay

RESUMEN: Aunque en el hospedero inmunocompetente el Zika es habitualmente una enfermedad leve y autolimitada, un incremento de casos de síndromes neurológicos, sobre todo Sindrome de Guillain-Barré, fue observado durante la epidemia de Zika en la Polinesia Francesa en el 2013 y posteriormente en diferentes países como Brasil, y Colombia. Presentamos el primer caso de sindrome neurológico asociado a Zika de adquisión post natal en el Paraguay. Se trata de una lactante menor de sexo femenino, de 9 meses de edad procedente de la ciudad de Coronel Oviedo, Paraguay, que, tras cuadro febril de 6 días de evolución, manifiesta sintomatología compatible con encefalitis, con alteración progresiva del sensorio que amerita ingreso a asistencia respiratoria mecánica, un LCR sin pleocitosis y sindrome convulsivo respaldado por electroencefalograma. El cuadro posteriormente tomó característica de polirradiculoneuropatía tipo Guillain Barré, con debilidad de miembros inferiores, arreflexia y LCR con disociación albúmino citológica. La electromiografía fue compatible con variante axonal de Guillain Barré. La resonancia magnética nuclear resultó normal. La paciente recibió inmunoglobulina a 2gr/kp, con mejoría progresiva completa de la motilidad y fuerza de miembros inferiores, así como de los reflejos osteotendinosos. Dada la progresión y distribución del virus Zika, sobre todo actualmente en las Américas, y su carácter explosivo en cuanto a la tasa de ataque, es de considerar la posibilidad de su presencia como noxa en manifestaciones neurológicas atípicas en pacientes de distintas edades

ABSTRACT: Although in the immunocompetent host Zika virus infection is usually a mild and self-limiting disease, an increase in cases of neurological syndromes, notably Guillain-Barré syndrome, was observed during the Zika epidemic in French Polynesia in 2013 and later in different countries Such as Brazil and Colombia. We present the first case of neurological syndrome associated with Zika of postnatal acquisition in Paraguay. It is an infant female, 9 months old, from the city of Coronel Oviedo, Paraguay, who, after a fever of 6 days of evolution, manifests symptomatology compatible with encephalitis, with progressive alteration of the sensorium that merits admission to mechanical ventilation, with non-pleocytosis CSF, and an electroencephalogram - supported convulsive syndrome. The following clinic was characterized by Guillain Barré type polyradiculoneuropathy, with weak limbs, arreflexia and CSF with cytological albumin dissociation. The electromyography was compatible with the axonal variant of Guillain Barré syndrome. Nuclear magnetic resonance was normal. The patient received immunoglobulin at 2gr/kp, with complete progressive improvement of the motility and strength of lower limbs, as well as the osteotendinous reflexes. Given the progression and distribution of the Zika virus, especially now in the Americas, and its explosive nature in relation to the attack rate, it is possible to consider its presence as noxa in atypical neurological manifestations in patients of different ages

Evaluation of idiopathic scoliosis by anterior and posterior arthrodesis / Avaliação do tratamento da escoliose idiopática por artrodese por via anterior e posterior / Evaluación del tratamiento de la escoliosis idiopática por artrodesis anterior y posterior

To evaluate comparatively surgical treatment of adolescent idiopathic scoliosis type 5CN by anterior and posterior approach.

Avaliar comparativamente o tratamento cirúrgico da escoliose idiopática do adolescente tipo 5CN por abordagem anterior e posterior.

Evaluar comparativamente el tratamiento quirúrgico de la escoliosis idiopática del adolescente del tipo 5CN por abordaje anterior y posterior.

SEGUNDOS MOLARES DECÍDUOS: REABSORÇÃO FISIOLÓGICA E PATOLÓGICA / Second deciduous molars: physiological and pathological resorption

Objetivo: Este estudo retrospectivo avaliou a perda dos segundos molares decíduos, por rizólise fisiológica ou patológica, em pacientes atendidos nas Clínicas de Odontopediatria I e II da Universidade Federal de Pernambuco. Foram examinados 112 prontuários, sendo os dados registrados em fichas individuais. Método: Foram analisadas as seguintes variáveis: gênero, faixa etária, tipo de tratamento (invasivo ou não invasivo), tipo de reabsorção dentária (patológica ou fisiológica) e arco dentário. Resultados: A reabsorção fisiológica foi mais frequente que a reabsorção patológica em ambos os arcos. Foi observado que existe associação estatisticamente significante entre a faixa etária de 2 a 4 anos e a reabsorção dentária (p<0,001). A média de idade dos pacientes para reabsorção fisiológica foi de 6,65 e 4,49 anos para a reabsorção patológica dos segundos molares decíduos. Conclusão: Houve perda precoce de segundos molares decíduos. Há grandes possibilidades de comprometimento da oclusão funcional do indivíduo.

Aim: This retrospective study evaluated the loss of the second deciduous molars either by physiological or pathological root resorption in patients enrolled at the Pediatric Dentistry Clinic I and II at the Federal University of Pernambuco. Methods: A review of 112 patient records were assessed and registered in a form. The following variables were analyzed: gender, age, type of treatment (invasive or no invasive), type of resorption (physiological or pathological) and region (maxillary or mandibular). Results: The physiological resorption was more observed than the pathological resorption in both arches. It was noted that there was a statistically significant association between the age group of 2-4 years old and the resorption (p<0.001). The mean age of patients for physiological resorption was 6.65 and 4.49 years old for pathological resorption of the second deciduous molars. Conclusion: It can be concluded that there was an early deciduous second molars loss. There are great possibilities of impaired functional occlusion of the individual.

Changes in root canal anatomy using three nickel-titanium rotary system: a cone beam computed tomography analysis

AIM: Cone beam computed tomography (CBCT) was used to evaluate the ability of three NiTi rotary systems to maintain the original root canal anatomy. METHODS: Sixty mesiobuccal canals of human mandibular first molars were divided into three groups with 20 root canals each. All teeth were scanned by CBCT before instrumentation. The images were captured digitally for further analysis using the Image Tools Software. The images were sectioned in three points, located at 9 mm, 6 mm and 3mm from the apex. In Group 1, the root canals were instrumented with ProTaper UniversalTM rotary system; in Group 2, with Twisted FileTM rotary system; and in Group 3, with MtwoTM rotary system. Instrumented teeth were scanned again using CBCT and the images of the uninstrumented canals were compared with images of the instrumented canals. The results were statistically analyzed using the one-way ANOVA test. A level of significance of 0.05 was adopted. RESULTS: The means of D1 at distances of 9 mm, 6 mm, and 3 mm from the apex were, respectively: Group 1: 0.88±0.257, 1.00±0.000, and 1.00±0.000; Group 2: 0.79±0.745, 0.65±0.669, and 0.25±0; Group 3: 0.50±0.745, 0.33±0.472, and 0.03±0.104. The means of D2 at distances of 9 mm, 6mm, and 3mm from the apex were respectively: Group 1: 1.00±0.00, 1.00±0.00, and 1.00±0.00; Group 2: 0.41±0.299, 0.30±0.428, and 0.50±0.707; Group 3: 0.58±0.910, 0.85±1.857, and 0.31±0.643. CONCLUSIONS: The CBCT analysis revealed that the ProTaper UniversalTM produced centered preparations and while the Twisted FileTM and MtwoTM rotary systems produced canal deviation.

Enuresis de causa no orgánica en edades pediátricas / Non-organic enuresis in pediatric ages

Introducción: la enuresis se define como la emisión involuntaria de orina que ocurre generalmente en el niño mientras duerme en la noche, aunque también puede ocurrir durante el sueño diurno. Se considera patológico por encima de los 5 años de edad. Objetivo: describir aspectos clínicos epidemiológicos de la enuresis de causa no orgánica en la población infanto juvenil del Equipo Básico de Salud 15 del Policlínico Docente Marta Martínez Figuera. Métodos: investigación descriptiva, de corte transversal realizada durante el periodo de tiempo comprendido entre enero de 2010 hasta enero 2011, en el municipio de Güines, provincia Mayabeque. La muestra estuvo constituida por 38 niños y adolescentes que cumplieron con criterios de inclusión previamente establecidos. Resultados: predominó en este estudio la enuresis infantil de tipo primario, entre los 5-8 años de edad y con un tiempo de evolución del síntoma entre 1-4 años. No se encontró diferencias estadísticamente significativas con relación al sexo, así como se demostró pobre asociación entre el síntoma enurético y la presencia de enfermedades comórbidas. La gran mayoría de los niños estudiados habían recibido tratamiento para su control en el momento del estudio; así como se demostró una evolución no adecuada del síntoma enurético a pesar del tratamiento utilizado. Conclusiones: se demostró la presencia de enuresis de causa no orgánica en los niños estudiados. Se considero conveniente diseñar estudios de intervención dirigidos a reducir las afectaciones para la salud en niños con esta patología

Introduction: enuresis is defined as the involuntary release of urine that usually occurs in children while sleeping at night, but it can also occur during daytime sleep. It is considered pathological over 5 years of age.Objective: to describe the clinical and epidemiological aspects of non-organic enuresis in the child and adolescent population of the 15th Basic Health Team of Marta Martinez Figuera Teaching Polyclinic.Methods: a descriptive, transversal research conducted during the time period from January 2010 to January 2011, in Güines municipality, Mayabeque province. The sample consisted of 38 children and adolescents who met inclusion criteria previously established.Results: in this study predominated the infantile enuresis of the primary type, between 5-8 years of age and with an evolution of symptoms within 1-4 years. No statistically significant differences were found with regard to sex and it was shown poor association between the enuretic symptom and the presence of comorbid diseases. The vast majority of the children studied had received treatment for their control at the time of the study, and it was demonstrated an inadequate evolution of the enuretic symptom despite treatment used.Conclusions: it was demonstrated the presence of non-organic enuresis in the children studied. It was considered convenient to design intervention studies aimed at reducing the affectations to health in children with this pathology

Eficacia da limpeza ou desinfecao do meato urinario antes da cateterizacao urinaria: revisao sistematica / Eficacia de la limpieza o desinfeccion del meato urinario antes del cateterismo urinario: revision sistematica / Effectiveness of cleaning or disinfecting the urinary meatus before urinary catheterization: a systematic review

As infeções do trato urinário associadas à cateterização são muito frequentes no contexto comunitário e hospitalar. Existem atualmente várias recomendações para sua prevenção, contudo, quando abordado o soluto a utilizar no meato urinário previamente à algaliação continuam a persistir dúvidas. Assim, este estudo procurou determinar a eficácia da limpeza do meato urinário com água ou soro fisiológico comparativamente à sua assepsia por meio de uma revisão sistemática com metanálise. Para isso foram seguidos os princípios propostos pelo Cochrane Handbook , a análise crítica realizada por dois investigadores e a análise estatística com recurso ao programa STATA 11.1. Podemos concluir que a limpeza ou desinfeção do meato urinário previamente à cateterização vesical não é estatisticamente significativa (OR=1,07, IC 95%=0,68-1,68, p=0,779), existindo alguma evidência de que a utilização de água/soro fisiológico reduz as taxas de ITU.

Las infecciones del tracto urinario asociadas con cateterismo son muy comunes en el contexto comunitario y hospitalario. Actualmente existen varias recomendaciones para su prevención. Sin embargo, las dudas persisten en la elección del soluto utilizado en el meato urinario antes del cateterismo. Por lo tanto, este estudio trata de determinar la eficacia de la limpieza del meato urinario con agua/solución salina comparativamente con su asepsia, mediante la realización de una revisión sistemática con meta-análisis. Para lo cual, se siguieron los principios propuestos por el Manual Cochrane, el análisis crítico realizado por dos investigadores y el análisis estadístico utilizando el programa STATA 11.1. Podemos concluir que la limpieza o desinfección del meato urinario antes del cateterismo no es estadísticamente significativo (OR=1,07, 95%CI=0,68-1,68, p=0,779) existiendo algunas evidencias de que el uso de agua/solución salina reduce las tasas de ITU.

The urinary tract infections associated with catheterization are very common in hospital and home care contexts. Currently there are several recommendations for its prevention, however, when approaching the kind of solute used in the urinary meatus prior to catheterization doubts continue to persist. Thus this study aimed at determining the effectiveness of cleaning the urinary meatus with water or saline comparing to its sterilization through a systematic review and meta-analysis. In order to do so, the principles proposed by the Cochrane Handbook were followed, a critical analysis was conducted by two researchers and the statistical analysis was performed with the use of STATA 11.1. We concluded that the cleaning or disinfection of the urinary canal prior to bladder catheterization is not statistically significant (OR=1.07, CI 95%=0.68-1.68, p=0.779) and that there is some evidence that the use of water/saline reduces rates of UTI (urinary tract infection).