Association between preterm infant body composition in the first 3 months of life and preschool age: a cohort study.

Compared with full-term infants, preterm infants have fat-free mass deficit in the first months of life, which increases the risk of metabolic diseases in the future. In this cohort of children born under 32-week gestational age or less than 1500 g, we aimed to evaluate the associations of body composition at term equivalent age and in the first 3 months of life with fat-free mass and fat mass percentage at 4 to 7 years of life. Body composition assessments by air displacement plethysmography and anthropometry were performed at term, at 3 months of corrected age, and at 4 to 7 years of age. Multiple linear regression analysis was used to observe the associations between body composition at these ages. At term, fat mass percentage showed a negative association and fat-free mass a positive association with fat-free mass at 4 to 7 years. The fat-free mass at 3 months and the gain in fat-free mass between term and 3 months showed positive associations with fat-free mass at 4 to 7 years.   Conclusion: Body composition at preschool age is associated with fat-free mass in the first 3 months of life, a sensitive period for the risk of metabolic diseases. What is Known: • Preterm infants have a deficit in fat-free mass and high adiposity at term equivalent age compared to full-term infants. • Fat-free mass reflects metabolic capacity throughout life and therefore is considered a protective factor against the risk of metabolic syndrome. What is New: •Fat-free mass gain in the first 3 months of corrected age is associated with fat-free mass at preschool and school ages. •The first 3 months of life is a sensitive period to the risk of metabolic diseases.

Fetal hemodynamics and placental histopathology in Down syndrome.

OBJECTIVE: To evaluate the association between Doppler patterns in fetuses with Down syndrome (DS) and their placental histopathologic findings. METHODS: A retrospective cross-sectional study was performed by collecting data from medical records of singleton pregnancies between January 2014 and January 2022, whose fetuses had a confirmed diagnosis of DS either prenatally or postnatally. Placental histopathology, maternal characteristics, and prenatal ultrasound (biometric parameters and umbilical artery [UA] Doppler) were evaluated. RESULTS: Of 69 eligible pregnant women, 61 met the inclusion and exclusion criteria. In the sample, 15 fetuses had an estimated fetal weight < 10th percentile for gestational age (GA) and were considered small for gestational age (SGA). Thirty-eight fetuses had increased resistance on the UA Doppler. Histologic changes were detected in 100% of the placentas, the most common being delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism. More than 50% of the placentas showed alterations related to placental insufficiency. We did not observe a statistically significant association between UA Doppler examination and placental alterations. All placentas analyzed in the SGA subgroup showed findings compatible with placental insufficiency. CONCLUSION: We found no statistically significant association between placental histopathologic findings and UA Doppler abnormalities in fetuses with DS. The placental alterations identified were delayed villous maturation, alterations associated with poor fetal vascular perfusion, and villous dysmorphism.

Energy expenditure and body composition in infants with bronchopulmonary dysplasia at term age.

In this cross-sectional study, conducted in a cohort of infants with a gestational age of < 32 weeks, we aimed to evaluate and compare resting energy expenditure (REE) and body composition between infants who developed bronchopulmonary dysplasia (BPD) and those who did not. REE and body composition were assessed at term equivalent age using indirect calorimetry and air displacement plethysmography. Anthropometric measurements (weight, head circumference, and length) were obtained and transformed into Z-scores per the Fenton (2013) growth curve, at birth and at term equivalent age. Forty-two infants were included in this study, of which 26.2% developed BPD. Infants with BPD had significantly higher energy expenditure at term equivalent age, with no difference in body composition between the two groups. CONCLUSION: Despite expending more energy, infants with BPD maintained a similar body composition distribution to those without BPD, and this is likely due to the recommended nutritional approach. WHAT IS KNOWN: • Greater resting energy expenditure impairs growth of preterm infants with bronchopulmonary dysplasia. WHAT IS NEW: • Although preterm infants with bronchopulmonary dysplasia had a higher resting energy expenditure at the corrected term age, this did not affect their body composition and growth.

Assessment of early nutritional intake in preterm infants with bronchopulmonary dysplasia: a cohort study.

This cohort study evaluated the nutritional supply in 78 very preterm newborns, with 20.5% developing bronchopulmonary dysplasia (BPD). This work aimed to evaluate the nutritional intake and the calorie/protein ratio received in the first 4 weeks of life. Anthropometric measures at birth and term age, the weight at each of the first 4 weeks of life, and the feeding practices were registered. The mean gestational age and birth weight were lower in those who developed BPD. At term age, head circumference and length Z-scores were significantly lower in newborns with BPD, who started enteral feeding and reached full diet later, staying longer in parenteral nutrition. The protein rate received by all newborns was similar, whether developing BPD or not, but those who developed BPD received significantly lower fluid volume and calorie rates after the second week. The daily calorie/protein ratio (30 kcal/1-g protein) was reached by 88.7% of the newborns who did not develop BPD in the third week, with those who developed BPD receiving less than this ratio until the second week, persisting in 56.3% of them on the fourth week.Conclusion: A calorie/protein ratio below that recommended for growth was found in preterm newborns who developed BPD, and providing nutrition for these newborns remains a challenge. What is Known: • The importance of preterm newborn nutrition is well known. • Early nutritional support may avoid severe BPD. What is New: • Newborns who developed BPD received a calorie/protein ratio below that recommended for preterm newborns' growth during the first 2 weeks of life, lasting until the fourth week in most of these newborns.

Hydrocephalus and occipital encephaloceles: presentation of a series and review of the literature.

INTRODUCTION: Encephaloceles are rare congenital malformations of the central nervous system in which brain tissue is extruded from a defect in the skull. Hydrocephalus can occur in 60 to 90% of patients with posterior encephaloceles when compared to other types of this malformation. This article aims to present a series of posterior encephaloceles and its association with hydrocephalus as well as promote a review of the pertinent literature. MATERIAL AND METHODS: A retrospective study of our series based on hospital charts of 50 patients with posterior encephaloceles was performed. Data on sex, location of encephalocele, presence of associated malformations, presence of neural tissue within the malformation, presence of hydrocephalus and microcephaly were recorded. RESULTS: There were 29 females and 21 males. There were 25 (50%) supratorcular, 8 (16%) torcular, and 17 (34%) infratorcular lesions. Mean age of encephalocele primary repair was 8 days (range 2-120 days). Hydrocephalus was diagnosed in 25 (50%) of the cases. Ventriculoperitoneal shunt was inserted in 24 patients. The mean age at VP shunt insertion was 1.3 months (range 0.3-9 months). Endoscopic third ventriculostomy was successfully performed in one patient. Dandy-Walker malformation and ventriculomegaly prior to encephalocele surgical correction were positively associated with hydrocephalus (p values 0.05 and 0.01, respectively). Chiari III malformation was found in 2 cases, both requiring CSF shunt for treatment of hydrocephalus and are stable in follow-up. Microcephaly was present in 9 cases. The known mortality rate was 8%. CONCLUSIONS: Hydrocephalus is common in patients with posterior encephaloceles, being more frequent in the supratorcular type, especially when associated to Dandy-Walker, Chiari III malformation, and pre-existing ventriculomegaly. The severity of giant encephaloceles, when associated to torcular types and microcephaly, is a limiting factor for development of hydrocephalus, due both to the rapid evolution of natural history and the structural changes in microcephaly.

Evaluation of continuing education of family health strategy teams for the early identification of suspected cases of cancer in children.

BACKGROUND: This study evaluated the influence of continuing education of family health strategy teams by the Ronald McDonald Institute program on the early diagnosis of cancer in children and adolescents. METHODS: The study applied Habicht's model to evaluate the adequacy and plausibility of continuing education by using as outcome the number of children with suspected cancer who were referred to the hospital of references in the 1 year before and 1 year after intervention and the number of patients referred by intervention group and control group family health strategy teams. Medical records from each hospital of reference were used to collect information of suspect cases of cancer. Descriptive analyses were performed using frequencies and mean values. Chi-square tests were used to assess statistically significant differences between the groups and periods by using p-values < 0.05. RESULTS: The results showed a 30.6% increase in the number of children referred to the hospital of reference for suspected cancer in the post-intervention period; in addition, the family health strategy teams that underwent the intervention referred 3.6 times more number of children to hospital of references than did the control group. Only the intervention group showed an increase in the number of confirmed cases. CONCLUSIONS: This evaluation of a continuing education program for early identification of pediatric cancer showed that the program was adequate in achieving the established goals and that the results could be attributed to the program.

Factors associated with the use of supplemental oxygen or positive pressure ventilation in the delivery room, in infants born with a gestational age ≥ 34 weeks.

BACKGROUND: Approximately 5-10 % of newborns require some form of resuscitationupon delivery; several factors, such as maternal abnormal conditions, gestational age and type of delivery could be responsible for this trend. This study aimed to describe the factors associated with the need for positive pressure ventilation (PPV) via a mask or endotracheal tube and the use of supplemental O2 in newborns with a gestational age greater than 34 weeks in Brazil. METHODS: We performed a cross-sectional study and obtained data from the Birth in Brazil Survey. The inclusion criterion was a gestational age ≥34 weeks. Exclusion criteria were newborns with congenital malformations, and cases with undetermined gestational age or type of delivery (vaginal, pre labor cesarean section and cesarean section during labor). The primary outcomes were need of PPV via a mask or endotracheal tube and the use of supplemental oxygen without PPV. Confounding variables, including maternal age, source of birth payment, years of maternal schooling, previous birth, newborn presentation, multiple pregnancy, and maternal obstetric risk, were analyzed. RESULTS: We included 22,720 newborns. Of these, 2974 (13.1 %) required supplementary oxygen. PPV with a bag and mask was used for 727 (3.2 %) newborns and tracheal intubation for 192 (0.8 %) newborns. Chest compression was necessary for 136 (0.6 %) newborns and drugs administered in 114 (0.5 %). 51.3 % of newborns were delivered by cesarean section, with the majority of cesarean sections (88.7 %) being performed prior to labor. Gestational age (late preterm infants: (Relative Risk-(RR) 2.46; 95 % (Confidence interval-CI 1.79-3.39), maternal obstetric risk (RR 1.59; 95 % CI1.30-1.94), and maternal age of 12-19 years old (RR 1.36; 95 % CI1.06-1.74) contributed to rates of PPV in the logistic regression analysis. Newborns aged between 37-38 weeks of gestaional age weren´t less likely to require PPV compared with those aged 39-41 weeks of gestational age. CONCLUSIONS: Late preterm infants, previous maternal obstetric risks and maternal age contributed to the higher needs of PPV and use of O2 in the delivery room. These variables need to be considered in planning care in the delivery room.

[The history of teaching at the Fernandes Figueira Institute: an interview with Susana Wuillaume]. / A história do ensino no Instituto Fernandes Figueira: entrevista com Susana Wuillaume.

This interview was conducted with Susana Maciel Wuillaume, a pediatrician with broad experience in education and in the management of the Fernandes Figueira Institute. Various topics in the institution's history and Wuillaume's individual trajectory were covered, such as the organization of the graduate course and the medical residency programs and the structure of the institution itself. This interview is part of a project to document and investigate the history of the Fernandes Figueira Institute, which celebrates its one hundredth anniversary in 2024.

Entrevista realizada com Susana Maciel Wuillaume, médica pediatra com larga experiência na docência e na gestão do Instituto Fernandes Figueira. São abordados diferentes temas da história institucional e da trajetória individual da entrevistada, como a organização da pós-graduação e dos programas de residências médica e a estruturação do próprio instituto. A entrevista faz parte de um projeto que documenta e investiga a história do Instituto Fernandes Figueira, que completa seu centenário em 2024.

Analysis of Down syndrome newborn outcomes in three neonatal intensive care units in Rio de Janeiro, Brazil.

OBJECTIVE: The aim of this study was to analyze the outcomes of newborns with Down syndrome admitted to three neonatal intensive care units in the city of Rio de Janeiro, Brazil. METHODS: A retrospective cohort study was conducted by analyzing the medical records between 2014 and 2018 of newborns with Down syndrome admitted to three neonatal intensive care units. The following variables were analyzed: maternal and perinatal data, neonatal malformations, neonatal intensive care unit intercurrences, and outcomes. RESULTS: A total of 119 newborns with Down syndrome were recruited, and 112 were selected for analysis. The most common maternal age group was >35 years (72.07%), the most common type of delivery was cesarean section (83.93%), and the majority of cases were male (53.57%). The most common reasons for neonatal intensive care unit hospitalization were congenital heart disease (57.66%) and prematurity (23.21%). The most common form of feeding was a combination of human milk and formula (83.93%). The second most common malformation was duodenal atresia (9.82%). The most common complications during neonatal intensive care unit hospitalization were transient tachypnea of the newborn (63.39%), hypoglycemia (18.75%), pulmonary hypertension (7.14%), and sepsis (7.14%). The mean length of stay in the neonatal intensive care unit was 27 days. The most common outcome was discharge (82.14%). Furthermore, 12.50% of newborns were transferred to an external neonatal intensive care unit, and 6% died. CONCLUSION: Newborns with Down syndrome are more likely to be admitted to the neonatal intensive care unit, and the length of hospital stay is longer due to complications related to congenital malformations common to this syndrome and prematurity.

Effects of osteopathic manipulative treatment on maternal-fetal hemodynamics in third trimester pregnant women: A prospective study.

OBJECTIVE: To evaluate the maternal-fetal hemodynamic effects after osteopathic manipulative treatment by measuring vital signs and Doppler velocimetry in third-trimester pregnant women. MATERIALS AND METHODS: This is a prospective study with pregnant women undergoing outpatient follow-up and hospitalized in a ward at Instituto Fernandes Figueira/Fiocruz, between August 2021 to August 2022, during the SARS-CoV-2 pandemic. This study was registered in REBEC under Register Number RBR-9q7kvg and approved by the ethics committee under number 32216620.0.0000.5269. The study population was composed of 51 pregnant women between 28 and 40 weeks of gestation, over 18 years of age, allocated in a single group. Pregnancies with multiple fetuses, malformations, premature rupture of the membrane, and active labor were excluded. The procedures evaluated maternal-fetal hemodynamics using three consecutive measures of ultrasound examination with Doppler velocimetry, and three maternal vital signs measured by an electronic blood pressure monitor. RESULTS: Most vital signs changed after osteopathic treatment. However, only the systolic blood pressure (109.92 ±14.42 to 110.71±12.8, p = 0.033), diastolic blood pressure (79.8±11.54 to 77.57±9.44, p = 0.018) and heart rate (87.59±11.93 to 81.12±10.26, p = 0.000) in the sitting position, systolic blood pressure (110.75±13.26 to 108.59±13.07; p = 0.034) in the supine, and heart rate (83.22±11.29 to 80.39±11.0; p = 0.013) in left lateral decubitus reached statistical significance. The oximetry measures (98.55±0.64 to 98.67±0.68; p = 0.098) stayed stable during all three positions. All artery values remained stable after treatment, and no statistically significant difference was recorded in the artery results. CONCLUSION: Responses to osteopathic treatment in women in the third trimester of pregnancy did not affect uteroplacental and fetoplacental circulation. However, some maternal vital signs had statistically significant results, with a decrease in diastolic blood pressure and heart rate, and an increase in systolic blood pressure in the sitting position, a decrease of heart rate in the left lateral decubitus position, and systolic blood pressure in the supine position. All the results observed were maintained in the normal parameters. The study responses attest to the safety of using the osteopathic manipulative treatment for the fetus and for pregnant women with comorbidities.

Maternal and perinatal outcomes of minimally invasive fetal surgeries: experience from two reference centers in Rio de Janeiro, Brazil.

BACKGROUND: Concerns regarding high open surgery-related maternal morbidity have led to improvements in minimally invasive fetal surgeries. OBJECTIVE: To analyze the perinatal and maternal outcomes of minimally invasive fetal surgery performed in Rio de Janeiro, Brazil. DESIGN AND SETTING: Retrospective cohort study conducted in two tertiary reference centers. METHODS: This retrospective descriptive study was conducted using medical records from 2011 to 2019. The outcomes included maternal and pregnancy complications, neonatal morbidity, and mortality from the intrauterine period to hospital discharge. RESULTS: Fifty mothers and 70 fetuses were included in this study. The pathologies included twin-twin transfusion syndrome, congenital diaphragmatic hernia, myelomeningocele, lower urinary tract obstruction, pleural effusion, congenital upper airway obstruction syndrome, and amniotic band syndrome. Regarding maternal complications, 8% had anesthetic complications, 12% had infectious complications, and 6% required blood transfusions. The mean gestational age at surgery was 25 weeks, the mean gestational age at delivery was 33 weeks, 83% of fetuses undergoing surgery were born alive, and 69% were discharged from the neonatal intensive care unit. CONCLUSION: Despite the small sample size, we demonstrated that minimally invasive fetal surgeries are safe for pregnant women. Perinatal mortality and prematurity rates in this study were comparable to those previously. Prematurity remains the most significant problem associated with fetal surgery.

Lockdown during the COVID-19 pandemic: lessons from a polarized scenario in Brazil.

Introduction: The COVID-19 pandemic led many countries to adopt strict measures aimed at reducing circulation of the virus and mitigating the burden on health services. Among these, the lockdown (social distancing/confinement) was probably the most controversial and most widely debated, since it affected the population's daily life abruptly, with consequences for people's emotional state and the operational logic of various economic sectors. Objective: Analyze the relationship been Brazilians' opinions on lockdown during the pandemic and individual, sociodemographic, and belief characteristics. Methods: We conducted an online survey to evaluate Brazilians' opinions on the lockdown during the COVID-19 pandemic. We prepared a questionnaire with questions on sociodemographic aspects and individuals' points of view toward the lockdown. We sent a link for the survey through social media and encouraged participants to also share the link in their respective social networks, as a snowball sample. Cluster analysis was performed to identify different opinion profiles. Cluster Analysis is a multivariate approach that aims to segment a set of data into distinct groups, using some classification criteria. Results: From April to May 2021, the link received 33,796 free participations via social networks from all over Brazil. We analyzed data from 33,363 participants. Pro-lockdown opinions predominated in most of the sociodemographic strata. Cluster analysis identified two groups: pro-lockdown, aligned with the scientific recommendations, and anti-lockdown, characterized by economic insecurity and denialism. Anti-lockdown participants downplayed the pandemic's seriousness and believed in unproven measures to fight SARS-CoV-2. However, these same participants were afraid of losing their jobs and of being unable to pay their bills. In general, participants did not believe in the feasibility of a lockdown in Brazil or in the efficacy of the prevailing government administration's measures. Conclusion: The study identified a lack of consensus among participants concerning lockdown as a practice. Issues such as disbelief in the pandemic's seriousness, denialism, and economic insecurity were important in the determination of the profiles identified in the study. Denialism is believed to have been a subjective defense against the economic problems resulting from social control measures and the lack of adequate social policies to deal with the pandemic. It was also highlighted that political polarization and the lack of central coordination during social distancing are crucial aspects. The variation in results in different locations highlights the diversity of the Brazilian scenario. By analyzing Brazilians' opinions about the lockdown, considering individual characteristics, the study seeks insights to face the pandemic and prepare for future crises, contributing to more effective public health strategies.

Survey of the Adequacy of Brazilian Children and Adolescents to the 24-Hour Movement Guidelines before and during the COVID-19 Pandemic.

The 24-Hour Movement Guidelines provide specific recommendations on movement behaviors for children and adolescents. The objective of this study was to verify the adequacy of children and adolescents to the guidelines for moderate to vigorous physical activity, recreational screen time, and sleep duration, and the overall adequacy to the guidelines, before and during the COVID-19 pandemic. A cross-sectional study was conducted with parents or guardians of children or adolescents from different regions of Brazil using a digital interview form including sociodemographic characteristics of families, moderate to vigorous physical activity, recreational screen time, and sleep duration before and during the pandemic. Statistically significant variation was observed in both groups in relation to moderate to vigorous physical activity and recreational screen time between the two periods evaluated. Overall adequacy to the guidelines before the pandemic was 19.28% for children from Group 1 (0-5 years old) and 39.50% for those from Group 2 (6 to 17 years old). During the pandemic, it corresponded to 3.58% in Group 1 and 4.94% in Group 2 (p-value between periods ≤0.001). This study showed the significant impact of pandemic restrictions on reducing overall compliance and physical activity, and increasing screen time among Brazilian children and adolescents.

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

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

Effects of intra-abdominal hypertension on maternal-fetal outcomes in term pregnant women: A systematic review.

OBJECTIVE: To carry out a systematic review to assess the effects of intra-abdominal hypertension on maternal-fetal outcomes. METHODS: The search was carried out between 28th June to 4th July 2022 on the Biblioteca Virtual em Saúde, Pubmed, Embase, Web of Science, and Cochrane databases. The study was registered in PROSPERO (CRD42020206526). The systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. To assess the methodological quality and control the risk of bias, New Castle was used. RESULTS: A total of 6203 articles were found. Of these, 5 met the selection criteria for a full reading. The selected studies included a total of 271 pregnant women, of which 242 underwent elective cesarean section and measurement of intra-abdominal pressure via a bladder catheter. In both pregnant women groups, the lowest intra-abdominal pressure values were found in the supine position with left lateral tilt. Prepartum values in normotensive women with singleton pregnancy (7.3±1.3 to 14.1 ± 1 mmHg) were lower than in gestational hypertensive disorders (12.0±3.3 to 18.3±2.6 mmHg). In postpartum, the values decreased in both groups but were even lower in normotensive women (3.7±0.8 to 9.9 ± 2.6 mmHg vs 8.5 ± 3.6 to 13.6 ± 3.3 mmHg). The same was true for twin pregnancies. The Sequential Organ Failure Assessment index ranged from 0.6 (0.5) to 0.9 (0.7) in both groups of pregnant women. The placental malondialdehyde levels were statistically (p < 0.05) higher in pregnant women with pre-eclampsia (2.52±1.05) than normotensive (1.42±0.54). CONCLUSIONS: Prepartum intra-abdominal pressure values in normotensive women were close or equal to intra-abdominal hypertension and compatible with gestational hypertensive disorders even in the postpartum period. IAP values were consistently lower in supine position with lateral tilt in both groups. Significant correlations were found between prematurity, low birth weight, pregnant women with hypertensive disorders, and increased intra-abdominal pressure. However, there was no significant association of dysfunction in any system in the relationship between intra-abdominal pressure and Sequential Organ Failure Assessment. Despite the higher malondialdehyde values in pregnant women with pre-eclampsia, the findings were inconclusive. Given the observed data on maternal and fetal outcomes, it would be recommended that intra-abdominal pressure measurements be standardized and used as a diagnostic tool during pregnancy. TRIAL REGISTRATION: PROSPERO registration: October 9th, 2020, CRD42020206526.

Detection of sexually transmitted infections among transvestites and transsexual women in prison in the metropolitan region of Rio de Janeiro, Brazil.

OBJECTIVE: To evaluate the seropositivity rate of rapid tests for HIV, syphilis and hepatitis B and C among transvestites and transgender women (transfeminine persons) inmates in the metropolitan region of Rio de Janeiro, analyzing the results based on sociodemographic, prison profile and access to health technologies to prevent sexually transmitted infections (STIs). METHODS: Cross-sectional census-type study carried out with transfeminine in eleven male prisons in Rio de Janeiro, between the months of April and June 2021. RESULTS: The detection rates found were 34.4% for HIV, and 48.9% for syphilis, and 0.8% for type B and C hepatitis. Seropositivity for more than one infection was verified in 25.4% of participants, and HIV/syphilis was the most prevalent. An increase in the level of education (p=0.037) and having a steady partner in prison (p=0.041) were considered protective factors for STIs in this population. Difficulties were identified in accessing STI prevention technologies, such as male condoms, lubricating gel, rapid tests, and prophylactic antiretroviral therapies for HIV. CONCLUSION: HIV and syphilis seropositivity rates were high, but within the profile found in this population in other studies inside or outside prisons. The data found indicates the need to incorporate effective strategies for access to health technologies for the prevention of STIs. The scarcity of scientific publications containing epidemiological data on STIs in the transfeminine prison population limited deeper comparisons of the results obtained in this study.

Early growth and body composition assessed by air displacement plethysmography in infants born with simple gastroschisis.

BACKGROUND: Gastroschisis is an abdominal wall malformation usually associated with impaired growth. OBJECTIVE: To evaluate the growth and body composition of infants born with simple gastroschisis in a referral center. METHODS: This was a single-center, prospective case series of infants with simple gastroschisis who were measured at birth, at discharge, and at 3 months. Body composition was assessed via air-displacement plethysmography at discharge and at 3 months. The results were compared with those reported for healthy infants at an equivalent gestational age. RESULTS: Simple gastroschisis infants were lighter and smaller at birth and remained similar at 3 months. All anthropometric z scores decreased from birth to discharge, followed by an increase but not a full recovery toward 3 months. Overall, gastroschisis infants had a similar FM percentage, FM% (11.1 ± 4.7), but a lower FFM, FFM (2481 ± 478 g), at discharge. FM% (18.5 ± 5.3) decreased at 3 months, and FFM remained lower (3788 ± 722 g) but improved between the two exams. Boys had significantly more FFM than girls at both evaluations. The multiple regression analysis showed that male sex, prematurity, total parenteral nutrition duration, and exclusive breast milk diets were associated with differences in body composition. CONCLUSIONS: Infants with simple gastroschisis cared for in a referral center experienced growth failure at discharge and showed a similar FM% but lower FFM than healthy infants. At 3 months, they exhibited smaller FM% and FFM, but FFM improved after the first exam, representing a better protein accretion. TYPE OF STUDY: Prognostic. LEVEL OF EVIDENCE: IV.

Cervical Intraepithelial Neoplasia grade 2 biopsy: Do p16INK4a and Ki-67 biomarkers contribute to the decision to treat? A cross-sectional study.

BACKGROUND: Managing cervical intraepithelial neoplasia grade 2 (CIN2) is challenging, considering the CIN2 regression rate, perinatal risks associated with excisional procedures, and insufficient well-established risk factors to predict progression. OBJECTIVES: To determine the ability of p16INK4a and Ki-67 staining in biopsies diagnosed with CIN2 to identify patients with higher-grade lesions (CIN3 or carcinoma). DESIGN AND SETTING: Cross-sectional study conducted at a referral center for treating uterine cervical lesions. METHODS: In 79 women, we analyzed the correlation of p16INK4a and Ki-67 expression in CIN2 biopsies with the presence of a higher-grade lesions, as determined via histopathology in surgical specimens from treated women or via two colposcopies and two cytological tests during follow-up for untreated women with at least a 6-month interval. The expression of these two biomarkers was verified by at least two independent pathologists and quantified using digital algorithms. RESULTS: Thirteen (16.8%) women with CIN2 biopsy exhibited higher-grade lesions on the surgical excision specimen or during follow-up. p16INK4a expression positively and negatively predicted the presence of higher-grade lesions in 17.19% and 86.67% patients, respectively. Ki-67 expression positively and negatively predicted the presence of higher-grade lesions in 40% and 88.24% patients, respectively. CONCLUSIONS: Negative p16INK4a and Ki67 immunohistochemical staining can assure absence of a higher-grade lesion in more than 85% of patients with CIN2 biopsies and can be used to prevent overtreatment of these patients. Positive IHC staining for p16INK4a and Ki-67 did not predict CIN3 in patients with CIN2 biopsies.

Look, you are (not) alone: circulating gift and the mental health of healthcare professionals during the COVID-19 pandemic. / Olha, você (não) está sozinho: a circulação da dádiva e a saúde mental de profissionais de saúde durante a pandemia de COVID-19.

The mental health of health professionals who worked directly in services during the COVID-19 pandemic to care for patients affected by the disease became a fundamental issue to be considered, given the several consequences of this activity for these professionals. This article aimed to understand the challenges and demands of health professionals concerning support to address the emotional and physical exhaustion of working on the so-called frontline during the COVID-19 pandemic. The qualitative methodological approach was based on semi-structured interviews conducted online with these professionals after the first months of the pandemic. The hero's place in which they were set, even if only in media discourses, soon gave way to their weaknesses and fragile work relationships to emerge: stress, fear, and the listening and reception desire. Marcel Mauss' gift theory was brought up considering that new ways of reading and interpreting health work relationships contribute to necessary and urgent reformulations of their current context, targeting mental health and, more broadly, the comprehensive health of healthcare professionals.

Durante a pandemia de COVID-19, a saúde mental dos profissionais de saúde, que trabalharam diretamente nos serviços voltados para o cuidado dos pacientes afetados pela doença, tornou-se questão fundamental a ser considerada, dado os diversos desdobramentos que essa atuação gerou para esses profissionais. O objetivo deste artigo foi compreender desafios e demandas dos profissionais de saúde em termos de suporte para lidar com o desgaste emocional e físico com a atuação na chamada linha de frente durante a pandemia de COVID-19. A abordagem metodológica qualitativa se deu a partir de entrevistas semiestruturadas realizadas em ambiente online com esses profissionais, passados os primeiros meses de pandemia. O lugar de herói em que eles foram colocados, ainda que apenas nos discursos midiáticos, logo deu espaço para que as fragilidades destes e das relações de trabalho aparecessem: estresse, medo e o desejo de escuta e acolhimento. A teoria da dádiva de Marcel Mauss foi trazida considerando que novas formas de leitura e interpretação das relações de trabalho em saúde contribuem para reformulações necessárias e urgentes do contexto em que se encontram hoje, visando a saúde mental e, mais amplamente, a saúde integral dos profissionais da área de saúde.