Advanced Paternal Age Affects the Sperm DNA Fragmentation Index and May Lead to Lower Good-quality Blastocysts.

Several studies show reductions in some seminal parameters in aged men and describe them as a consequence of many age-dependent changes in male organisms. This study aims to evaluate the impact of age on seminal parameters, particularly the DNA fragmentation index (DFI), and outcomes after in vitro fertilization (IVF) cycles. This is a retrospective study that includes 367 patients who underwent sperm chromatin structure assay testing between 2016 and 2021. The participants were split into three groups according to age: < 35 years (younger group, n = 63), 35-45 years (intermediate group, n = 227), and ≥ 45 years (older group, n = 77). The mean DFI (%) was compared. Among all patients, 255 received IVF cycles after DFI evaluation. For these patients, the sperm concentration, motility, and volume, as well as the fertilization rate, mean oocyte age, and good-quality blastocyst formation rate, were analyzed. One-way ANOVA was applied. The older group showed a significantly higher sperm than did the younger group (28.6% vs. 20.8% p = 0.0135). Despite not presenting a significant difference, the DFI level tends to be inversely related to good-quality blastocyst formation since the oocyte age was similar between the groups (32.0 v.s 33.6 vs. 32.3 years, respectively, p = 0.1183). Among aged men, the sperm DFI level is increased but other seminal parameters are not modified. Considering that men with a high sperm DFI can present some degree of infertility due to high sperm chromatin damage, male age should also be considered a limiting factor of IVF.

Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens. / Elaboración e implementación de un protocolo para la Hora Dorada de recién nacidos prematuros utilizando ciencia de la implementación.

OBJECTIVE: describe the process of designing and implementing a care protocol for the first hour of life of premature newborns. METHOD: a participatory research study using an implementation science framework, the Consolidated Framework for Implementation Research (CFIR) was employed to determine drivers and facilitators of implementation success of the Golden Hour protocol for newborns at a large university hospital in southeastern Brazil. A multi-professional team, including first line providers and managers participated in six stages of quality improvement: situational diagnosis; protocol elaboration; training protocol implementation; barrier and facilitator assessment; and protocol monitoring and review. Qualitative and monitoring data collected across these six stages were analyzed using descriptive statistics and content analysis. RESULTS: the institution's Golden Hour protocol was organized by the multi-professional team based on a collective and dialogical approach. The protocol prioritized the infant's cardiopulmonary stability, as well as prevention of hypothermia, hypoglycemia and infection. After four months of implementation, the care team was evaluated the protocol as a good quality intervention, necessary for the service, low-cost and not very complex. One suggested improvement recommended was to carry out refresher training to address staff turnover. CONCLUSION: implementation of the Golden Hour protocol introduced an appropriate and feasible neonatal care quality improvement process, which requires periodic refresher training to ensure greater adherence and better neonatal results.

Knowledge regarding extracorporeal membrane oxygenation management among Brazilian pediatric intensivists: a cross-sectional survey.

OBJECTIVE: To assess Brazilian pediatric intensivists' general knowledge of extracorporeal membrane oxygenation, including evidence for its use, the national funding model, indications, and complications. METHODS: This was a multicenter cross-sectional survey including 45 Brazilian pediatric intensive care units. A convenience sample of 654 intensivists was surveyed regarding their knowledge on managing patients on extracorporeal membrane oxygenation, its indications, complications, funding, and literature evidence. RESULTS: The survey addressed questions regarding the knowledge and experience of pediatric intensivists with extracorporeal membrane oxygenation, including two clinical cases and 6 optional questions about the management of patients on extracorporeal membrane oxygenation. Of the 45 invited centers, 42 (91%) participated in the study, and 412 of 654 (63%) pediatric intensivists responded to the survey. Most pediatric intensive care units were from the Southeast region of Brazil (59.5%), and private/for-profit hospitals represented 28.6% of the participating centers. The average age of respondents was 41.4 (standard deviation 9.1) years, and the majority (77%) were women. Only 12.4% of respondents had taken an extracorporeal membrane oxygenation course. Only 19% of surveyed hospitals have an extracorporeal membrane oxygenation program, and only 27% of intensivists reported having already managed patients on extracorporeal membrane oxygenation. Specific extracorporeal membrane oxygenation management questions were responded to by only 64 physicians (15.5%), who had a fair/good correct response rate (median 63.4%; range 32.8% to 91.9%). CONCLUSION: Most Brazilian pediatric intensivists demonstrated limited knowledge regarding extracorporeal membrane oxygenation, including its indications and complications. Extracorporeal membrane oxygenation is not yet widely available in Brazil, with few intensivists prepared to manage patients on extracorporeal membrane oxygenation and even fewer intensivists recognizing when to refer patients to extracorporeal membrane oxygenation centers.

Fertilization outcome, embryo development and birth after unstimulated IVM.

BACKGROUND/PURPOSES: A common observation in oocyte in vitro maturation (IVM) cycles is poor embryo quality. However, no study was dedicated to assess zygote and early cleavage embryo quality in IVM cycles. The objective of this study is to analyze fertilization outcome, embryo development and the resulting pregnancy and births in unstimulated IVM cycles. METHODS: IVM oocytes were collected 36 h post hCG and matured in vitro for 28-30 h. All oocytes were inseminated by ICSI. Resulting zygotes and embryos were assessed on day-1, 2 and 3, when transfers were made. RESULTS: The overall oocyte maturation and fertilization rates were 63% and 62%, respectively. Abnormal fertilization rate was 27%. [corrected] Ninety five and 14.6% of the 2Pn zygotes reached the 2-cell and 8-cell stage at day-2 and day-3, respectively. Embryo quality assessment on day-3 at transfer revealed that only 9% of the embryos were of very good quality. Most embryos showed developmental delay. An average of 3.29 embryos were transferred per patient resulting in implantation and clinical gestation rates of 16% and 32%, respectively. Overall 14 healthy babies were born and there is one ongoing pregnancy. CONCLUSION: Results show a significant rate of abnormal fertilization and poor embryo quality after IVM, which is reflected in a higher than average number of embryos being transferred. However, pregnancy, implantation and birth rates are reasonably high and allow us to consider IVM a valuable approach for the treatment of infertility in PCO or PCOS patients.

First Baby Born in Brazil after Simultaneous Diagnosis through Non-Invasive and Conventional PGT-A.

Non-invasive preimplantation genetic testing for aneuploidies (niPGT-A) aiming to assess cell-free embryonic DNA in spent culture media is promising, especially because it might overcome the diminished rates of implantation caused by the inadequate performance of trophectoderm (TE) biopsy. Our center is part of the largest study to date assessing the concordance between conventional PGT-A and niPGT-A, and we report here the delivery of the first baby born in Brazil using niPGT-A. The parents of the baby were admitted to our center in 2018. They did not present history of infertility, and they were interested in using in vitro fertilization (IVF) and PGT-A in order to avoid congenital anomalies in the offspring. A total of 11 (3 day-5 and 8 day-6) expanded blastocysts were biopsied, and the spent culture media (culture from day-4 to day-6) from 8 day-6 blastocysts were collected for niPGT-A. Overall, 7 embryos yielded informative results for trophectoderm (TE) and media samples. Among the embryos with informative results, 5 presented concordant diagnosis between conventional PGT-A and niPGT-A, and 2 presented discordant diagnosis (1 false-positive and one false-negative). The Blastocyst 4, diagnosed as 46, XY by both niPGT-A and conventional PGT-A, was warmed up and transferred, resulting in the birth of a healthy 3.8 kg boy in February 2020. Based on our results and the recent literature, we believe that the safest current application of niPGT-A would be as a method of embryo selection for patients without an indication for conventional PGT-A. The approximate 80% of reliability of niPGT-A in the diagnosis of ploidy is superior to predictions provided by other non-invasive approaches like morphology and morphokinetics selection.

Abordagens para o teste genético pré-implantacional não-invasivo para aneuploidias (non-invasive preimplantation genetic testing for aneuploidies, niPGT-A, em inglês) com o objetivo de avaliar o DNA embrionário livre são promissoras, especialmente porque estas podem reverter as menores taxas de implantação causadas por inadequada biópsia de trofectoderma (TE). Nesse contexto, nosso centro é parte do maior estudo atual que avalia as taxas de concordância entre PGT-A convencional e niPGT-A, e relatamos aqui o nascimento do primeiro bebê brasileiro após niPGT-A. Os pais do bebê foram admitidos no nosso centro em 2018. Eles não apresentavam histórico de infertilidade, e estavam interessados em utilizar os tratamentos de fertilização in vitro (FIV) e PGT-A para evitar anomalias congênitas na progênie. Um total de 11 blastocistos expandidos (3 do dia-5 e 8 do dia-6) foram submetidos a biópsia, e os meios de cultivo condicionados (cultivo do dia-4 ao dia-6) de 8 blastocistos do dia-6 foram coletados para niPGT-A. No total, resultados informativos para as amostras de TE e dos meios foram obtidos para sete embriões. Entre os embriões com resultado informativo, 5 apresentaram diagnóstico concordante entre PGT-A convencional e niPGT-A, e 2 apresentaram diagnóstico discordante (1 falso positivo e 1 falso negativo). O Blastocisto 4, diagnosticado como 46, XY por ambos niPGT-A e PGT-A convencional, foi desvitrificado e transferido, o que resultou no nascimento de um menino saudável, que pesava 3,8 kg, em fevereiro de 2020. Com base em nossos resultados e literatura contemporânea, acreditamos que a aplicação atual mais segura do niPGT-A seria como método de seleção embrionária para pacientes sem indicação ao PGT-A convencional. A confiabilidade aproximada de 80% do niPGT-A para determinação da ploidia ainda é superior àquela obtida com abordagens não invasivas, como seleção morfológica ou morfocinética.

Serum level of cardiac troponin I in pediatric patients with sepsis or septic shock.

OBJECTIVES: To evaluate serum level of contractile protein troponin I (cTnI) within the 24 hrs of sepsis and septic shock diagnosis in children and to correlate with the outcome (discharge from hospital or death). DESIGN: Prospective, observational study. SETTING: Pediatric Intensive Care Unit, at Hospital Infantil Nossa Senhora da Glória, Vitória, ES, Brazil. PATIENTS: Two hundred eighteen consecutive admissions of septic patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Measurement of serum cTnI (IMMULITE cTnI assay, Diagnostic Product Corporation, Los Angeles, CA) and creatine kinase MB isoenzyme and electrocardiographic tracings were performed within 24 hrs of sepsis or septic shock diagnosis. The pediatric index of mortality, pediatric index of mortality-2 was calculated for each patient. Primary diseases most frequently associated were pneumonia (42%) and meningitis (18%). The overall mortality was 12% (27 cases), 2.7% in the sepsis group, and 33% in the septic shock group. Both Pediatric Index of Mortality and Pediatric Index of Mortality-2 reached good discrimination. Electrocardiographic abnormalities were infrequent (9.2%). Abnormal serum levels of cTnI occurred in ten (4.5%) patients, significantly more frequent in the septic shock group than in sepsis group (13% vs. 0.7%, respectively; p = 0.000). Although frequency of elevated serum cTnI was significantly higher in nonsurvivors than in survivors (5 of 27 vs. 5 of 191, respectively; p = 0.003), this frequency not showed significant relationship with electrocardiogram alteration, creatine kinase MB isoenzyme levels, etiology of sepsis, or length of hospital days. In addition, a logistic regression analysis, taking in account age, gender, length of hospital days, sepsis definition, presence of meningitis, creatine kinase MB isoenzyme, and cTnI serum levels, demonstrated that severity of septic disease was the only variable significantly associated with the death. CONCLUSIONS: Evaluation of serum levels of cTnI within the first 24 hrs of diagnosis of sepsis or septic shock in children was not better than creatine kinase MB isoenzyme or clinical evaluation, to predict the outcome (death or discharge from hospital) of septic process.

Elaboración e implementación de un protocolo para la Hora Dorada de recién nacidos prematuros utilizando ciencia de la implementación / Elaboration and implementation of a protocol for the Golden Hour of premature newborns using an Implementation Science lens / Elaboração e implementação de protocolo para Hora Ouro do recém-nascido prematuro utilizando ciência da implementação

Objetivo: describir el proceso de diseño e implementación de un protocolo de atención para la primera hora de vida del recién nacido prematuro. Método: investigación participativa, que utilizó el marco de la ciencia de la implementación y los dominios del Consolidated Framework for Implementation Research. Estudio realizado en un hospital escuela del sureste de Brasil, con la participación del equipo multidisciplinario y de los gestores. El estudio se organizó en seis etapas, mediante del ciclo de mejora continua (Plan, Do, Check, Act): diagnóstico situacional; elaboración del protocolo; capacitaciones; implementación del protocolo; relevamiento de barreras y facilitadores; seguimiento y revisión del protocolo. Los datos fueron analizados mediante estadística descriptiva y análisis de contenido. Resultados: el primer protocolo de la Hora Dorada de la institución fue organizado por el equipo multidisciplinario a partir de un enfoque colectivo y dialógico. El protocolo priorizó la estabilidad cardiorrespiratoria, la prevención de hipotermia, hipoglucemia e infección. Después de cuatro meses de capacitación e implementación, el protocolo fue evaluado como una intervención de calidad, necesaria para el servicio, de bajo costo y de poca complejidad. La principal sugerencia de mejora fue realizar actividades educativas frecuentes. Conclusión: la implementación generó cambios e inició un proceso de mejora de la calidad de la atención neonatal, es necesario que la capacitación sea continua para lograr mayor adherencia y mejores resultados.

Objective: describe the process of designing and implementing a care protocol for the first hour of life of premature newborns. Method: a participatory research study using an implementation science framework, the Consolidated Framework for Implementation Research (CFIR) was employed to determine drivers and facilitators of implementation success of the Golden Hour protocol for newborns at a large university hospital in southeastern Brazil. A multi-professional team, including first line providers and managers participated in six stages of quality improvement: situational diagnosis; protocol elaboration; training protocol implementation; barrier and facilitator assessment; and protocol monitoring and review. Qualitative and monitoring data collected across these six stages were analyzed using descriptive statistics and content analysis. Results: the institution's Golden Hour protocol was organized by the multi-professional team based on a collective and dialogical approach. The protocol prioritized the infant's cardiopulmonary stability, as well as prevention of hypothermia, hypoglycemia and infection. After four months of implementation, the care team was evaluated the protocol as a good quality intervention, necessary for the service, low-cost and not very complex. One suggested improvement recommended was to carry out refresher training to address staff turnover. Conclusion: implementation of the Golden Hour protocol introduced an appropriate and feasible neonatal care quality improvement process, which requires periodic refresher training to ensure greater adherence and better neonatal results.

Objetivo: descrever o processo de elaboração e implementação de protocolo assistencial para a primeira hora de vida do recém-nascido prematuro. Método: pesquisa participativa, que utilizou referencial da ciência da implementação e os domínios do Consolidated Framework for Implementation Research. Estudo realizado em hospital universitário no sudeste do Brasil, com participação da equipe multiprofissional e gestores. O estudo foi organizado em seis etapas, por meio do ciclo de melhoria contínua (Plan, Do, Check, Act): diagnóstico situacional; elaboração do protocolo; treinamentos; implementação do protocolo; levantamento de barreiras e facilitadores; monitoramento e revisão do protocolo. Os dados foram analisados por estatística descritiva e análise de conteúdo. Resultados: o primeiro protocolo Hora Ouro da instituição foi organizado pela equipe multiprofissional a partir de uma abordagem coletiva e dialógica. O protocolo priorizou a estabilidade cardiorrespiratória, prevenção de hipotermia, de hipoglicemia e de infecção. Após treinamento e implementação por quatro meses, o protocolo foi avaliado como uma intervenção de qualidade, necessária ao serviço, de baixo custo e pouco complexa. A principal sugestão de melhoria foi realizar ações educativas frequentes. Conclusão: a implementação provocou mudanças e iniciou um processo de melhoria da qualidade da assistência neonatal, sendo necessária a manutenção dos treinamentos para maior adesão e melhores resultados.

Knowledge regarding extracorporeal membrane oxygenation management among Brazilian pediatric intensivists: a cross-sectional survey / Conhecimento do manejo da oxigenação por membrana extracorpórea de intensivistas pediátricos brasileiros: um inquérito transversal

ABSTRACT Objective: To assess Brazilian pediatric intensivists' general knowledge of extracorporeal membrane oxygenation, including evidence for its use, the national funding model, indications, and complications. Methods: This was a multicenter cross-sectional survey including 45 Brazilian pediatric intensive care units. A convenience sample of 654 intensivists was surveyed regarding their knowledge on managing patients on extracorporeal membrane oxygenation, its indications, complications, funding, and literature evidence. Results: The survey addressed questions regarding the knowledge and experience of pediatric intensivists with extracorporeal membrane oxygenation, including two clinical cases and 6 optional questions about the management of patients on extracorporeal membrane oxygenation. Of the 45 invited centers, 42 (91%) participated in the study, and 412 of 654 (63%) pediatric intensivists responded to the survey. Most pediatric intensive care units were from the Southeast region of Brazil (59.5%), and private/for-profit hospitals represented 28.6% of the participating centers. The average age of respondents was 41.4 (standard deviation 9.1) years, and the majority (77%) were women. Only 12.4% of respondents had taken an extracorporeal membrane oxygenation course. Only 19% of surveyed hospitals have an extracorporeal membrane oxygenation program, and only 27% of intensivists reported having already managed patients on extracorporeal membrane oxygenation. Specific extracorporeal membrane oxygenation management questions were responded to by only 64 physicians (15.5%), who had a fair/good correct response rate (median 63.4%; range 32.8% to 91.9%). Conclusion: Most Brazilian pediatric intensivists demonstrated limited knowledge regarding extracorporeal membrane oxygenation, including its indications and complications. Extracorporeal membrane oxygenation is not yet widely available in Brazil, with few intensivists prepared to manage patients on extracorporeal membrane oxygenation and even fewer intensivists recognizing when to refer patients to extracorporeal membrane oxygenation centers.

RESUMO Objetivo: Avaliar os conhecimentos gerais dos intensivistas pediátricos brasileiros sobre oxigenação por membrana extracorpórea, incluindo evidências de uso, modelo de custeio nacional, indicações e complicações. Métodos: Este estudo foi um inquérito transversal multicêntrico que incluiu 45 unidades de terapia intensiva pediátrica brasileiras. Realizou-se inquérito de conveniência com 654 intensivistas quanto aos seus conhecimentos sobre manejo de pacientes em oxigenação por membrana extracorpórea, suas indicações, complicações, custeio e evidências bibliográficas. Resultados: O inquérito abordou questões relativas aos conhecimentos e à experiência dos intensivistas pediátricos sobre oxigenação por membrana extracorpórea, incluindo dois casos clínicos e seis questões facultativas sobre o manejo de pacientes em oxigenação por membrana extracorpórea. Dos 45 centros convidados, 42 (91%) participaram do estudo, e 412 (63%) dos 654 intensivistas pediátricos responderam ao inquérito. A maioria das unidades de terapia intensiva pediátrica eram da Região Sudeste do Brasil (59,5%), e os hospitais privados com fins lucrativos representavam 28,6% dos centros participantes. A média de idade dos respondentes era de 41,4 (desvio-padrão de 9,1) anos, e a maioria (77%) era mulher. Apenas 12,4% dos respondentes tinham formação em oxigenação por membrana extracorpórea. Dos hospitais pesquisados, apenas 19% tinham um programa de oxigenação por membrana extracorpórea, e apenas 27% dos intensivistas declararam já ter manejado pacientes em oxigenação por membrana extracorpórea. Apenas 64 médicos (15,5%) responderam a questões específicas sobre o manejo de oxigenação por membrana extracorpórea (mediana 63,4%; oscilando entre 32,8% e 91,9%). Conclusão: A maioria dos intensivistas pediátricos brasileiros demonstrou conhecimentos limitados de oxigenação por membrana extracorpórea, incluindo suas indicações e complicações. A oxigenação por membrana extracorpórea ainda não está amplamente disponível no Brasil, com poucos intensivistas preparados para o manejo de pacientes em oxigenação por membrana extracorpórea e ainda menos intensivistas capazes de reconhecer quando devem encaminhar pacientes para centros de oxigenação por membrana extracorpórea.

Avaliação do conhecimento dos profissionais de Enfermagem na prevenção da lesão por pressão na terapia intensiva / Evaluación del conocimiento de los profesionales de Enfermería en la prevención de lesiones por presión en cuidados intensivos / Evaluation of the knowledge of nursing professionals in the prevention of pressure ulcer in intensive care

RESUMO Objetivo analisar o conhecimento dos profissionais de Enfermagem sobre a avaliação, prevenção e classificação das lesões por pressão na terapia intensiva antes e após a realização de um treinamento. Método trata-se de um estudo comparativo, tipo antes e depois, transversal, com delineamento prospectivo, que utilizou o instrumento Teste de Conhecimento sobre Lesão por Pressão de Caliri-Pieper (TCLP CALIRI-PIEPER) aplicado antes e após a realização de um treinamento com 55 e 50 profissionais da Enfermagem, respectivamente. A média de acerto aceitável foi de acima de 90%. Resultados do total de 41 itens do instrumento, 14 (34%) não obtiveram pontuação média acima de 90% de acerto, sendo os técnicos de Enfermagem inseridos neste contingente. Evidenciou-se que o efeito do treinamento na amostra total obteve, em média, um acréscimo de 3,5 pontos no nível de conhecimento. A diferença média entre a pontuação obtida no pré e pós-teste foi estatisticamente significativa (p<0,001). Conclusões e implicações para a prática os participantes avaliados demonstraram níveis de conhecimento eficaz e baixa divergência entre as categorias, evidenciando que os profissionais estão capacitados e preparados, possuindo domínio nos fatores relacionados à avaliação, prevenção e classificação das lesões por pressão na terapia intensiva após a realização de um treinamento.

RESUMEN Objetivo analizar los conocimientos de los profesionales de Enfermería sobre la evaluación, prevención y clasificación de las lesiones por presión en cuidados intensivos antes y después de la realización de una formación. Método se trata de un estudio comparativo, antes y después, transversal con un diseño prospectivo que utilizó el instrumento Caliri-Pieper Pressure Injury Knowledge Test (CALIRI-PIEPER TCLP) aplicado antes y después del entrenamiento con 55 y 50 profesionales de Enfermería, respectivamente. La media aceptable de derecho a golpe fue superior al 90%. Resultados del total de 41 ítems del instrumento, 14 (34%) no obtuvieron un puntaje promedio superior al 90% de acierto, con los técnicos de Enfermería incluidos en este contingente. Se evidenció que el efecto formación en la muestra total obtuvo, en promedio, un incremento de 3,5 puntos en el nivel de conocimientos. La diferencia promedio entre las puntuaciones previas y posteriores a la prueba fue estadísticamente significativa (p <0,001). Conclusiones e implicaciones para la práctica los participantes evaluados demostraron niveles de conocimiento efectivo y baja divergencia entre las categorías, evidenciando que los profesionales están capacitados y preparados, teniendo dominio de los factores relacionados con la evaluación, prevención y clasificación de lesiones por presión en cuidados intensivos después del entrenamiento.

ABSTRACT Objective to analyze the knowledge of Nursing professionals on the assessment, prevention and classification of pressure ulcers in intensive care before and after a training course. Method this is a comparative, before-and-after, cross-sectional, prospective study that used the Caliri-Pieper Pressure Ulcer Knowledge Test (CALIRI-PIEPER PUKT) applied before and after training with 55 and 50 nursing professionals, respectively. The acceptable mean score was above 90%. Results of the total of 41 items of the instrument, 14 (34%) did not obtain an average score above 90% of correct answers, and the nursing technicians were included in this contingent. It was evident that the effect of the training on the total sample obtained, on average, a 3.5 point increase in the level of knowledge. The mean difference between the scores obtained in the pre- and post-test was statistically significant (p<0.001). Conclusions and implications for the practice the participants evaluated demonstrated effective levels of knowledge and low divergence between the categories, showing that the professionals are trained and prepared, having domain in the factors related to the evaluation, prevention and classification of pressure ulcers in intensive care after training.

The impact of age on blastocyst scoring after single and double embryo transfers.

OBJECTIVE: The aim of the present study was to assess the putative relationship between patient's age and blastocyst scores, in single (SET) or double (DET) transfer cycles, that resulted in single or twin pregnancy or non-pregnancy. Second, we analyzed the effect of maternal age on clinical gestation and implantation rates after single and double blastocyst transfers. METHODS: Retrospective analysis of 164 assisted reproduction cycles with embryo transfers. RESULTS: Data demonstrated that for both, young (<35 years of age) and older (≥35 years of age) women, trophectoderm (TE) score is the most important parameter to assess concerning embryo selection. However, inner cell mass (ICM) also plays an important role on blastocyst selection in the group of older patients. In addition, our data shows that for young women the transfer of a single blastocyst results in similar gestational rates as those for DET. CONCLUSION: We suggest that blastocyst grading for patients aged 35 years or above shall be performed using a strict grading policy, possibly not of a single parameter, but TE, ICM and expansion grades together, to choose the "best combined-score blastocyst". DETs should be considered, particularly after previous cycles with pregnancy failures.

First Baby Born in Brazil after Simultaneous Diagnosis through Non-Invasive and Conventional PGT-A / Primeiro bebê nascido no Brasil após diagnóstico simultâneo por PGT-A não-invasivo e convencional

Abstract Non-invasive preimplantation genetic testing for aneuploidies (niPGT-A) aiming to assess cell-free embryonic DNA in spent culturemedia is promising, especially because it might overcome the diminished rates of implantation caused by the inadequate performance of trophectoderm (TE) biopsy. Our center is part of the largest study to date assessing the concordance between conventional PGT-A and niPGT-A, and we report here the delivery of the first baby born in Brazil using niPGT-A. The parents of the baby were admitted to our center in 2018. They did not present history of infertility, and they were interested in using in vitro fertilization (IVF) and PGT-A in order to avoid congenital anomalies in the offspring. A total of 11 (3 day-5 and 8 day-6) expanded blastocysts were biopsied, and the spent culture media (culture from day-4 to day-6) from 8 day-6 blastocysts were collected for niPGT-A. Overall, 7 embryos yielded informative results for trophectoderm (TE) and media samples. Among the embryos with informative results, 5 presented concordant diagnosis between conventional PGTA and niPGT-A, and 2 presented discordant diagnosis (1 false-positive and one falsenegative). The Blastocyst 4, diagnosed as 46, XY by both niPGT-A and conventional PGTA, was warmed up and transferred, resulting in the birth of a healthy 3.8 kg boy in February 2020. Based on our results and the recent literature, we believe that the safest current application of niPGT-A would be as a method of embryo selection for patients without an indication for conventional PGT-A. The approximate 80% of reliability of niPGT-A in the diagnosis of ploidy is superior to predictions provided by other noninvasive approaches like morphology and morphokinetics selection.

Resumo Abordagens para o teste genético pré-implantacional não-invasivo para aneuploidias (non-invasive preimplantation genetic testing for aneuploidies, niPGT-A, em inglês) com o objetivo de avaliar o DNA embrionário livre são promissoras, especialmente porque estas podem reverter as menores taxas de implantação causadas por inadequada biópsia de trofectoderma (TE). Nesse contexto, nosso centro é parte do maior estudo atual que avalia as taxas de concordância entre PGT-A convencional e niPGT-A, e relatamos aqui o nascimento do primeiro bebê brasileiro após niPGT-A. Os pais do bebê foram admitidos no nosso centro em 2018. Eles não apresentavam histórico de infertilidade, e estavam interessados em utilizar os tratamentos de fertilização in vitro (FIV) e PGT-A para evitar anomalias congênitas na progênie.Umtotal de 11 blastocistos expandidos (3 do dia-5 e 8 do dia-6) foram submetidos a biópsia, e os meios de cultivo condicionados (cultivo do dia-4 ao dia-6) de 8 blastocistos do dia-6 foram coletados para niPGT-A. No total, resultados informativos para as amostras de TE e dos meios foram obtidos para sete embriões. Entre os embriões com resultado informativo, 5 apresentaram diagnóstico concordante entre PGT-A convencional e niPGT-A, e 2 apresentaram diagnóstico discordante (1 falso positivo e 1 falso negativo). O Blastocisto 4, diagnosticado como 46, XY por ambos niPGT-A e PGT-A convencional, foi desvitrificado e transferido, o que resultou no nascimento de ummenino saudável, que pesava 3,8 kg, em fevereiro de 2020. Com base em nossos resultados e literatura contemporânea, acreditamos que a aplicação atualmais segura do niPGT-A seria como método de seleção embrionária para pacientes sem indicação ao PGT-A convencional. A confiabilidade aproximada de 80% do niPGT-A para determinação da ploidia ainda é superior àquela obtida com abordagens não invasivas, como seleção morfológica ou morfocinética.

Level of Physical Activity and In-Hospital Course of Patients with Acute Coronary Syndrome.

BACKGROUND: Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the modern world. A sedentary lifestyle, present in 85% of the Brazilian population, is considered a risk factor for the development of coronary artery disease. However, the correlation of a sedentary lifestyle with cardiovascular events (CVE) during hospitalization for ACS is not well established. OBJECTIVE: To evaluate the association between physical activity level, assessed with the International Physical Activity Questionnaire (IPAQ), with in-hospital prognosis in patients with ACS. METHODS: Observational, cross-sectional, and analytical study with 215 subjects with a diagnosis of ACS consecutively admitted to a referral hospital for cardiac patients between July 2009 and February 2011. All volunteers answered the short version of the IPAQ and were observed for the occurrence of CVE during hospitalization with a standardized assessment conducted by the researcher and corroborated by data from medical records. RESULTS: The patients were admitted with diagnoses of unstable angina (34.4%), acute myocardial infarction (AMI) without ST elevation (41.4%), and AMI with ST elevation (24.2%). According to the level of physical activity, the patients were classified as non-active (56.3%) and active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence of in-hospital complications was associated with the length of hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR = 2.54), and was independent of age, systolic blood pressure, and prior congestive heart failure. CONCLUSION: A physically active lifestyle reduces the risk of CVE during hospitalization in patients with ACS.

[Pulmonary lesions and total parenteral nutrition in children admitted to a pediatric intensive care unit]. / Lesões pulmonares e nutrição parenteral total em crianças internadas em unidade de terapia intensiva pediátrica.

OBJECTIVE: To describe lung injuries in autopsied pediatric patients (neonates through 15 years old) subjected or not to total parenteral nutrition, in an intensive care unit. METHODS: Sections from six paraffin-embedded lung fragments, from 114 children were studied by routine staining. Demographic, clinical and therapeutic data were retrieved from the records. Statistical analysis was performed using Statistical Package for the Social Sciences. RESULTS: The 114 patients were divided in two groups: 50 who were treated with total parenteral nutrition with lipid emulsion and 64 who did not receive total parenteral nutrition. The two groups did not differ in gender (p = 0.654), age (p = 0.682) or body weight (p = 0.175), but duration of hospital stay (p = 0.000), prematurity (p = 0.008) and treatment with blood products (p = 0.009) were all higher in the group treated with total parenteral nutrition. All patients received mechanical ventilation during hospitalization. Chi-square comparisons showed that diffuse alveolar injury (p = 0.022), pulmonary fibrosis (p = 0.019), pneumocyte hyperplasia (p = 0.004), microthromboembolism (p = 0.047) and thrombophlebitis (0.033) all exhibited a significant relationship with total parenteral nutrition. However, a multivariate analysis by logistic regression, taking into account prematurity and duration of hospital stay, demonstrated that total parenteral nutrition was an independent factor only with respect of pulmonary fibrosis. CONCLUSION: Although lung injuries were significantly more frequent in children who had received total parenteral nutrition, it was impossible to conclude that the lipid infusion had a direct relationship with these injuries, because prematurity and duration of hospital stay were significant co-factors.

Embryos from in Vitro Maturation (IVM) Technique Can Be Successfully Vitrified Resulting in the Birth of a Healthy Child.

IVM can be an advantageous technique when applied to PCOS (Polycystic Ovarian Syndrome) patients. The oocytes are retrieved from antral follicles of non-stimulated ovaries, specially preventing hyperstimulation syndrome. Apart from its role as a reproductive treatment, IVM has emerged as a promising tool for emergency fertility preservation, since it can be performed flexibly in either follicular or luteal phase. A 34-year-old patient with PCOS, high body mass index and tubal factor was submitted twice to IVM treatment. Her husband has low count spermatozoa. The first IVM cycle was in 2009, she transferred 3 fresh embryos and got pregnant giving birth to a healthy boy weighing 3.3 kg. In 2013, the patient returned for another IVM cycle and the embryos had to be vitrified because she failed to develop an adequate endometrium for transfer. In the next cycle, the endometrium was prepared using estrogen and progesterone and the two best embryos were warmed up and transferred. She became pregnant and after 36 weeks gave birth to a healthy girl weighing 2.7 kg. She still has four embryos left to transfer. IVM may be an alternative technique to be considered when dealing with PCOS patients. Although clinical outcomes are currently inferior when compared with conventional hormone driven ART (Artificial Reproductive Techniques), it does apply in some cases while preventing hyperstimulation risks. Thus, embryos obtained by IVM can also be vitrified with successful outcomes.

Rede social no cuidado à pessoa estomizada por câncer colorretal / Social network in care for the person ostomized due to colorretal cancer

Objetivo: compreender a influência da rede social no cuidado de pessoas com estomia por câncer colorretal e descrever o tipo de apoio que a rede social oferece para essas pessoas. Método: trata-se de estudo qualitativo, decritivo, com 11 pessoas com câncer colorretal. Coletaram-se os dados por meio de entrevista semiestruturada, submetendo-os a técnica de Análise de Conteúdo. Utilizou-se o referencial teórico-metodológico de rede social de Sanicola. Resultados: observa-se que a rede social primária foi composta principalmente por filhos, irmãos, cônjuges e amigos, que ofereceram apoio emocional, material e cuidados. A rede social secundária, composta pelos profissionais de ambulatórios e hospitais, proporcionou acolhimento, orientações e suporte material. Revela-se a fragilidade das unidades de atenção primária à saúde para atender as demandas de cuidado. Conclusão: demostrou-se que a rede social exerce forte influência no cuidado à pessoa com estomia e ressalta-se a importância do apoio dos profissionais de todos os níveis de atenção à saúde na promoção de uma assistência integral, resolutiva e visando o autocuidado apoiado.(AU)

Objective: to understand the influence of the social network on the care of people with colorectal cancer and to describe the type of support that the social network offers for these people. Method: This is a qualitative, descriptive study, with 11 people with colorectal cancer. The data were collected through a semi-structured interview, subjecting them to the technique of content analysis. The theoretical-methodological framework of Sanicola's social network was used. Results: it is observed that the primary social network was composed mainly of children, siblings, spouses and friends, who offered emotional support, material and care. The secondary social network, made up of professionals from outpatient clinics and hospitals, provided reception, guidance and material support. It reveals the fragility of primary health care units to meet the demands of care. Conclusion: it was demonstrated that the social network exerts a strong influence on the care of the person with ostomy and the importance of the support of the professionals of all levels of attention to health in the promotion of integral assistance, resolutive and aiming at self-care supported.(AU)

Objetivo: comprender la influencia de la red social en el cuidado de personas con estomia por cáncer colorrectal y describir el tipo de apoyo que la red social ofrece para esas personas. Método: se trata de un estudio cualitativo, descriptivo,con 11 personas con cáncer colorrectal. Se recolectaron los datos por medio de entrevista semiestructurada, sometiéndolos a la técnica de análisis de contenido. Se utilizó el referencial teórico-metodológico de red social de Sanicola. Resultados: se observa que la red social primaria fue compuesta principalmente por hijos, hermanos, cónyuges y amigos, que ofrecieron apoyo emocional, material y cuidados. La red social secundaria, compuesta por los profesionales de ambulatorios y hospitales, proporcionó acogida, orientaciones y soporte material. Se revela la fragilidad de las unidades de atención primaria a la salud para atender las demandas de cuidado. Conclusión: se demuestra que la red social ejerce una fuerte influencia en el cuidado a la persona con estomia y se resalta la importancia del apoyo de los profesionales de todos los niveles de atención a la salud en la promoción de una asistencia integral, resolutiva y visando el autocuidado apoyado.(AU)

Perfil sociodemográfico de pacientes com estomia definitiva por câncer colorretal: interferência na qualidade de vida / Sociodemographic profile of patients with definitive ostomy by colorretal cancer: interference in the quality of life / Perfil sociodemográfico de pacientes con estomía definitiva por cáncer colorretal: interferencia en la calidad de vida

Objetivo: Este estudo teve como objetivo descrever o perfil sociodemográfico de pessoas com estomias definitivas acometidas pelo câncer colorretal de um município do Rio de Janeiro e associá-lo à qualidade de vida. Método: Trata-se de um estudo descritivo, transversal, com abordagem quantitativa, realizado no período de janeiro a abril de 2018, no Pólo de Ostomizados I do Município de Itaboraí. Os dados foram coletados mediante questionário estruturado e a análise dos dados foi realizada com o software Minitab versão 18. Resultados: De 83 pessoas cadastradas, somente 35 participaram. Identificouse a predominância do sexo masculino, casados, estomia do tipo colostomia, tempo de estomia de 1-3 anos, idade entre 50 e 69 anos. Conclusão: Esse trabalho possibilitou conhecermos a população de estomizados acometidos pelo câncer colorretal levando, assim, a uma melhor compreensão sobre pessoas com estomias definitivas com o intuito de poder orientar para uma melhor assistência de enfermagem.(AU)

Objetivo: Este estudo teve como objetivo descrever o perfil sociodemográfico de pessoas com estomias definitivas acometidas pelo câncer colorretal de um município do Rio de Janeiro e associá-lo à qualidade de vida. Método: Trata-se de um estudo descritivo, transversal, com abordagem quantitativa, realizado no período de janeiro a abril de 2018, no Pólo de Ostomizados I do Município de Itaboraí. Os dados foram coletados mediante questionário estruturado e a análise dos dados foi realizada com o software Minitab versão 18. Resultados: De 83 pessoas cadastradas, somente 35 participaram. Identificouse a predominância do sexo masculino, casados, estomia do tipo colostomia, tempo de estomia de 1-3 anos, idade entre 50 e 69 anos. Conclusão: Esse trabalho possibilitou conhecermos a população de estomizados acometidos pelo câncer colorretal levando, assim, a uma melhor compreensão sobre pessoas com estomias definitivas com o intuito de poder orientar para uma melhor assistência de enfermagem.(AU)

Objetivo: Este estudio tuvo como objetivo describir el perfil sociodemográfico de personas con estomias definitivas acometidas por el cáncer colorrectal de un Municipio de Río de Janeiro y asociarlo a la calidad de vida. Método: Se trata de un estudio descriptivo, transversal, con abordaje cuantitativo, realizado en el período de enero a abril de 2018, en el Polo de Ostomizados I del Municipio de Itaboraí. Los datos fueron recolectados mediante cuestionario estructurado y el análisis de los datos fue realizado con el software Minitab versión 18. Resultados: De 83 personas catastradas, sólo 35 participaron. Se identificó el predominio del sexo masculino, casados, estomia del tipo colostomía, tiempo de estomia de 1-3 años, edad entre 50 y 69 años. Conclusión: Este trabajo posibilitó conocer a la población de estomizados acometidos por el cáncer colorrectal llevando así una mejor comprensión sobre personas con estomias definitivas con el propósito de poder orientar para una mejor asistencia de enfermería.(AU)

Takayasu's arteritis in children and adolescents: report of three cases.

Takayasu's arteritis (TA) is a systemic vasculitis that affects mainly the aorta and its major branches. Despite being the third most frequent vasculitis in childhood, the occurrence of TA in the pediatric age group is scarce. We report three cases of TA in children, emphasizing signs and symptoms, angiographic alterations and therapeutics.

Level of Physical Activity and In-Hospital Course of Patients with Acute Coronary Syndrome / Nível de Atividade Física e Evolução Intra-Hospitalar de Pacientes com Síndrome Coronariana Aguda

Abstract Background: Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the modern world. A sedentary lifestyle, present in 85% of the Brazilian population, is considered a risk factor for the development of coronary artery disease. However, the correlation of a sedentary lifestyle with cardiovascular events (CVE) during hospitalization for ACS is not well established. Objective: To evaluate the association between physical activity level, assessed with the International Physical Activity Questionnaire (IPAQ), with in-hospital prognosis in patients with ACS. Methods: Observational, cross-sectional, and analytical study with 215 subjects with a diagnosis of ACS consecutively admitted to a referral hospital for cardiac patients between July 2009 and February 2011. All volunteers answered the short version of the IPAQ and were observed for the occurrence of CVE during hospitalization with a standardized assessment conducted by the researcher and corroborated by data from medical records. Results: The patients were admitted with diagnoses of unstable angina (34.4%), acute myocardial infarction (AMI) without ST elevation (41.4%), and AMI with ST elevation (24.2%). According to the level of physical activity, the patients were classified as non-active (56.3%) and active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence of in-hospital complications was associated with the length of hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR = 2.54), and was independent of age, systolic blood pressure, and prior congestive heart failure. Conclusion: A physically active lifestyle reduces the risk of CVE during hospitalization in patients with ACS.

Resumo Fundamento: A síndrome coronariana aguda (SCA) constitui uma das principais causas de morbimortalidade no mundo moderno. O sedentarismo, presente em 85% da população brasileira, é considerado fator de risco para o surgimento de doença arterial coronariana. Porém, não está bem estabelecida a correlação do sedentarismo com a ocorrência de eventos cardiovasculares (ECV) durante o internamento de portadores da SCA. Objetivo: Determinar o grau de atividade física de portadores de SCA, mediante a utilização do Questionário Internacional de Atividade Física (IPAQ), associando com o prognóstico intra-hospitalar. Métodos: Estudo observacional, transversal e analítico com 215 sujeitos admitidos consecutivamente com diagnóstico de SCA em um hospital de referência cardiológica no período de julho de 2009 a fevereiro de 2011. Todos os voluntários responderam à versão curta do IPAQ e foram seguidos quanto ao aparecimento de ECV durante o internamento, a partir de avaliação padronizada administrada pelo pesquisador, corroborada com dados do prontuário médico. Resultados: Os pacientes foram internados com diagnósticos de angina instável (34,4%), infarto agudo do miocárdio (IAM) sem supradesnivelamento de ST (41,4%) e IAM com supradesnivelamento de ST (24,2%). De acordo com o nível de atividade física, foram classificados em não ativos (56,3%) e ativos (43,7%). Constatou-se a presença de ECV em 35,3% da amostra. A ocorrência de complicação intra-hospitalar esteve associada ao tempo de internamento (odds ratio [OR] = 1,15) e inatividade física (OR = 2,54) e foi independente da idade, pressão arterial sistólica e insuficiência cardíaca congestiva prévia. Conclusão: Estilo de vida fisicamente ativo reduz o risco de ECV durante o internamento em pacientes com SCA.

O enfermeiro e sua participação no processo de reabilitação da pessoa com estoma / El enfermero y su participacion en la rehabilitacion de personas con estoma / The nurse and her participation in the process of rehabilitation of the person with a stoma

O estudo teve como objeto o papel do enfermeiro no processo de reabilitação dos estomizados, destacando-se sua inclusão laboral. O objetivo foi discutir, a partir do ponto de vista do estomizado, as orientações fornecidas pelos enfermeiros em relação à inclusão laboral. Trata-se de uma pesquisa descritivo-exploratória, qualitativa, realizada com vinte estomizados definitivos, em um instituto de reabilitação localizado no Rio de Janeiro, por meio de entrevista semiestruturada. Os resultados revelaram que poucos estomizados foram orientados pelos profissionais de enfermagem a respeito do retorno às atividades trabalhistas, e que os referidos profissionais não foram citados como essenciais para o processo de reabilitação dos sujeitos do estudo. Conclui-se que há lacunas e equívocos neste processo de reabilitação, principalmente em relação às orientações sobre a inclusão social pelo trabalho, que podem ser ocasionados pela falta de conhecimento dos enfermeiros em relação à temática, e pela não aplicação da Sistematização da Assistência em Enfermagem.

The object of this study is the role of the nurse in the process of rehabilitation of persons with stomas, with emphasis on their inclusion in work. The objective was to discuss, from the perspective of the person with a stoma, the guidance provided by the nurses in relation to inclusion in work activities. It is descriptive-exploratory qualitative research, carried out using a semi-structured interview with twenty persons with permanent stomas, in a rehabilitation institute in Rio de Janeiro. The results showed that few of the people with stomas received guidance from the nursing professionals in relation to returning to work activities, and the health professionals were not referred to as essential for the study's subjects' rehabilitative process. It is concluded that there are gaps and misconceptions in this process of rehabilitation, principally in relation to the advice on social inclusion through work, which may be caused by the nurses' lack of knowledge regarding the issue; and the non-application of Systematization of Nursing Care.

The object of this study is the role of the nurse in the process of rehabilitation of persons with stomas, with emphasis on their inclusion in work. The objective was to discuss, from the perspective of the person with a stoma, the guidance provided by the nurses in relation to inclusion in work activities. It is descriptive-exploratory qualitative research, carried out using a semi-structured interview with twenty persons with permanent stomas, in a rehabilitation institute in Rio de Janeiro. The results showed that few of the people with stomas received guidance from the nursing professionals in relation to returning to work activities, and the health professionals were not referred to as essential for the study's subjects' rehabilitative process. It is concluded that there are gaps and misconceptions in this process of rehabilitation, principally in relation to the advice on social inclusion through work, which may be caused by the nurses' lack of knowledge regarding the issue; and the non-application of Systematization of Nursing Care.