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BACKGROUND: Rosacea is a chronic inflammatory disease, and doxycycline is a widely recommended treatment for it due to its anti-inflammatory action. Oral isotretinoin reduces sebaceous gland activity and modulates toll-like receptors, reducing inflammation. Our aim was to investigate the effect of these two drugs on the expression of cutaneous immunohistochemical biomarkers related to etiopathogenic factors involved in rosacea. METHODS: We conducted a randomized, comparative, and evaluator-blinded trial, including 40 participants with moderate and severe papulopustular and ocular rosacea. Participants were treated with doxycycline (DOXY) 100 mg or isotretinoin (ISO) 0.3 mg/kg daily. Immunohistochemistry at baseline and after 4 months was used to demonstrate the expression of the biomarker on the affected skin. RESULTS: The following changes were detected: a reduction in the vessel count after using VEGF with DOXY (P = 0.010); a decrease in VEGF intensity with ISO (P < 0.001) and DOXY (P = 0.020); a reduction of nitric oxide synthase enzyme with both drugs in the inflammatory infiltrate (ISO P < 0.001; DOXY P = 0.003); however, only with ISO was there a significant (P = 0.030) decrease at the level of the sebaceous glands, indicating a reduction of nitric oxide synthesis; a reduction of TRPV-1 expression at the level of the sebaceous glands was observed only with DOXY (P = 0.041); a decrease of cathelicidin LL37 expression, a key antimicrobial peptide in the etiopathogenesis of rosacea, was noted with both drugs, although at the level of sebaceous glands, only with DOXY (P = 0.007). CONCLUSIONS: Oral isotretinoin and doxycycline have modified the expression of cutaneous biomarkers related to rosacea etiopathogenesis, demonstrating their role in controlling inflammatory and vascular processes.
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OBJECTIVE: The aim of this study was to understand the dynamics of families with children with myelomeningocele undergoing intrauterine fetal surgery. METHODS: A retrospective cohort pilot study was carried out with 11 mothers of children who had undergone intrauterine myelomeningocele repair. Participants in this study responded to an electronic questionnaire (via Google Forms), developed by the study authors, that consisted of 22 multiple-choice questions, of which 17 were closed-ended and 5 had a standardized format. RESULTS: The mean (± standard deviation) of the mothers' age was 37.6 (± 3.5) years. The median of gestational age at delivery and birthweight were 34.9 (range, 33 to 36.1) weeks and 2,300 (range, 1,950 to 2,763) g, respectively. The majority of mothers were white (81.8%), had university degree (81.8%), were Catholic (63.6%), and were married (100%). The majority of mothers rated their relationship with their husband, family, and friends as excellent (54.5, 72.7, and 54.5%, respectively). All 11 mothers reported that the newborn with myelomeningocele was born <37 weeks gestation and the birthweight most often<2,500 g. Approximately 64% of the mothers reported that their child required adaptations or had special needs, of which walking aids (50%) and bladder control (50%) were the most common ones. CONCLUSION: Telemedicine proved to be a useful tool in the long-term follow-up of children who underwent intrauterine surgery to correct myelomeningocele.
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Meningomielocele , Mães , Telemedicina , Humanos , Meningomielocele/cirurgia , Projetos Piloto , Feminino , Adulto , Estudos Retrospectivos , Inquéritos e Questionários , Gravidez , Recém-Nascido , Relações Familiares , Idade GestacionalRESUMO
INTRODUCTION AND OBJECTIVES: Food allergy has several negative nutritional consequences and may persist beyond the first year of lives. This study aimed to assess the role of a complete oral amino acid-based supplement in the diet of children on cow's milk protein elimination diet because of food allergy. MATERIALS AND METHODS: This study included two groups of children aged 1-5 years paired by age and socioeconomic status: (1) study group, on cow's milk protein elimination diet plus an oral amino acid-based supplement, and (2) control group, on cow's milk protein elimination diet. Sociodemographic, clinical, anthropometric, and dietary data were obtained through online interviews. Two 24-h dietary recalls were collected on nonconsecutive days. Both groups comprised mostly boys. RESULTS: The study group presented lower values of body mass index. The frequency of feeding difficulties was similar between groups. The study group had a higher intake of energy, protein, carbohydrates, calcium, iron, zinc, phosphorus, magnesium, copper, selenium, vitamins D, E, B1, B2, B6, and B12, niacin, and folic acid compared to the control group. A higher proportion of children in the study group had adequate intake according to the recommendations made for energy, carbohydrates, iron, phosphorus, selenium, vitamins A, D, E, B1, B2, and B6, and folic acid. CONCLUSIONS: The use of a complete oral amino acid-based supplement has a positive effect on the diet quality of preschoolers on cow's milk elimination diet because of food allergy, promoting higher intake of energy, calcium, vitamin D, and other essential nutrients.
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Aminoácidos , Suplementos Nutricionais , Hipersensibilidade a Leite , Animais , Bovinos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Aminoácidos/administração & dosagem , Estudos Transversais , Dieta de Eliminação , Leite/imunologia , Proteínas do Leite/administração & dosagem , Proteínas do Leite/imunologiaRESUMO
This study analyzed food insecurity and associated factors in the urban area of a municipality in the Amazon River basin, Western Amazon. This is a cross-sectional population-based study conducted from August to November 2021 with 983 households selected by stratified probability sampling. A multinomial logistic regression model was used, adopting the following criteria: p-value < 20% in the bivariate analysis and p-value < 5% for the multivariate adjustment. The results of the analyses were described as odds ratio (OR) and 95% confidence interval (95%CI). The following variables were significantly associated with mild or moderate food insecurity: household water insecurity; number of residents ≥ 5 in the household; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; and having any resident as a beneficiary of the Brazilian Income Transfer Program. The analysis model for severe food insecurity showed that living with household water insecurity; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; age of the head of the family < 55 years; and family income lower that two minimum wages increased the chances of severe food insecurity when compared to those with food security. In conclusion, this study found a high prevalence of food insecurity in the Municipality of Itapiranga, State of Amazonas, North Region of Brazil, associated with social and economic vulnerability, lack of public services, and household water insecurity.
Este estudo analisa a insegurança alimentar e os fatores a ela associados na área urbana de um município na bacia hidrográfica do Rio Amazonas, Amazônia Ocidental. Trata-se de pesquisa transversal, de base populacional, realizada de agosto a novembro de 2021, com 983 domicílios selecionados por amostragem probabilística estratificada. Empregou-se o modelo de regressão logística multinomial, adotando-se os seguintes critérios: valor de p < 20% na análise bivariada e valor de p < 5% para o ajuste multivariado. Os resultados das análises foram descritos como odds ratios (OR) e intervalo de 95% de confiança (IC95%). Foram significantemente associadas à insegurança alimentar leve ou moderada as seguintes variáveis: insegurança hídrica domiciliar, número de moradores ≥ 5 no domicílio, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro, como chefe da família e ter algum morador beneficiário do Programa Bolsa Família. No modelo de análise para a insegurança alimentar grave constatou-se que viver em insegurança hídrica domiciliar, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro chefe da família, e tendo este menos que 55 anos, e renda familiar menor que dois salários mínimos aumentaram as chances de insegurança alimentar grave, comparativamente àqueles em segurança alimentar. Em conclusão, verificou-se alta prevalência de insegurança alimentar no Município de Itapiranga, Amazonas, Região Norte do Brasil, associada à situação de vulnerabilidade social e econômica, à falta de serviços públicos e à insegurança hídrica domiciliar.
Este estudio analiza la inseguridad alimentaria y los factores asociados, en el área urbana de un municipio de la cuenca hidrográfica del río Amazonas, Amazonia occidental. Se trata de una encuesta transversal, de base poblacional, realizada en el período de agosto a noviembre del 2021, con 983 hogares seleccionados mediante muestreo probabilístico estratificado. Se utilizó el modelo de regresión logística multinomial, adoptando los siguientes criterios: valor de p < 20% en el análisis bivariado y valor de p < 5% para el ajuste multivariado. Los resultados de los análisis se describieron como odds ratios (OR) e intervalo de 95% de confianza (IC95%). Las siguientes variables se asociaron significativamente con la inseguridad alimentaria leve o moderada: inseguridad hídrica en el hogar, número de residentes ≥ 5 en el hogar, pertenecer a la clase socioeconómica "D" o "E", tener padre, madre u otra persona como cabeza de familia y tener a algún residente como beneficiario del Programa Bolsa Familia. En el modelo de análisis para la inseguridad alimentaria severa se encontró que vivir en hogar con inseguridad hídrica, pertenecer a la clase socioeconómica D o E, tener padre, madre u otra persona como cabeza de familia, edad del jefe de familia < 55 años, y un ingreso familiar más bajo que dos salarios mínimos aumentó las probabilidades de sufrir inseguridad alimentaria grave, en comparación con aquellos en situación de seguridad alimentaria. En conclusión, se constató una alta prevalencia de inseguridad alimentaria en el Municipio de Itapiranga, en el interior del Amazonas, Región Norte de Brasil, asociada a la situación de vulnerabilidad social y económica, a la falta de servicios públicos y a la inseguridad hídrica de los hogares.
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Características da Família , Insegurança Alimentar , Fatores Socioeconômicos , Humanos , Brasil/epidemiologia , Estudos Transversais , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Insegurança Hídrica , População Urbana/estatística & dados numéricos , Adulto Jovem , Rios , Abastecimento de Alimentos/estatística & dados numéricosRESUMO
Objective: To evaluate the cumulative incidence, risk factors, and outcomes of COVID-19 in patients with Cushing's disease (CD). Subjects and methods: In all, 60 patients with CD following up in our outpatient clinic answered via phone interview a questionnaire about the occurrence of COVID-19 infection documented by RT-PCR (including the diagnosis date and clinical outcome) and vaccination status. Clinical and biochemical data on disease activity (hypercortisolism) and comorbidities (obesity, diabetes mellitus, and hypertension) were obtained from the patients' electronic medical records. Risk ratios (RRs) of risk factors were obtained using univariate and multivariate analyses. Results: The cumulative incidence of COVID-19 in patients with CD during the observation period was 31.7%, which was higher than that in the general reference population (9.5%). The cumulative incidence of COVID-19 was significantly higher in patients with hypercortisolism (57% versus 17% in those without hypercortisolism, p = 0.012) and obesity (54% versus 9% in those without obesity, p < 0.001) but not in patients with hypertension or diabetes mellitus. On multivariate analysis, hypercortisolism and obesity were each independent risk factors for COVID-19 (RR 2.18, 95% CI 1.06-4.46, p = 0.033 and RR 5.19, 95% CI 1.61-16.74, p = 0.006, respectively). Conclusion: The incidence of COVID-19 in patients with CD was associated with hypercortisolism, as expected, and obesity, a novel and unexpected finding. Thus, correction of hypercortisolism and obesity should be implemented in patients with CD during the current and future COVID-19 outbreaks.
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COVID-19 , Síndrome de Cushing , Diabetes Mellitus , Hipertensão , Hipersecreção Hipofisária de ACTH , Humanos , Hipersecreção Hipofisária de ACTH/complicações , Hipersecreção Hipofisária de ACTH/epidemiologia , Síndrome de Cushing/complicações , Síndrome de Cushing/epidemiologia , COVID-19/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Hipertensão/epidemiologia , Diabetes Mellitus/epidemiologiaRESUMO
OBJECTIVE: To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN: Retrospective cohort with data retrieved from an ongoing national registry. SETTING: 19 Brazilian university public hospitals. PATIENTS: Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES: Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS: Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION: The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.
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ABSTRACT Objective: To evaluate the cumulative incidence, risk factors, and outcomes of COVID-19 in patients with Cushing's disease (CD). Subjects and methods: In all, 60 patients with CD following up in our outpatient clinic answered via phone interview a questionnaire about the occurrence of COVID-19 infection documented by RT-PCR (including the diagnosis date and clinical outcome) and vaccination status. Clinical and biochemical data on disease activity (hypercortisolism) and comorbidities (obesity, diabetes mellitus, and hypertension) were obtained from the patients' electronic medical records. Risk ratios (RRs) of risk factors were obtained using univariate and multivariate analyses. Results: The cumulative incidence of COVID-19 in patients with CD during the observation period was 31.7%, which was higher than that in the general reference population (9.5%). The cumulative incidence of COVID-19 was significantly higher in patients with hypercortisolism (57% versus 17% in those without hypercortisolism, p = 0.012) and obesity (54% versus 9% in those without obesity, p < 0.001) but not in patients with hypertension or diabetes mellitus. On multivariate analysis, hypercortisolism and obesity were each independent risk factors for COVID-19 (RR 2.18, 95% CI 1.06-4.46, p = 0.033 and RR 5.19, 95% CI 1.61-16.74, p = 0.006, respectively). Conclusion: The incidence of COVID-19 in patients with CD was associated with hypercortisolism, as expected, and obesity, a novel and unexpected finding. Thus, correction of hypercortisolism and obesity should be implemented in patients with CD during the current and future COVID-19 outbreaks.
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Resumo: Este estudo analisa a insegurança alimentar e os fatores a ela associados na área urbana de um município na bacia hidrográfica do Rio Amazonas, Amazônia Ocidental. Trata-se de pesquisa transversal, de base populacional, realizada de agosto a novembro de 2021, com 983 domicílios selecionados por amostragem probabilística estratificada. Empregou-se o modelo de regressão logística multinomial, adotando-se os seguintes critérios: valor de p < 20% na análise bivariada e valor de p < 5% para o ajuste multivariado. Os resultados das análises foram descritos como odds ratios (OR) e intervalo de 95% de confiança (IC95%). Foram significantemente associadas à insegurança alimentar leve ou moderada as seguintes variáveis: insegurança hídrica domiciliar, número de moradores ≥ 5 no domicílio, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro, como chefe da família e ter algum morador beneficiário do Programa Bolsa Família. No modelo de análise para a insegurança alimentar grave constatou-se que viver em insegurança hídrica domiciliar, pertencer à classe socioeconômica D ou E, ter pai, mãe ou outro chefe da família, e tendo este menos que 55 anos, e renda familiar menor que dois salários mínimos aumentaram as chances de insegurança alimentar grave, comparativamente àqueles em segurança alimentar. Em conclusão, verificou-se alta prevalência de insegurança alimentar no Município de Itapiranga, Amazonas, Região Norte do Brasil, associada à situação de vulnerabilidade social e econômica, à falta de serviços públicos e à insegurança hídrica domiciliar.
Abstract: This study analyzed food insecurity and associated factors in the urban area of a municipality in the Amazon River basin, Western Amazon. This is a cross-sectional population-based study conducted from August to November 2021 with 983 households selected by stratified probability sampling. A multinomial logistic regression model was used, adopting the following criteria: p-value < 20% in the bivariate analysis and p-value < 5% for the multivariate adjustment. The results of the analyses were described as odds ratio (OR) and 95% confidence interval (95%CI). The following variables were significantly associated with mild or moderate food insecurity: household water insecurity; number of residents ≥ 5 in the household; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; and having any resident as a beneficiary of the Brazilian Income Transfer Program. The analysis model for severe food insecurity showed that living with household water insecurity; belonging to socioeconomic class D or E; having a father, mother or another as the head of the family; age of the head of the family < 55 years; and family income lower that two minimum wages increased the chances of severe food insecurity when compared to those with food security. In conclusion, this study found a high prevalence of food insecurity in the Municipality of Itapiranga, State of Amazonas, North Region of Brazil, associated with social and economic vulnerability, lack of public services, and household water insecurity.
Resumen: Este estudio analiza la inseguridad alimentaria y los factores asociados, en el área urbana de un municipio de la cuenca hidrográfica del río Amazonas, Amazonia occidental. Se trata de una encuesta transversal, de base poblacional, realizada en el período de agosto a noviembre del 2021, con 983 hogares seleccionados mediante muestreo probabilístico estratificado. Se utilizó el modelo de regresión logística multinomial, adoptando los siguientes criterios: valor de p < 20% en el análisis bivariado y valor de p < 5% para el ajuste multivariado. Los resultados de los análisis se describieron como odds ratios (OR) e intervalo de 95% de confianza (IC95%). Las siguientes variables se asociaron significativamente con la inseguridad alimentaria leve o moderada: inseguridad hídrica en el hogar, número de residentes ≥ 5 en el hogar, pertenecer a la clase socioeconómica "D" o "E", tener padre, madre u otra persona como cabeza de familia y tener a algún residente como beneficiario del Programa Bolsa Familia. En el modelo de análisis para la inseguridad alimentaria severa se encontró que vivir en hogar con inseguridad hídrica, pertenecer a la clase socioeconómica D o E, tener padre, madre u otra persona como cabeza de familia, edad del jefe de familia < 55 años, y un ingreso familiar más bajo que dos salarios mínimos aumentó las probabilidades de sufrir inseguridad alimentaria grave, en comparación con aquellos en situación de seguridad alimentaria. En conclusión, se constató una alta prevalencia de inseguridad alimentaria en el Municipio de Itapiranga, en el interior del Amazonas, Región Norte de Brasil, asociada a la situación de vulnerabilidad social y económica, a la falta de servicios públicos y a la inseguridad hídrica de los hogares.
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ABSTRACT Objective: to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. Methods: a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. Results: 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. Conclusions: assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.
RESUMEN Objetivo: analizar el grado de afectación tisular en las lesiones tempranas del pezón resultantes de la lactancia materna y asociar los hallazgos con las manifestaciones clínicas de las mujeres que amamantan. Métodos: estudio retrospectivo, transversal, con datos primarios y banco de imágenes fotográficas de dos ensayos clínicos aleatorizados. Las imágenes fotográficas fueron analizadas por dos evaluadores independientes, utilizando el Nipple Trauma Score. Para el análisis se aplicaron las pruebas de Chi-Cuadrado, Mann-Whitney y coeficiente Kappa. Resultados: se analizaron 115 mujeres lactantes y sus respectivas 186 imágenes fotográficas. El grado de acuerdo de los evaluadores utilizando el Nipple Trauma Score fue del 93,6%. El nivel de dolor en el pezón durante la lactancia es moderado y existe presencia de lesiones del pezón con más del 25% de la superficie del pezón comprometida. Conclusiones: la asistencia a la mujer lactante debe priorizar el nivel de dolor que presenta en detrimento del tamaño de la lesión del pezón.
RESUMO Objetivo: analisar o grau de comprometimento tecidual das lesões mamilares precoces decorrentes da amamentação e associar achados com as manifestações clínicas de mulheres em amamentação. Métodos: estudo retrospectivo, transversal, envolvendo o uso de dados primários e de banco de imagens fotográficas provenientes de dois ensaios clínicos randomizados. Imagens fotográficas foram analisadas por duas avaliadoras independentes a partir do instrumento Nipple Trauma Score. Para análise, aplicou-se os testes Qui-Quadrado, Mann-Whitney e coeficiente Kappa. Resultados: foram analisadas 115 lactantes e respectivas 186 imagens fotográficas. O grau de concordância das avaliadoras pelo instrumento Nipple Trauma Score foi de 93,6%. O nível de dor mamilar encontrado durante as mamadas é moderado e há presença de lesões mamilares com mais de 25% de área da superfície do mamilo comprometida. Conclusões: a assistência a mulheres que amamentam deve priorizar o nível de dor apresentado em detrimento do tamanho da lesão mamilar.
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SUMMARY OBJECTIVE: The aim of this study was to understand the dynamics of families with children with myelomeningocele undergoing intrauterine fetal surgery. METHODS: A retrospective cohort pilot study was carried out with 11 mothers of children who had undergone intrauterine myelomeningocele repair. Participants in this study responded to an electronic questionnaire (via Google Forms), developed by the study authors, that consisted of 22 multiple-choice questions, of which 17 were closed-ended and 5 had a standardized format. RESULTS: The mean (± standard deviation) of the mothers' age was 37.6 (± 3.5) years. The median of gestational age at delivery and birthweight were 34.9 (range, 33 to 36.1) weeks and 2,300 (range, 1,950 to 2,763) g, respectively. The majority of mothers were white (81.8%), had university degree (81.8%), were Catholic (63.6%), and were married (100%). The majority of mothers rated their relationship with their husband, family, and friends as excellent (54.5, 72.7, and 54.5%, respectively). All 11 mothers reported that the newborn with myelomeningocele was born <37 weeks gestation and the birthweight most often<2,500 g. Approximately 64% of the mothers reported that their child required adaptations or had special needs, of which walking aids (50%) and bladder control (50%) were the most common ones. CONCLUSION: Telemedicine proved to be a useful tool in the long-term follow-up of children who underwent intrauterine surgery to correct myelomeningocele.
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OBJECTIVE: to analyze the initial nipple damage degree by breastfeeding practice and to associate findings with clinical manifestations of breastfeeding women. METHODS: a retrospective, cross-sectional study with primary data and photographic images database from two randomized clinical trials. Photographic images were analyzed by two independent evaluators using the Nipple Trauma Score. For analysis, the chi-square, Mann-Whitney tests and Kappa coefficient were applied. RESULTS: 115 breastfeeding women and their respective 186 photographic images were analyzed. The degree of agreement of evaluators using the Nipple Trauma Score was 93.6%. The nipple pain score during breastfeeding was moderate and compromised more than 25% of the nipple surface area. CONCLUSIONS: assistance to breastfeeding women should prioritize nipple pain intensity instead of the nipple damage size.
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Aleitamento Materno , Mamilos , Humanos , Feminino , Estudos Retrospectivos , Mamilos/lesões , Estudos Transversais , Medição da Dor/métodosRESUMO
OBJECTIVES: This study aimed to analyze, in the São Paulo state of Brazil, time trends in prevalence, neonatal mortality, and neonatal lethality of central nervous system congenital malformations (CNS-CM) between 2004 and 2015. METHODS: Population-based study of all live births with gestational age ≥22 weeks and/or birthweight ≥400 g from mothers living in São Paulo State, during 2004-2015. CNS-CM was defined by the presence of International Classification Disease 10th edition codes Q00-Q07 in the death and/or live birth certificates. CNS-CM was classified as isolated (only Q00-Q07 codes), and non-isolated (with congenital anomalies codes nonrelated to CNS-CM). CNS-CM associated neonatal death was defined as death between 0 and 27 days after birth in infants with CNS-CM. CNS-CM prevalence, neonatal mortality, and lethality rates were calculated, and their annual trends were analyzed by Prais-Winsten Model. The annual percent change (APC) with 95% confidence interval (95%CI) was obtained. RESULTS: 7,237,628 live births were included in the study and CNS-CM were reported in 7526 (0.1%). CNS-CM associated neonatal deaths occurred in 2935 (39.0%). Isolated CNS-CM and non-isolated CNS-CM were found respectively in 5475 and 2051 livebirths, with 1525 (28%) and 1410 (69%) neonatal deaths. CNS-CM prevalence and neonatal lethality were stationary, however neonatal mortality decreased (APC -1.66; 95%CI -3.09 to -0.21) during the study. For isolated CNS-CM, prevalence, neonatal mortality, and lethality decreased over the period. For non-isolated CNS-CM, the prevalence increased, neonatal mortality was stationary, and lethality decreased during the period. The median time of CNS-CM associated neonatal deaths was 18 h after birth. CONCLUSIONS: During a 12-year period in São Paulo State, Brazil, neonatal mortality of infants with CNS-CM in general and with isolated CNS-CM showed a decreasing pattern. Nevertheless CNS-CM mortality remained elevated, mostly in the first day after birth.
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Malformações do Sistema Nervoso , Morte Perinatal , Recém-Nascido , Lactente , Gravidez , Feminino , Humanos , Nascido Vivo/epidemiologia , Brasil/epidemiologia , Malformações do Sistema Nervoso/epidemiologia , Mortalidade InfantilRESUMO
OBJECTIVE: Evaluate the pain of critically ill newborns is a challenge because of the devices for cardiorespiratory support. This study aim to verify the adults' gaze when assessing the critically ill neonates' pain at bedside. STUDY DESIGN: Cross-sectional study in which pediatricians, nursing technicians, and parents evaluated critically ill neonates' pain at bedside, for 20 seconds with eye-tracking glasses. At the end, they answered whether the neonate was in pain or not. Visual tracking outcomes: number and time of visual fixations in four areas of interest (AOI) (face, trunk, and upper [UL] and lower [LL] limbs) were compared between groups and according to pain perception (present/absent). RESULTS: A total of 62 adults (21 pediatricians, 23 nursing technicians, 18 parents) evaluated 27 neonates (gestational age: 31.8 ± 4.4 weeks; birth weight: 1,645 ± 1,234 g). More adults fixed their gaze on the face (96.8%) and trunk (96.8%), followed by UL (74.2%) and LL (66.1%). Parents performed a greater number of fixations on the trunk than nursing technicians (11.0 vs. 5.5 vs. 6.0; p = 0.023). Controlled for visual tracking variables, each second of eye fixation in AOI (1.21; 95% confidence interval [CI]: 1.03-1.42; p = 0.018) and UL (1.07; 95% CI: 1.03-1.10; p < 0.001) increased the chance of perceiving the presence of pain. CONCLUSION: Adults, when assessing at bedside critically ill newborns' pain, fixed their eyes mainly on the face and trunk. The time spent looking at the UL was associated with the perception of pain presence. KEY POINTS: · Pain assessment in critically ill newborns is a challenge.. · To assess critically ill neonates' pain, adults mainly look at the face and trunk.. · Looking at the upper limbs also helps in assessing critically ill neonates' pain..
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OBJECTIVE: to describe the frequency of underreporting of unfavorable outcomes of congenital syphilis in the state of São Paulo, Brazil, 2007-2018. METHODS: this was a descriptive study of cases of abortion, fetal and non-fetal deaths due to congenital syphilis reported on the Notifiable Health Conditions Information System (Sistema de Informação de Agravos de Notificação - SINAN), and those of congenital syphilis registered in any line in the Death Certificate, on the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM), by means of probabilistic and deterministic linkage. RESULTS: of the 27,713 cases of congenital syphilis reported, 1,320 progressed to death (871 fetal deaths, 449 infant deaths) and were matched to the SIM; 355 deaths (259 fetal deaths, 96 infant deaths) were not included on SINAN; there was an increase in unfavorable outcomes,11.4% for infant deaths due to congenital syphilis, 3.0% for fetal deaths and 1.9% for abortions. CONCLUSION: the use of different relationship techniques proved to be adequate to identify the frequency of underreporting of unfavorable outcomes of congenital syphilis in the state of São Paulo.
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Sífilis Congênita , Lactente , Gravidez , Feminino , Humanos , Sífilis Congênita/epidemiologia , Brasil/epidemiologia , Morte Fetal , Sistemas de Informação , Morte do LactenteRESUMO
Introduction: Premature birth, perinatal asphyxia, and infections are the main causes of neonatal death. Growth deviations at birth also affect neonatal survival according to week of gestation at birth, particularly in developing countries. The purpose of this study was to verify the association between inappropriate birth weight and neonatal death in term live births. Methods: This is an observational follow-up study with all term live births from 2004 to 2013 in Sao Paulo State, Brazil. Data were retrieved with the deterministic linkage of death and birth certificates. The definition of very small for gestational age (VSGA) and very large for gestational age (VLGA) used the 10th percentile of 37 weeks and the 90th percentile of 41 weeks + 6 days, respectively, based on the Intergrowth-21st. We measured the outcome in terms of time to death and the status of each subject (death or censorship) in the neonatal period (0-27 days). Survival functions were calculated using the Kaplan-Meier method stratified according to the adequacy of birth weight into three groups (normal, very small, or very large). We used multivariate Cox regression to adjust for proportional hazard ratios (HRs). Results: The neonatal death rate during the study period was 12.03/10,000 live births. We found 1.8% newborns with VSGA and 2.7% with VLGA. The adjusted analysis showed a significant increase in mortality risk for VSGA infants (HR = 4.25; 95% CI: 3.89-4.65), independent of sex, 1-min Apgar score, and five maternal factors. Discussion: The risk of neonatal death in full-term live births was approximately four times greater in those with birth weight restriction. The development of strategies to control the factors that determine fetal growth restriction through planned and structured prenatal care can substantially reduce the risk of neonatal death in full-term live births, especially in developing countries such as Brazil.
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This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.
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Força da Mão , Humanos , Feminino , Idoso , Masculino , Estudos Transversais , Fatores de RiscoRESUMO
Moderate and late preterm newborns comprise around 85% of live births < 37 weeks gestation. Data on their neonatal mortality in middle-income countries is limited. This study aims to analyze the temporal trend, causes and timing of neonatal mortality of infants with 320/7-366/7 weeks gestation without congenital anomalies from 2004-2015 in the population of São Paulo State, Brazil. A database was built by deterministic linkage of birth and death certificates. Causes of death were classified by ICD-10 codes. Among 7,317,611 live births in the period, there were 545,606 infants with 320/7-366/7 weeks gestation without congenital anomalies, and 5782 of them died between 0 and 27 days. The neonatal mortality rate decreased from 16.4 in 2004 to 7.6 per thousand live births in 2015 (7.47% annual decrease by Prais-Winsten model). Perinatal asphyxia, respiratory disorders and infections were responsible, respectively, for 14%, 27% and 44% of the 5782 deaths. Median time to death was 24, 53 and 168 h, respectively, for perinatal asphyxia, respiratory disorders, and infections. Bottlenecks in perinatal health care are probably associated with the results that indicate the need for policies to reduce preventable neonatal deaths of moderate and late preterm infants in the most developed state of Brazil.
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BACKGROUND: In high- and middle-income countries, mortality associated to congenital diaphragmatic hernia (CDH) is high and variable. In Brazil, data is scarce regarding the prevalence, mortality, and lethality of CDH. This study aimed to analyze, in São Paulo state of Brazil, the temporal trends of prevalence, neonatal mortality and lethality of CDH and identify the time to CDH-associated neonatal death. METHODS: Population-based study of all live births with gestational age ≥ 22 weeks, birthweight ≥400g, from mothers residing in São Paulo State, Brazil, during 2004-2015. CDH definition and its subgroups classification were based on ICD-10 codes reported in the death and/or live birth certificates. CDH-associated neonatal death was defined as death up to 27 days after birth of infants with CDH. CDH prevalence, neonatal mortality and lethality were calculated and their annual percent change (APC) with 95% confidence intervals (95%CI) was analyzed by Prais-Winsten. Kaplan-Meier estimator identified the time after birth that CDH-associated neonatal death occurred. RESULTS: CDH prevalence was 1.67 per 10,000 live births, with a significant increase throughout the period (APC 2.55; 95%CI 1.30 to 3.83). CDH neonatal mortality also increased over the time (APC 2.09; 95%CI 0.27 to 3.94), while the lethality was 78.78% and remained stationary. For isolated CDH, CDH associated to non-chromosomal anomalies and CDH associated to chromosomal anomalies the lethality was, respectively, 72.25%, 91.06% and 97.96%, during the study period. For CDH as a whole and for all subgroups, 50% of deaths occurred within the first day after birth. CONCLUSIONS: During a 12-year period in São Paulo State, Brazil, CDH prevalence and neonatal mortality showed a significant increase, while lethality remained stable, yet very high, compared to rates reported in high income countries.
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Hérnias Diafragmáticas Congênitas , Morte Perinatal , Recém-Nascido , Lactente , Feminino , Humanos , Hérnias Diafragmáticas Congênitas/epidemiologia , Brasil/epidemiologia , Mortalidade Infantil , Peso ao NascerRESUMO
OBJECTIVE: To evaluate students' qualification after a six-month basic course of Neonatal Performed Echocardiography (NPEcho), adjusted by the motivational profile. STUDY DESIGN: Prospective cohort of 16 neonatologists/neonatal fellows who underwent the basic NPEcho course in 2019 (18 h face-to-face theoretical classes; 36 h hands-on training) and 12 in 2020 (18 h online theoretical classes; 36 h hands-on training). Students' qualification was defined as ≥70% in post-test, video test, and practical evaluation in neonates. Academic Motivation Scale was applied. RESULTS: Scores in 2019 vs. 2020 were: pre-test -32% vs. 40% (p = 0.029), final theoretical score -78% vs. 69% (p = 0.007), and practical evaluation -88% vs. 65% (p = 0.003), resulting in 68.8% in 2019 vs. 33.3% in 2020 qualified students. Students' motivational profile were similar in 2019 and 2020. CONCLUSION: The NPEcho was successful in qualifying students with face-to-face theoretical classes, but the online format was inadequate to achieve the learning goals.
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Aprendizagem , Motivação , Recém-Nascido , Humanos , Estudos Prospectivos , EcocardiografiaRESUMO
BACKGROUND: The aim of this study was to assess whether neonatologist-performed echocardiography (NPE) changed the previously planned hemodynamic approach in critically ill newborn infants. METHODS: This prospective cross-sectional study included the first NPE of 199 neonates. Before the exam, the clinical team was asked about the planned hemodynamic approach and the answer was classified as an intention to change or not to change the therapy. After being informed about the NPE results, the clinical management was grouped as performed as previously planned (maintained) or modified. RESULTS: NPE modified the planned pre-exam approach in 80 cases (40.2%; 95% CI: 33.3-47.4%), and variables associated with an increased chance of this modification were exams to assess pulmonary hemodynamics (prevalent ratio (PR): 1.75; 95% CI: 1.02-3.00) and to assess systemic flow (PR: 1.68; 95% CI: 1.06-2.68) in relation to those requested for patent ductus arteriosus, pre-exam intention of changing the prescribed management (PR: 2.16; 95% CI: 1.50-3.11), use of catecholamines (PR: 1.68; 95% CI: 1.24-2.28) and birthweight (per kg) (PR: 0.81; 95% CI: 0.68-0.98). CONCLUSION: The NPE was an important tool to direct hemodynamic management in a different approach from the previous intention of the clinical team, mainly for critically ill neonates. IMPACT: This study shows that neonatologist-performed echocardiography guides the therapeutic planning in the NICU, mainly in the more unstable newborns, with lower birthweight and receiving catecholamines. Exams requested with the intention of modifying the current approach were more likely to change the management in a different way than planned pre-exam.