Aesthetic assessment instrument for breasts reconstruction.

INTRODUCTION: Few validated aesthetic assessment instruments in breast reconstruction use discrete scales to facilitate studies with multiple evaluators. OBJECTIVE: This research aimed to propose an aesthetic assessment scale for reconstructed breasts. METHODOLOGY: A scale was suggested using discrete variables, with responses ranging from 1 to 10, and the responses for each category could be summed to obtain an average that could be used in studies with multiple evaluators. To test the instrument suggested in this study, 5 experienced plastic surgeons assessed 46 patients. For all the analyses, a rejection level for the null hypothesis of 5% (p < 0.05) was adopted. RESULTS: The suggested scale obtained valid intraclass correlation coefficients, with 0.9 for the overall aesthetic evaluation of the breast and the lowest being 0.77 for defining the inframammary fold. We observed good diagnostic accuracy in all comparisons, with the area under the curve ranging from 0.85 to 0.97. Regarding convergent validity, we observed correlations of 0.77 (p < 0.001) between breast volume and volume symmetry, 0.66 (p < 0.001) between breast shape and contour naturalness. The test-retest reliability was 0.708, which is considered good. CONCLUSION: The results of this study support the effectiveness of the proposed new aesthetic evaluation scale, revealing consistency among different evaluators and over time. Convergent validation strengthens the relationship between the variables of the new scale and those of the Garbay scale. Furthermore, the robust diagnostic accuracy highlights the clinical utility of the new scale in assessing aesthetic outcomes in breast reconstructions.

Impact of the Koala Project on clinical outcomes of preterm infants in two maternity hospitals / Impacto do Projeto Coala nos resultados clínicos de pacientes prematuros em duas maternidades

ABSTRACT Objective: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. Methods: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91-95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). Results: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p<0.001) and bronchopulmonary dysplasia (p<0.001). There were no deaths in the second stage, and there was a non-significant increase in the absolute number of necrotizing enterocolitis cases. Conclusions: The Koala project seems to be an effective and feasible strategy to reduce adverse situations in the management of premature children, but research with a greater sample is needed.

RESUMO Objetivo: Descrever o impacto do projeto Coala (Controle Ativo de Oxigênio Alvo) nos desfechos clínicos em pacientes nascidos com menos de 36 semanas de gestação, em duas maternidades, comparando antes e depois da implementação da estratégia. Métodos: Trata-se de um estudo de intervenção com cem prematuros vivos, com idade gestacional ≤36 semanas, que utilizaram oxigênio em duas maternidades entre janeiro de 2020 e agosto de 2021. A meta para a saturação de oxigênio alvo com este projeto foi de 91-95%. Comparações entre as duas etapas (antes e depois da implantação do projeto) foram feitas avaliando os desfechos de retinopatia da prematuridade, displasia broncopulmonar, enterocolite necrosante e óbitos. As variáveis contínuas foram descritas por meio de média, mediana, desvio padrão e intervalo interquartil. O nível de significância adotado foi de 5% e o software empregado foi o R Core Team 2021 (versão 4.1.0). Resultados: Observou-se que, após o uso de controle de oxigênio segundo o protocolo Coala, houve redução significativa nos casos de retinopatia da prematuridade (p<0,001) e displasia broncopulmonar (p<0,001). Não houve óbitos na segunda etapa e houve aumento não significativo no número absoluto de casos de enterocolite necrosante. Conclusões: O projeto Coala parece ser uma estratégia eficaz e viável para reduzir situações adversas no manejo de crianças prematuras, mas pesquisas com amostras maiores são necessárias.

Validade baseada nos processos de respostas - Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / Validity based on the response processes of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofuncional Clinical History

RESUMO Objetivo Apresentar a etapa da evidência de validade baseada nos processos de respostas do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial. Método Estudo desenvolvido conforme recomendações para validação de testes em Fonoaudiologia. Realizada análise da validade baseada nos processos de resposta do instrumento. Participaram dez fonoaudiólogos, que atuam em clínica e/ou pesquisa da Motricidade Orofacial com população entre 6 e 71 meses de idade, que aplicaram o Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial junto aos responsáveis pelas crianças. Os fonoaudiólogos emitiram apreciação sobre aplicabilidade do instrumento via formulário eletrônico do Google®, contendo questões dicóticas e/ou múltipla escolha, e escala likert com espaço para justificar respostas negativas. Os dados foram tabulados em planilhas Microsoft Excel 2016® e analisados pelo Índice de Validade de Conteúdo (IVC). Utilizado software R Core Team 2022 (Versão 4.2.2). Resultados Todos os itens do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial foram válidos na aplicação em contexto real. Protocolo de História Clínica Miofuncional Orofacial - IVC 100% quanto à facilidade de aplicação e preenchimento, e uso na prática profissional; e IVC 90% quanto à utilidade para clínica fonoaudiológica. O Instrutivo obteve IVC 80% quanto à utilidade e 70% referente à necessidade de leitura prévia para preenchimento do Protocolo MMBGR Lactentes e Pré-escolares. Conclusão O Instrutivo e o Protocolo História Clínica Miofuncional Orofacial, pertencentes ao protocolo MMBGR - Lactentes e Pré-escolares tiveram comprovada validade baseada nos processos de resposta, para uso na clínica fonoaudiológica.

ABSTRACT Purpose Present the step of evidence of validity based on the responses to procedures of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History. Methods Study developed according to phonoaudiologic tests validations recommendations. Validity analysis performed based on the process of instrument response. Ten speech therapists, that work on phonoaudiology clinic and/or orofacial myofunctional research on the population with age between 6 to 71 months, participated and applied the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History with those responsible for the children. The speech therapists appraised the instrument applicability via Google®️ electronic forms, containing dichotic and/or multiple-choice questions, and likert scale with space to justify negative answers. The data was tabulated on Microsoft Excel 2016®️ worksheets and analyzed by the content validity index (CVI). The software R Core Team 2022 (Versão 4.2.2) was used. Results All items from the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History were valid when applied to real contexts. Orofacial Myofunctional Clinic history protocol- IVC 100% in terms of ease of application and filling and usage in professional practice; IVC 90% in terms of usefulness for phonoaudiology clinic. The instructional got IVC 80% in terms of clinic usefulness and 70% regarding to the prior reading necessity to fill the MMBGR Protocol Infants and Preschoolers. Conclusion The Instrucional and Orofacial Myofunctional Clinical History, in the MMBGR Protocol Infants and Preschoolers had its validity proven based on the processes of responses to the usage on phonoaudiology clinic.

Impact of the Koala Project on clinical outcomes of preterm infants in two maternity hospitals.

OBJECTIVE: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. METHODS: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91-95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). RESULTS: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p<0.001) and bronchopulmonary dysplasia (p<0.001). There were no deaths in the second stage, and there was a non-significant increase in the absolute number of necrotizing enterocolitis cases. CONCLUSIONS: The Koala project seems to be an effective and feasible strategy to reduce adverse situations in the management of premature children, but research with a greater sample is needed.

Pediatric Dysphonia and the Access to Voice Therapy: A Study in Speech Therapy Services Available in a Capital City in the Northeast of Brazil.

OBJECTIVES: Defining the laryngeal and vocal alterations in the pediatric group studied in private speech therapy facilities; and estimating the time period between the problem being identified by the parents and the access to the proper provided services. METHODS: A cross-sectional analytical observational research with data collected from medical records by the speech therapist of each private facility. A written form was prepared and sent to the speech therapists of the 40 existing facilities. We received 124 of them from the pediatric group being assisted in 15 of the facilities. The form included questions about gender, age, vocal complaints; general degree of dysphonia; otorhinolaryngological diagnosis of vocal fold alterations; the age that the problem was identified by the parents and the beginning of speech therapy. The larynx was examined by videonasopharyngolaryngoscopy, and voice quality by auditory-perceptual assessment. RESULTS: The time period between the identification of the participant's dysphonia by the parents and the start of speech therapy was considered long (3.5years). The group showed variance in the proportion of nodule and cyst between genders. The highest prevalence of nodules occurred in boys; and the cyst in girls. Moderate general dysphonia occurred between 4 and 17years old, average age of 7years and 7months, with greater distribution between 5 and 10years of age. CONCLUSIONS: The average time delay until the start of speech therapy was 3.5years, more frequently in the 5-10years group and due to nodules in boys and cysts in girls.

Impact of the Koala Project on clinical outcomes of preterm infants in two maternity hospitals / Impacto do Projeto Coala nos resultados clínicos de pacientes prematuros em duas maternidades

ABSTRACT Objective: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. Methods: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91-95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). Results: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p<0.001) and bronchopulmonary dysplasia (p<0.001). There were no deaths in the second stage, and there was a non-significant increase in the absolute number of necrotizing enterocolitis cases. Conclusions: The Koala project seems to be an effective and feasible strategy to reduce adverse situations in the management of premature children, but research with a greater sample is needed.

RESUMO Objetivo: Descrever o impacto do projeto Coala (Controle Ativo de Oxigênio Alvo) nos desfechos clínicos em pacientes nascidos com menos de 36 semanas de gestação, em duas maternidades, comparando antes e depois da implementação da estratégia. Métodos: Trata-se de um estudo de intervenção com cem prematuros vivos, com idade gestacional ≤36 semanas, que utilizaram oxigênio em duas maternidades entre janeiro de 2020 e agosto de 2021. A meta para a saturação de oxigênio alvo com este projeto foi de 91-95%. Comparações entre as duas etapas (antes e depois da implantação do projeto) foram feitas avaliando os desfechos de retinopatia da prematuridade, displasia broncopulmonar, enterocolite necrosante e óbitos. As variáveis contínuas foram descritas por meio de média, mediana, desvio padrão e intervalo interquartil. O nível de significância adotado foi de 5% e o software empregado foi o R Core Team 2021 (versão 4.1.0). Resultados: Observou-se que, após o uso de controle de oxigênio segundo o protocolo Coala, houve redução significativa nos casos de retinopatia da prematuridade (p<0,001) e displasia broncopulmonar (p<0,001). Não houve óbitos na segunda etapa e houve aumento não significativo no número absoluto de casos de enterocolite necrosante. Conclusões: O projeto Coala parece ser uma estratégia eficaz e viável para reduzir situações adversas no manejo de crianças prematuras, mas pesquisas com amostras maiores são necessárias.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers

Abstract Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants(d =-0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = -0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

Perfil dos fonoaudiólogos com formação em motricidade orofacial no Brasil / Profile of speech therapists trained in orofacial myology in Brazil

RESUMO Objetivo Caracterizar o perfil do fonoaudiólogo brasileiro com formação especializada em motricidade orofacial (MO). Métodos Estudo descritivo e exploratório, transversal, de abordagem quantitativa, realizado entre setembro 2022 e fevereiro 2023, com parceria do Conselho Federal de Fonoaudiologia. Participaram 87 fonoaudiólogos com formação em MO. Resultados Evidenciou-se predominância feminina, faixa etária entre 41 e 50 anos e tempo de formação especializada em MO entre 16 e 20 anos; maioria com título de especialista e da Região Sudeste do Brasil, atuando em consultórios/ambulatórios e/ou clínicas, com ações interdisciplinares com Medicina e Odontologia, abrangendo adultos e crianças, principalmente na rede privada. Prevaleceram os domínios da MO quanto à reabilitação de estruturas moles e hábito oral e maior uso de tecnologias: leve - acolhimento e assistência; leve-dura - avaliação e terapia e dura - fotobiomodulação. Conclusão Os fonoaudiólogos brasileiros com formação especializada em MO, participantes do estudo, são, em sua maioria, mulheres com mais de 41 anos de idade, que detêm titulação de especialista, com práticas nos vários domínios e níveis de tecnologia da área, principalmente em diagnóstico e reabilitação dos distúrbios miofuncionais orofaciais.

ABSTRACT Purpose To characterize the profile of Brazilian speech therapists with specialized training in orofacial myology (OM). Methods Descriptive and exploratory, cross-sectional study, with a quantitative approach, carried out between September 2022 and February 2023, in partnership with CFFa. Eighty-seven speech therapists with specialized training in OM participated. Results showed female predominance, age between 41 and 50 years, and time of specialized training in OM between 16-20 years; most with specialist titles in the Southeast of Brazil. Most work in offices/outpatient clinics and/or clinics with interdisciplinary actions with Medicine and Dentistry; seeing adults and children, mainly in a private sector. As to OM domains there was a predominance of rehabilitation of soft structures and oral habits, and most use technologies: light - reception and assistance, light-hard - evaluation and therapy, and hard - photobiomodulation (40.2%). Conclusion The Brazilian speech therapists with specialized training in OM participating in the study are mostly women over 41 years old, who hold the title of specialists, and carry out practices in various domains and levels of technology in the area, with a predominance of diagnosis and rehabilitation of oromyofunctional disorders.

Analysis of breast cancer survival in a northeastern Brazilian state based on prognostic factors: A retrospective cohort study.

Breast cancer is a major health problem worldwide. Analysis of breast cancer epidemiology in emerging countries enables assessment of prognostic factors, cancer care quality, and the equity of resource distribution. We aimed to estimate the overall (OS) and cancer-specific survival (SS) of breast cancer patients in the northeastern Brazilian state of Sergipe to identify independent prognostic factors. We analyzed a cohort for the factors age at diagnosis, place of residence, time to treatment, staging, and molecular classification, using the Kaplan-Meier method, log-rank test, Pearson's chi-squared test and Cox regression model. The outcome was the vital status at the end of the study. Our analysis showed an OS probability of 0.72 and an SS probability of 0.75. In multivariate analysis, time to treatment within 60 days, stage IV, and triple-negative classification remained independent prognostic factors for both OS [unadjusted hazard ratio (HRp) 1.50 (1.21; 1.86), HRp 16.56 (8.35; 32.85), and HRp 2.73 (1.73; 4.29), respectively] and SS [HRp 1.43 (1.13; 1.81), HRp 20.53 (9.45; 44.56), and HRp 3.14 (1.88; 5.26), respectively]. Better survival was demonstrated for the following patients: those receiving their first treatment after 60 days, with an OS of 52.5 months (51.2; 53.8) and SS of 53.5 months (52.3; 54.7); stage I patients, with an OS of 58.8 months (57.7; 60.0) and SS of 59.2 months (58.1; 60.3); patients without nodal metastasis, with an OS of 54.2 months (53.0; 55.4) and SS of 55.6 months (54.5; 56.7); and patients with luminal A classification, with an OS of 56.8 months (55.0; 58.5) and SS of 57.8 months (56.2; 59.4). This study identified independent prognostic factors and that OS and SS were lower for patients from Sergipe than for patients in high-income areas. Therefore, determining the profiles of breast cancer patients in this population will inform specific cancer care.

Protocolos fonoaudiológicos de história clínica: revisão integrativa / Clinical history speech-language pathology protocols: integrative review

RESUMO Objetivo identificar, coletar e analisar, na literatura científica, evidências da existência de protocolos fonoaudiológicos de levantamento da história clínica, conforme classificação de risco, especialmente para distúrbios oromiofuncionais, em lactentes e pré-escolares. Estratégia de pesquisa foram selecionados estudos publicados, sem delimitação temporal, nas bases de dados eletrônicas LILACS, SciELO e PubMed e na literatura cinza (Google Acadêmico). Critérios de seleção estudos disponíveis na íntegra nas línguas portuguesa e inglesa, que identificassem protocolos fonoaudiológicos de história clínica aplicáveis a lactentes (6 a 23 meses de vida) e pré-escolares (24 a 71 meses de vida). Foram excluídas as revisões narrativas e de literatura (integrativa, sistêmica e escopo). Resultados foram encontradas 1371 publicações brasileiras no período de 1980 a 2022. Destas, foram identificadas apenas cinco que tratavam de protocolos fonoaudiológicos para levantamento de dados pregressos a partir da história clínica da faixa etária de 6 a 71 meses. Apenas um desses protocolos possuía classificação de risco para distúrbios fonoaudiológicos, distribuídos na área de linguagem e fluência. Os outros três eram da área de motricidade orofacial (MO) e não continham classificação de risco para distúrbio miofuncional orofacial. Conclusão existem poucos protocolos fonoaudiológicos para levantamento da história clínica de lactentes e pré-escolares que contenham, ou não, classificação de risco, publicados em revistas de acesso aberto e que passaram por processos completos de validação, sendo necessário ampliar estudos e publicações desses instrumentos, inclusive na área de MO.

ABSTRACT Purpose to identify, collect and analyze in the scientific literature evidence of the existence of speech therapy protocols for collecting clinical history, according to risk classification, especially for oromyofunctional disorders, in infants and preschoolers. Research Strategy We selected published studies, without temporal delimitation, in the electronic databases LILACS, SciELO and PUBMED; and in the gray literature (Google Academic). Selection criteria available in full in Portuguese and English, which identify speech-language pathology protocols of clinical history applicable to infants (6 to 23 months of age) and preschoolers (24 to 71 months of age). Narrative and literature reviews (integrative, systemic, and scope) were excluded. Results 1371 Brazilian publications were found in the period from 1980 to 2022. Of these, only five publications on speech therapy protocols were identified for collecting previous data from the clinical history of the age group between 6 and 71 months. Only two of these protocols have a risk classification for speech-language disorders, distributed in the areas of language and fluency. The other three are from the Orofacial Motricity (OM) area and do not carry a risk classification for orofacial myofunctional disorder. Conclusion There are few speech therapy protocols for surveying the clinical history of infants and preschoolers, whether or not they contain risk classification, published in open access journals that have a complete validation process.Therefore there is a need for more research and publication of these instruments, including in the area of OM.

Prevalência e fatores de risco associados ao delirium em uma unidade de terapia intensiva / Prevalencia y factores de riesgo asociados al delirium en una unidad de cuidados intensivos / Prevalence and risk factors associated with delirium at a critical care unit

Resumo Objetivo Identificar a prevalência e os fatores de risco associados ao delirium em pacientes internados em uma unidade de terapia intensiva no nordeste do Brasil. Métodos Estudo transversal realizado entre julho de 2017 e abril de 2018 com 316 pacientes hospitalizados por pelo menos 48h, ≥18 anos, com Richmond Agitation-Sedation Scale ≥ -3. A análise estatística incluiu análise univariada e multivariada; um modelo log-binomial foi utilizado para razões de prevalência ajustadas. Resultados A análise univariada indicou uma prevalência de delirium em 45,9%, meia idade (49,8 ± 17,4 vs. 44,0 ± 17,6, p=0,003) e neurocirurgia (62,5% vs. 26,1%, p<0,001). A contenção física (81,3% vs. 40,9%, p<0,001), alimentação por sonda nasoenteral (85,9% vs. 57,6%, p<0,001) e ventilação mecânica (50,0% vs. 29,2%, p<0,001) foram associadas à prevalência de delirium. Conclusão Idade, contenção física, alimentação por sonda e uso de anticonvulsivantes aumentaram a prevalência de delirium em nossa amostra.

Resumen Objetivo Identificar la prevalencia y los factores de riesgo asociados al delirium en pacientes internados en una unidad de cuidados intensivos en el nordeste de Brasil. Métodos Estudio transversal realizado entre julio de 2017 y abril de 2018 con 316 pacientes hospitalizados por al menos 48 horas, ≥18 años, con Richmond Agitation-Sedation Scale ≥ -3. El análisis estadístico incluyó análisis univariado y multivariado. Se utilizó un modelo log-binomial para razones de prevalencia ajustadas. Resultados El análisis univariado indicó una prevalencia de delirium en el 45,9 %, mediana edad (49,8 ± 17,4 vs. 44,0 ± 17,6, p=0,003) y neurocirugía (62,5 % vs. 26,1 %, p<0,001). La contención física (81,3 % vs. 40,9 %, p<0,001), alimentación por sonda nasoenteral (85,9 % vs. 57,6 %, p<0,001) y ventilación mecánica (50,0 % vs. 29,2 %, p<0,001) fueron factores asociados a la prevalencia de delirium. Conclusión Edad, contención física, alimentación por sonda y uso de anticonvulsivos aumentaron la prevalencia de delirium en nuestra muestra.

Abstract Objective Identify the prevalence and risk factors associated with delirium in patients in a critical care unit in northeastern Brazil. Methods A cross-sectional study that enrolled 316 patients with at least 48h of hospitalization, ≥18 years old, with Richmond Agitation-Sedation Scale ≥ -3, between July 2017 and April 2018. Statistical analysis included univariate and multivariate analysis, we employed a log-binomial model for adjusted prevalence ratios. Results Univariate analysis indicated that delirium was prevalent among 45.9%, middle age (49.8 ± 17.4 vs. 44.0 ± 17.6, p=0.003) and neurosurgery (62.5% vs. 26.1%, p<0.001). Physical restraining (81.3% vs. 40.9%, p<0.001), nasoenteral tube feeding (85.9% vs. 57.6%, p<0.001) and mechanical ventilation (50.0% vs. 29.2%, p<0.001) was associated with prevalence of delirium . Conclusion Age, physical restraint, tube feeding, and the use of anticonvulsants increase the prevalence of delirium in our sample.

Protocolo MMBRG - Lactentes e Pré-Escolares: Exame Clínico Miofuncional Orofacial / MMBRG Protocol - Infants and Preschoolers: Myofunctional Orofacial Clinic Examination

RESUMO Objetivo Apresentar Exame Clínico Miofuncional Orofacial pertencente ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo sua validação. Método Inicialmente foi realizada a validade do conteúdo do teste adaptado do Protocolo MBGR, para faixa etária entre 6 e 71 meses, fundamentada na bibliografia e experiência entre autores (originais e atuais). Para análise de conteúdo e aparência participaram 10 fonoaudiólogos especialistas em Motricidade Orofacial, que preencheram formulário eletrônico com questões dicóticas e escala de Likert, em dois momentos. Foi calculado Índice de Validade de Conteúdo e Teste Binomial Exato. Na sequência houve análise da validade baseada nos processos de resposta, seguida da análise da confiabilidade do Exame Clínico, com 155 participantes, por 7 fonoaudiólogos experientes e calibrados, sendo verificada a concordância entre e intra examinadores pelo Coeficiente de Correlação Intraclasse. Resultados Houve acréscimos, modificações e exclusão de itens conforme faixa etária, concluindo-se o Protocolo Exame Clínico Miofuncional Orofacial para lactentes e pré-escolares, que obteve 90,5% com concordância; e 100% dos escores adequados por pelo menos 90% dos especialistas. Quanto à confiabilidade, a maioria dos itens dos Exames Extraoral e Intraoral e Mastigação obtiveram concordância razoável a boa, ou, até mesmo, excelente. Conclusão O "Exame Clínico Miofuncional Orofacial" teve validação baseada no conteúdo do teste, nos processos de resposta e confiabilidade concluída, e junto ao "Instrutivo" e à "História Clínica" integra o "Protocolo MMBGR - Lactentes e Pré-escolares", para atuação fonoaudiológica na faixa etária entre 6 e 71 meses de idade.

ABSTRACT Purpose To present the Myofunctional Orofacial Clinical Examination Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including its validation. Methods Initially, test content-based validity was evaluated from the MBGR Protocol to be used with the age group between 6 and 71 months based on the bibliography and experience between the authors (original and current). For the content and appearance analysis, 10 speech therapists specialized in Orofacial Motricity attended and filled out an electronic form with dichotic and Likert scale questions in two moments. We used the Content Validity Index and the Exact Binomial Test. Then there was a validity based on the response processes analysis followed by a reliability of the Clinical Examination with 155 participants by 7 experienced and calibrated speech therapists, and the examiners between and within agreement was verified by the Intraclass Correlation Coefficient. Results There were additions, modifications, and exclusions of items according to the age group, resulting in the Myofunctional Orofacial Clinical Examination Protocol for Infants and Preschoolers, which obtained 90.5% agreement; and 100% of the appropriate scores by at least 90% of the specialists. In reliability, most items of the Extraoral and Intraoral Examination and Chewing obtained a reasonable to good, or even excellent, agreement. Conclusion The "Clinical Myofunctional Clinical Examination" was validated based on the test content, response process, and reliability and, along with the "Instructional" and the "Clinical History" is part of the "MMBGR Protocol - Infants and Preschoolers" for speech therapy activities in the age group between 6 and 71 months of age.

Protocolo MMBRG - Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History

RESUMO Objetivo Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. Método Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. Resultados Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. Conclusão "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

ABSTRACT Purpose To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. Methods Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. Results We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. Conclusion "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

Soroprevalência de marcadores de triagem sorológica para doenças transmissíveis por transfusão em doadores de sangue em Sergipe, Brasil / Seroprevalence of serological screening markers for transfusion-transmitted diseases in blood donors in Sergipe, Brazil / Seroprevalencia de marcadores de cribado serológico para enfermedades transmisibles por transfusión en donantes de sangre en Sergipe, Brasil

A transfusão de sangue é um procedimento comum nos serviços de saúde, embora não seja isento de riscos. O descarte sorológico e a análise do perfil do doador fornecem informações essenciais para a segurança da transfusão. Este artigo avalia a prevalência e a tendência de descarte das bolsas de sangue por positividade sorológica para doenças transmissíveis por transfusão do hemocentro de Sergipe. Trata-se de um estudo observacional, relativo às doações realizadas entre janeiro de 2007 e dezembro de 2018. Das 308.953 doações, 16.828 (5,45%) foram descartadas devido à positividade em alguma sorologia de triagem. Verificou-se uma tendência de diminuição do descarte de bolsas de sangue nas sorologias testadas. As sorologias responsáveis pelo descarte foram: anti-HBc (2,09%), sífilis (1,49%), anti-HIV (0,82%), HBsAg (0,62%), anti-HCV (0,52%), anti-HTLV-1/2 (0,23%) e Chagas (0,15%). Com relação ao perfil do doador, houve maior descarte de doadores homens, de reposição e de faixas etárias avançadas. Neste estudo foi encontrada uma alta prevalência de descarte, embora com tendência decrescente para todas as sorologias, exceto sífilis, que permaneceu estacionária no período. Os resultados reforçam a necessidade dos processos de triagem sorológica para garantir a segurança transfusional, tendo em vista que essas doenças ainda são frequentes na população. Evidencia-se a importância da realização de campanhas educativas, de testagem e tratamento para as principais infecções de risco transfusional para que diminua a taxa de descarte de bolsas de sangue e melhore a qualidade transfusional.

Although a common health care procedure, blood transfusion is not risk-free. Serological disposal and donor profile analysis provide key information for transfusion safety. This study evaluates the prevalence and tendency of discarding blood bags due to serological positivity for transfusion-transmitted diseases at a blood center in Sergipe, Brazil. An observational study was conducted on donations made between January 2007 and December 2018. Of the 308,953 donations received, 16,828 (5.45%) were discarded due to positive screening serology, with a decrease trend in discard for the serologies tested. Anti-HBc (2.09%), syphilis (1.49%), anti-HIV (0.82%), HBsAg (0.62%), anti-HCV (0.52 %), anti-HTLV-1/2 (0.23%) and Chagas (0.15%) were the serologies responsible for disposal. As for donor profile, greater discard was observed for men, replacement and advanced age donors. Results showed a high prevalence of discard, but with a decreasing trend for all serologies excepting syphilis, which remained stationary in the period. They reinforce the importance of serological screening processes for ensuring transfusion safety, as these diseases are still common among the population. Carrying out educational, testing and treatment campaigns for the main transfusion risk infections is essential to reduce blood bag disposal rate and improve transfusion quality.

La transfusión de sangre es un procedimiento común en los servicios de salud, aunque no está libre de riesgos. La eliminación serológica y el análisis del perfil del donante proporcionan información esencial para la seguridad de las transfusiones. Este estudio tiene como objetivo evaluar la prevalencia y tendencia del descarte de bolsas de sangre por positividad serológica para enfermedades transmisibles por transfusión en el hemocentro de Sergipe (Brasil). Se trata de un estudio observacional, relacionado con las donaciones realizadas entre enero de 2007 y diciembre de 2018. De las 308.953 donaciones, 16.828 (5,45%) se descartaron por positividad en alguna serología de cribado. Hubo una tendencia a disminuir el descarte de bolsas de sangre en las serologías probadas. Las serologías responsables de la eliminación fueron: anti-HBc (2,09%), sífilis (1,49%), anti-VIH (0,82%), HBsAg (0,62%), anti-HCV (0,52%), anti-HTLV-1/2 (0,23%) y Chagas (0,15%). En cuanto al perfil del donante, hubo un mayor descarte en los donantes masculinos, de reemplazo y en edad avanzada. En el estudio se constató una alta prevalencia de descarte, aunque con tendencia decreciente para todas las serologías, excepto para sífilis, que se mantuvo estacionaria en el período. Los resultados refuerzan la necesidad de procesos de cribado serológico para garantizar la seguridad transfusional, dado que estas enfermedades aún son comunes en la población. Se resalta la importancia de realizar campañas de educación, testeo y tratamiento de las principales infecciones de riesgo transfusional para reducir la tasa de eliminación de bolsas de sangre y mejorar la calidad transfusional.

Correlação entre o sistema sanguíneo ABO e portadores de gastrite / Correlation between the ABO blood group system and gastritis

RESUMO: Introdução: A infecção pelo Helicobacter pylori (HP) e fatores ambientais são importantes fatores de risco para gastrite. Estudos apontam correlação entre o sistema ABO e doenças gastrointestinais. Objetivos: caracterizar o perfil sociodemográfico de portadores de gastrite e HP e sua correlação com o sistema do grupo sanguíneo ABO. Materiais e métodos: Estudo prospectivo e descritivo, realizado em Aracaju, Sergipe, Brasil, de abril/2018 a maio/2019. Amostra constituída por 133 pacientes que realizaram endoscopia digestiva alta, análise histopatológi-ca e tipagem sanguínea. Foram diagnosticados com gastrite 93 pacientes. Utilizou-se questionário sociodemográ-fico e clínico. Os dados foram analisados pelo RCore Team 2019 e submetidos a análises descritivas e inferenciais. Nível de significância 5%. Resultados: Idade média 53,7 anos (DP 17,4) sendo 48 (51,6%) do sexo masculino (p=0,018), 56 (65,9%) pardos, 45 (52,9%) casados e 33 (35,5%) tinham empregos fixos. Dos portadores de gastrite, 59 (63,4%) eram do tipo sanguíneo O. Dentre os tipos de gastrite, 31(33,4%) eram enantematosa leve e 16 (51,6%) desses eram do tipo O. Houve prevalência do tipo O em todos os graus de atividade inflamatória. Foi detectado H. pylori em 29 (31,2%) pacientes, sendo o fenótipo O mais prevalente nos graus moderado e severo da infecção. Conclusão: Os homens foram mais acometidos de gastrite, independente do tipo segundo a classificação de Sydney. O fenótipo sanguíneo O foi mais prevalente nos portadores de gastrite, naqueles que apresentaram atividade inflamatória à histologia e em portadores de H. pylori grau moderado e severo. (AU)

ABSTRACT: Introduction: Helicobacter pylori (HP) infection and environmental factors are important risk factors for gastritis. Studies show a correlation between the ABO system and gastrointestinal diseases. Aims: To characterize the sociodemographic profile of patients with gastritis and HP and its correlation with the ABO blood group system. Materials and methods: Prospective and descriptive study, carried out in Aracaju, Sergipe, Brazil, from April / 2018 to May / 2019. Samples were collected from 133 patients who underwent upper digestive endoscopy, histo-pathological analysis, and blood typing. Out of which, 93 patients were diagnosed with gastritis. A sociodemographic and clinical questionnaire was also used. Data analyzed by RCore Team 2019 and submitted to descriptive and inferential analyzes. Results: Average age 53.7 (SD 17.4) with 48 (51.6%) being male (p = 0.018), 56 (65.9%) brown, 45 (52.9%) married and 33 (35.5%) pursuing permanent jobs. Fifty-nine patients (63.4%) out of those with gastritis were blood type O. Among the types of gastritis, 31 (33.4%) were mild enanthematous and 16 (51.6%) of these were type O. There was a prevalence type O in all degrees of inflammatory activity. H. pylori were detected in 29 (31.2%) patients; the most prevalent phenotype being the moderate and severe degrees of infection. Conclusion: Men were mostly affected by gastritis, regardless of the type according to the Sydney classification. The blood phenotype O was more prevalent in patients with gastritis, in those who had inflammatory activity at histology and in patients with moderate, and severe H.pylori. (AU)

Influência da localização geográfica no acesso às terapias de reperfusão e mortalidade de pacientes com IAMcSST em Sergipe: registro VICTIM / Influence of geographical location on access to reperfusion therapies and mortality of patients with STEMI in Sergipe: VICTIM register

Resumo Fundamento A concentração de serviços de alta complexidade em Aracaju/SE pode proporcionar disparidade na qualidade assistencial para os pacientes do SUS com infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMcSST) cujos sintomas se iniciaram em outras regiões de saúde do estado. Objetivo Avaliar disparidades no acesso às terapias de reperfusão e mortalidade em 30 dias, entre pacientes com IAMcSST, usuários do SUS, em cada uma das 7 regiões de saúde em Sergipe. Métodos Foram avaliados 844 pacientes com IAMcSST no período de 2014 a 2018 atendidos pelo único hospital com capacidade de ofertar intervenção coronariana percutânea (ICP) primária para usuários do SUS no estado de Sergipe. Os pacientes foram divididos em 7 grupos de acordo com o local de início dos sintomas e obedecendo a divisão já existente das regiões de saúde do Estado. Para comparação entre grupos, foi considerada diferença significativa quando p < 0,05. Resultados Do total de 844 pacientes vítimas de IAMcSST e transferidos ao hospital com ICP que atende pacientes do SUS, 386 pacientes (45,8%) realizaram angioplastia primária. A taxa média do uso de fibrinolítico foi de 2,6%, não havendo diferenças entre as regiões. O tempo médio total de chegada ao hospital com ICP foi de 21h55' com mediana de 10h22' (6h30' - 22h52'). A mortalidade total em 30 dias foi 12,8%, mas sem diferenças entre as regiões, mesmo quando ajustada para idade e sexo. Conclusões Este estudo revela que os fibrinolíticos são subutilizados em todo o estado e que existe um atraso significativo no acesso ao hospital com ICP, em todas as regiões de saúde de Sergipe.

Abstract Background The concentration of high-complexity services in Aracaju, Sergipe can impose certain disparity in the quality of care for the patients with ST-segment elevation acute myocardial infarction (STEMI) (STEMI) who receive care from Brazil's Unified Health System (SUS, acronym in Portuguese) and whose symptoms started in other health regions of the state. Objective To evaluate disparities in access to reperfusion therapies and 30-day mortality, among patients with STEMI, who were users of SUS, in each of the 7 health regions of Sergipe. Methods A total of 844 patients with STEMI in the period from 2014 to 2018, assisted by the only hospital with the capacity to offer primary percutaneous coronary intervention (PPCI) to SUS users in the state of Sergipe, were evaluated. The patients were divided into 7 groups according to the location at the onset of symptoms, following the existing division of health regions in the state. For comparison between groups, a significant difference was considered when p < 0.05. Results Of the total of 844 patients suffering from STEMI who were transferred to the hospital with PPCI that serves SUS patients, 386 patients (45.8%) underwent primary angioplasty. The mean rate of fibrinolytic use was 2.6%, with no differences between the regions. The mean total time of arrival to the hospital with PPCI was 21 hours and 55 minutes, with a median of 10 hours and 22 minutes (6 hours and 30 minutes to 22 hours and 52 minutes). Total 30-day mortality was 12.8%, but without differences between the regions, even when adjusted for age and sex. Conclusions This study reveals that fibrinolytics are underused throughout the state and that there is a significant delay in access to the hospital with PPCI, in all health regions of Sergipe.

Acesso à Terapia de Reperfusão e Mortalidade em Mulheres com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST: Registro VICTIM / Access to Reperfusion Therapy and Mortality in Women with ST-Segment-Elevation Myocardial Infarction: VICTIM Register

Resumo Fundamento: A reperfusão miocárdica é parte fundamental do tratamento para infarto agudo do miocárdio com supradesnivelamento de ST (IAMCSST) e é responsável por reduzir morbimortalidade no paciente acometido. No entanto, as taxas de reperfusão são geralmente mais baixas e as taxas de mortalidade mais altas em mulheres que em homens. Objetivos: Avaliar a prevalência do uso de terapias de reperfusão em mulheres e homens com IAMCSST nos hospitais com capacidade para realizar intervenção coronariana percutânea (ICP) no estado de Sergipe. Métodos: Trata-se de estudo transversal que utilizou dados do Registro VICTIM. Foram avaliados pacientes com diagnóstico de IAMCSST admitidos nos quatro hospitais com capacidade para realizar ICP no estado de Sergipe, sendo um público e três privados, no período de dezembro de 2014 a junho de 2018. Foi aplicada análise multivariada com modelo ajustado utilizando mortalidade como variável dependente. Em todas as análises, o nível de significância adotado foi de 5% (p<0,05). Resultados: Foram incluídos 878 voluntários com diagnóstico confirmado de IAMCSST, dos quais 33,4% eram mulheres. Apenas 53,3% dos pacientes foram submetidos à reperfusão miocárdica (134 mulheres versus 334 homens). A fibrinólise foi realizada somente em 2,3% de todos os pacientes (1,7% das mulheres versus 2,6% dos homens; p=0,422). Nas mulheres, a taxa de ICP primária foi menor (44% versus 54,5%; p=0,003) e a mortalidade hospitalar foi maior (16,1% versus 6,7%; p<0,001) que nos homens. Conclusão: As mulheres apresentam taxas significativamente menores de ICP primária e significativamente maiores de mortalidade hospitalar que os homens. A taxa de reperfusão em ambos os gêneros foi baixa e houve nítida subutilização de agentes trombolíticos.

Abstract Background: Myocardial reperfusion is a fundamental part of the treatment for ST elevation myocardial infarction (STEMI) and is responsible for reducing morbidity and mortality in affected patients. However, reperfusion rates are usually lower and mortality rates higher in women compared to men. Objectives: To evaluate the prevalence of the use of reperfusion therapies among women and men with STEMI in hospitals where percutaneous coronary intervention (PCI) is available in the state of Sergipe. Methods: This is a cross-sectional study that used data from the VICTIM Register. Patients diagnosed with STEMI admitted to the four hospitals (one public and three private) where PCI is available in the state of Sergipe were evaluated, from December 2014 to June 2018. A multivariate analysis with adjusted model using mortality as a dependent variable was made. In all analyses, the level of significance adopted was 5% (p < 0.05). Results: A total of 878 volunteers with a confirmed diagnosis of STEMI, of which 33.4% were women, were included in the study. Only 53.3% of the patients underwent myocardial reperfusion (134 women versus 334 men). Fibrinolysis was performed only in 2.3% of all patients (1.7% of women versus 2.6% of men; p = 0.422). The rate of primary PCI was lower (44% versus 54.5%; p = 0.003) and hospital mortality was higher (16.1% versus 6.7%; p < 0.001) in women than in men. Conclusion: Women have significantly lower rates of primary PCI and higher hospital mortality. Reperfusion rates were low in both sexes and there was a clear underutilization of thrombolytic agents.

Association of PON1, TNF-α and TGF-ß gene polymorphisms with prognosis in oral and oropharyngeal squamous cell carcinoma.

OBJECTIVE: The oral and oropharyngeal squamous cell carcinoma (OOSCC) accounts for 90-95% of tumours in the oral cavity. Single nucleotide polymorphism (SNP) in the coding region of PON1, tumour necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-ß) have been associated with to development of different cancers. Our aim was to investigate the prognostic value of PON1 (rs854560 and rs662), TNF-α (rs1800629 and rs361525) and TGF-ß (rs1800469) SNPs in OOSCC. MATERIALS AND METHODS: We genotyped 163 OOSCC patients and 146 patients from group of control for PON1 (rs854560 and rs662), TNF-α (rs1800629 and rs361525) and TGF-ß (rs1800469) SNPs by real-time polymerase chain reaction (PCR). RESULTS: TNF-α (rs1800629) GG genotype was significantly more frequent in intraoral lesions and clinical stages III and IV, while the polymorphic AA genotype in lip lesion and clinical stages I and II. Moreover, TGF-ß (rs1800469) AG and AA genotypes were significantly more frequent in larger tumours (T3 e T4). TNF-α (rs1800629) AG genotype had poor survival and patients carrying the PON1 (rs662) TT genotype tended to poor survival. CONCLUSIONS: Results suggest that the rs1800629 and rs1800469 could exert influence in the more aggressive behaviour of OOSCC and the genotypes AG of rs1800629, and TT of rs662 could be markers with prognostic value in OOSCC.

Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil.

OBJECTIVES: Identifying and understanding the main risk factors associated with extubation failure of very low birthweight (VLBW) infants in different populations can subsequently help in establishing better criteria while taking decision of extubation. The aim of the study was to identify factors associated with extubation failure in VLBW infants. METHODS: A cohort study of VLBW infants who underwent their first extubation between April 2018 and December 2019 in a Neonatal Intensive Care Unit, Alagoas, Brazil, were included in this study. Extubation failure was defined as reintubation within seven days of extubation. Relative risks of predictive variables different between the extubation success group (ES) and extubation failure group (EF) were estimated with a robust Poisson regression model. RESULTS: Out of the 112 infants included, 26 (23%) cases exhibited extubation failure. Extremely low birth weight (RR 2.55, 95% CI 1.07, 6.06), mechanical ventilation duration for first extubation greater than seven days (RR 2.66, 95% CI 1.10, 6.45), vaginal delivery (RR 2.07, 95% CI 1.03, 4.18) and maternal chorioamnionitis (RR 4.89, 95% CI 1.26-18.98) remained independently associated with extubation failure. EF had a significant greater need for respiratory support, longer oxygen therapy duration, more bronchopulmonary dysplasia (BPD) and longer length of hospital stay, even when adjusted for confounding variables. CONCLUSIONS: Extremely low birth weight infants needing mechanical ventilation, wherein the duration for first extubation was longer than seven days, with vaginal delivery and maternal chorioamnionitis failed more frequently at the first attempt of extubation. And this failure increased the risk of BPD and the length of hospital stay.

Prevalência do descarte de bolsas de sangue por sífilis em um serviço de hemoterapia no estado de Sergipe, Brasil / Prevalence of disposal of blood units due to syphilis in a hemotherapy service in the state of Sergipe, Brazil

Introdução: A doação de sangue é um ato capaz de salvar vidas. Quando a triagem sorológica é positiva, a bolsa de sangue é descartada. Este trabalho teve como objetivo avaliar a prevalência de descarte de bolsas de sangue em razão da positividade dos testes de triagem para sífilis. Métodos: Foi realizado um estudo epidemiológico observacional, com avaliação transversal e da tendência temporal da positividade do VDRL de acordo com as variáveis epidemiológicas, a partir de dados coletados no banco de sangue do Hemocentro de Sergipe das doações ocorridas de 1 de janeiro de 2007 a 31 de dezembro de 2018. Resultados: Do total de 308.953 doações de sangue, 4.594 bolsas (1,48%) foram descartadas devido a positividade para sífilis. A positividade foi significativamente maior no sexo masculino (OR = 1,14). Houve aumento significativo da prevalência com o aumento da faixa etária, de 0,63% (IC95% 0,51-0,760 em menores de 20 anos até 4,54% (IC95% 3,88-5,30) em pessoas com 60 anos e mais. Entre o período de 2007-2011 foi identificada uma tendência de crescimento da soroprevalência para sífilis (APC = 31,4) seguida pela estabilização do número de descarte de bolsas nos últimos anos. Discussão: O estudo identifica que, apesar de ter havido um aumento significativo no período inicial, a tendência foi de estabilidade nos últimos anos avaliados. É importante destacar a falta de um exame que indique concretamente a presença ativa da sífilis, pois todos os testes podem permanecer como cicatrizes por longos períodos, mesmos em pessoas com o tratamento adequado. (AU)

Introduction: Blood donation is an act that can save lives. When serological screening is positive, the blood bag is discarded. This study aimed to assess the prevalence of blood bag disposal due to positive screening tests for syphilis. Methods: An observational epidemiological study was carried out, with cross-sectional temporal trend assessment of VDRL positivity according to epidemiological variables, based on data collected in the blood bank of the Sergipe Blood Center, from the donations that occurred from 1 st January, 2007 to December 31 st , 2018. Results: Of the total of 308,953 blood donations, 4,594 bags (1.48%) were discarded due to positive serology for syphilis. Positivity was significantly higher in males (odds ratio = 1.14). There was a significant increase in prevalence with age, from 0.63% (95% CI 0.51-0.76) in individuals under 20 years old to 4.54% (95% CI 3.88-5.30) in those with 60 years and over. Between 2007-2011, a trend of increase in seroprevalence for syphilis was identified (annual percent change = 31.4), followed by stabilization in the disposal of bags in recent years. Discussion: Despite the increase in syphilis reported in society, the study identified that, although there was a significant increase in the initial period, it has been followed by stability in the last years evaluated. What is important is the lack of a test that in fact indicates the active presence of syphilis, since all tests can identify serological scars that remain for long periods, even in people with proper treatment. (AU)