Impact of enhanced recovery after surgery (ERAS) guidelines implementation in cesarean delivery: A systematic review and meta-analysis.

BACKGROUND: Cesarean delivery rate is increasing, with no prediction of this rate to drop. Implementation of Early Recovery After Surgery (ERAS) program adapted to this high prevalent obstetrical surgical procedure proposes better peri-operative care achievement with improved maternal medical care, namely reduced morbidity, faster return to normal daily activities and improved impact on quality of life. Our aim was to analyze the outcomes of ERAS guidelines implementation in cesarean sections (CS). MATERIAL AND METHODS: A systematic review was performed across 3 databases (MEDLINE (Pubmed), Scopus and Web of Science), with no time or language filters, for articles comparing outcomes on pregnant women who delivered via CS with ERAS guidelines implementation versus the traditional approach without ERAS implementation. Outcomes established: primary - hospital length of stay; secondary - opioid consumption, readmission rates and maternal complications (overall, surgical site infection and emetic morbidity). Statistical analyses were conducted using Review Manager 5.4 and its results were expressed as mean difference, standardized mean difference and odds ratio, with 95% of confidence intervals. This systematic review was reported according to the PRISMA statement. RESULTS: This systematic review included 16 studies (3 randomized controlled trials (RCT), 4 prospective cohorts and 9 retrospective cohorts), with a pool analysis of 19,001 women (9752 with the traditional approach and 9249 following ERAS guidelines). Our results showed a significative decrease in length of hospital stay (MD: -13.78 h; CI 95 % -19.28 to -8.28; p < 0.00001) and opioid consumption (SMD: -0.91; CI 95 % -1.51 to -0.32; p = 0.003), with similar readmission rates (OR: 0.85; CI 95 % 0.50 to 1.44; p = 0.53) and maternal complications, namely: overall (OR: 0.87; CI 95 % 0.56 to 1.35; p = 0.53); surgical site infection (OR: 1.13; CI 95 % 0.72 to 1.77; p = 0.60) and emetic morbidity (OR: 0.78; CI 95 % 0.31 to 1.96; p = 0.60). CONCLUSIONS: ERAS guidelines applied at CS management are associated with decreased length of stay and opioid consumption, without negatively impact on readmission rates and overall maternal complications, including surgical site infection and emetic morbidity. The reduced number of RCT studies and the heterogeneity of the studies (heterogeneous inter-study protocols) constitutes the major limitation of the evidence found. Still, these findings may be a foremost help to confirm the beneficial impact of an ERAS approach during peri-cesarean management.

Placenta Accreta Spectrum Disorders - The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal / Patologia do espectro do acretismo placentário - O impacto da criação de uma equipa multidisciplinar nos desfechos maternos em Portugal

Abstract Objective To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). Methods Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group - 2010-2014; and MDT group - 2015-2021. Descriptive analysis of their characteristics and maternal outcomes. Results During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy - one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. Conclusion After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

Resumo Objetivo Descrever uma coorte de casos do espectro do acretismo placentário (PAS) de uma instituição terciária e comparar os resultados maternos antes e depois da criação de uma equipa multidisciplinar (MDT). Métodos Estudo retrospectivo utilizando bancos de dados hospitalares. Identificação de casos de PAS com confirmação patológica entre 2010 e 2021. Divisão em dois grupos: grupo Standard Care (SC) - 2010-2014; e grupo MDT - 2015-2021. Análise descritiva de suas características e desfechos maternos. Resultados Durante o período do estudo, houve 53 casos de PAS (24 - grupo SC; 29 - grupo MDT). Grupo Standard Care: 1 placenta increta e 3 percretas; 12,5% (3/24) tiveram suspeita anteparto; 4 casos tiveram histerectomia periparto - uma eletiva devido à suspeita anteparto de PAS; 3 devido a hemorragia pós-parto. A média de perda hemática estimada (EBL) foi de 2.469 mL; transfusão de concentrado eritrocitário (PRBC) em 25% (6/24) - mediana 7,5 unidades. Equipa multidisciplinar: 4 casos de placenta increta e 3 percretas. A taxa de suspeita anteparto foi de 24,1% (7/29); foram realizadas 9 histerectomias, 7 eletivas por suspeita anteparto de PAS, 1 após diagnóstico intraparto de PAS e 1 após rotura uterina após interrupção da gravidez no segundo trimestre. A EBL média foi de 1.250 mL, com transfusão de PRBC em 37,9% (11/29) - mediana de 2 unidades. Conclusão Após a criação da MDT, houve redução na média de EBL e na mediana do número de unidades de PRBC transfundidas, apesar do maior número de PAS invasivos.

Preoperative staging of uterine cancer: can transvaginal ultrasonography play a role?

Introduction: Preoperative staging of uterine cancer has recently been implied as an important contribution to an accurate selection of low-risk cases, ultimately avoiding unnecessary lymph node debulking. The aim of this study was to evaluate the validity of transvaginal ultrasonography (TVS) in preoperative staging of uterine cancer in comparison to pelvic magnetic resonance imaging (MRI) and permanent section. Methods: We conducted a prospective longitudinal multicenter trial between 2017 and 2018. Inclusion criteria comprised cases of endometrial neoplasia histologically confirmed or strong imaging suspicion, candidates for elective surgery as primary treatment. Proportions of Agreement (PA), kappa statistic (K), sensitivity, specificity and accuracy were calculated with 95% confidence intervals (95%CI). Results: Eighty-two patients were eligible for the study, presenting a mean age of 68 years (standard deviation 11). In what concerns the TVS evaluation of myometrial invasion, the subjective and objective methods of Gordon and Karlsson presented a sensitivity of 79%, 79% and 67% [95%CI 63-91; 63-91; 50-81], a specificity of 65%, 58% and 79% [95%CI 49-79; 42-73; 64-89] and an overall accuracy of 72%, 68% and 73% [95%CI 61-81; 57-78; 63-82]. MRI presented respectively a sensitivity, specificity and overall accuracy of 92%, 70% and 82% [95%CI 77-98; 52-85; 71-90]. Regarding cervical involvement, the sensitivity was respectively 31%, 50% and 67% [95%CI 9-61; 21-79; 35-90] for the subjective method, objective TVS and MRI, and the specificity was 98%, 90% and 100% [95%CI 92-100; 77-97; 94;100]. Agreement between TVS and MRI was superior in the assessment of cervical invasion, with PA ranging from 0.82 to 0.93 and K from 0.45 to 0.58, in comparison to myometrial invasion with PA ranging from 0.68 to 0.73 and K from 0.31 to 0.50. Considering the assessment of cervical involvement, as MRI showed a specificity of 100% it is not possible to increase the specificity. However, it was possible to increase the sensitivity, considering the combination of TVS with objective approach and MRI. Conclusion: TVS may have a promising role as a tool for preoperative staging of endometrial carcinoma, presenting a performance that approximates to MRI, with a higher agreement in the assessment of cervical invasion.

Non-Excisional therapeutic modalities in vaginal intraepithelial neoplasia.

Vaginal intraepithelial neoplasia is an uncommon Human Papilloma Virus-related premalignant lesion of the lower genital tract. There is still no consensus regarding its management. Therapeutic modalities include observation, laser ablation, topical agents, radiation and surgical approach. Due to the current increasing adherence to minimally invasive therapies the aim of this study is to identify and characterize non-excisional treatment modalities. Expectant management is the first therapeutical option in low-grade lesions management. Up to 81% of lesions through an expectant approach regressed spontaneously and most of them were low-grade lesions. In contrast, high-grade lesions, due to its higher potential to invasion progression and low regression rate, require treatment, which should be selected depending on its characteristics and the patient's preference. Laser ablation is suitable for multifocal lesions in sexually active young women with a cure rate up to 90% and recurrence rate up to 6.3%. Brachytherapy can be 71.4%-90% efficient with a maximum of 5.8% and 20% of persistence rate and recurrence rate, respectively. However, due to its toxicity, it should be reserved for selected cases only. Topical modalities for multifocal lesions, such as Imiquimod 5% and 5-Flouorouracil, have a good therapeutic effect, low pharmacological morbidity, and 25%-98% cure rate, 11.1%-75% persistence rate and 5.6%-94.4% recurrence rate.

Fatores associados a óbitos de adultos hospitalizados vivendo com AIDS / Factores associated with deaths of hospitalized adults living whith AIDS / Factores asociados con la muerte en adultos hospitalizados con SIDA

Este trabalho visa identificar os fatores associados a óbitos de adultos hospitalizadas com aids. Para isso, foi realizado estudo do tipo transversal, desenvolvido mediante dados secundários obtidos de prontuários hospitalar de 263 adultos com diagnóstico de aids em Fortaleza, Ceará. As variáveis sociodemográficas e clínicas foram consideradas preditoras e o óbito foi a variável desfecho. Foram expressas as frequências absoluta e relativa de cada variável e aplicados os testes exato de Fisher ou qui-quadrado de Pearson. Os fatores relacionados significativamente ao risco de óbito entre adultos foram: ensino fundamental incompleto (p = 0,001, OR = 1,85; IC = 1,02-3,37), estar afastado do trabalho (p = 0,039, OR = 1,59; IC = 0,81-3,23), possuir doença renal (92%; OR = 3,05; IC = 1,49-6,59), sífilis (85%; OR = 3,05; IC = 1,49-6,58), herpes simples (95%; OR = 3,98; IC = 1,16-19,01), histoplasmose (82%; OR = 0,22; I.C = 0,09-0,46), última contagem de LTCD4 < 200 (p = 0,002; OR = 3,35; IC = 1,37-9,20), queixas de dispneia e febre na admissão hospitalar (p < 0,001; OR = 0,74; IC = 0,20-2,67), tempo de internamento até sete dias (p < 0,001; OR = 0,12; IC = 0,03-0,33), primeira admissão no hospital (p = 0,002; OR = 2,15; IC = 1,31-3,55), acima de três internações no hospital (p = 0,003; OR = 3,09; IC = 1,43-6,88), ter sido internado em UTI (p < 0,001; OR = 0,12; IC = 0,04-0,28), ter realizado hemodiálise (p < 0,001; OR = 0,09; IC = 0,02-0,24), ventilação mecânica (p < 0,001; OR = 0,06; IC = 0,02-0,14) e recebido hemocomponentes e/ou hemoderivados (p < 0,001; OR = 0,18; IC = 0,10-0,32). Com esses dados, concluímos que os óbitos de adultos com aids aconteceram majoritariamente entre pessoas com condições sociodemográficas vulneráveis e com incidência considerável de doenças oportunistas, com demandas de cuidados intensivos.

This cross-sectional study identifies the factors associated with deaths of hospitalized adults with AIDS. Secondary data were collected from the hospital records of 263 adults diagnosed with AIDS in Fortaleza, Ceará, Brazil. Sociodemographic and clinical variables were considered predictors and death the outcome variable. The absolute and relative frequencies of each variable were expressed and Fisher's exact or Pearson's chi-square tests were applied. Factors significantly related to the risk of death among adults were: having incomplete primary education (p = 0.001, OR = 1.85; CI = 1.02-3.37), being off work (p = 0.039, OR = 1.59; CI = 0.81-3.23), having kidney disease (92%; OR = 3.05; CI = 1.49-6.59), syphilis (85%; OR = 3.05; CI = 1.49-6.58), herpes simplex (95%; OR = 3.98; CI = 1.16-19.01), histoplasmosis (82%; OR = 0.22; IC = 0.09-0.46), last LTCD4 count < 200 (p = 0.002; OR = 3.35; IC = 1.37-9.20), complaints of dyspnea and fever on hospital admission (p < 0.001; OR = 0.74; IC = 0.20-2.67), length of stay up to seven days (p < 0.001; OR = 0.12; IC = 0.03-0.33), first hospital admission (p = 0.002; OR = 2.15; IC = 1.31-3.55), over 3 hospital admissions (p = 0.003; OR = 3.09; IC = 1.43-6.88), ICU admission (p < 0.001; OR = 0.12; IC = 0.04-0.28), having performed hemodialysis (p < 0.001; OR = 0.09; IC = 0.02-0.24), mechanical ventilation (p < 0.001; OR = 0.06; IC = 0.02-0.14), and receiving hemocomponents and/or hemoderivatives (p < 0.001; OR = 0.18; IC = 0.10-0.32). In conclusion, deaths of adults with AIDS occurred mostly among those with vulnerable sociodemographic conditions and with considerable incidence of opportunistic diseases, demanding intensive care.

Este trabajo pretende identificar los factores asociados a óbito en adultos hospitalizados con sida. Para ello, se realizó un estudio transversal, basado en datos secundarios obtenidos de historias clínicas de 263 adultos con diagnóstico de sida en Fortaleza, Ceará (Brasil). Las variables sociodemográficas y clínicas fueron consideradas predictoras; y el óbito fue la variable resultado. Se expresaron las frecuencias absoluta y relativa de cada variable y se aplicaron las pruebas exactas de Fisher o chi-cuadrado de Pearson. Los factores relacionados significativamente al riesgo de óbito entre adultos fueron: poseer enseñanza primaria incompleta (p = 0,001, OR = 1,85; IC = 1,02-3,37), estar alejado del trabajo (p = 0,039, OR = 1,59; IC = 0,81-3,23), poseer Enfermedad Renal (92%; OR = 3,05; IC = 1,49-6,59), sífilis (85%; OR = 3,05; IC = 1,49-6,58), herpes simple (95%; OR = 3,98; IC = 1,16-19,01), histoplasmosis (82%; OR = 0,22; IC = 0,09-0,46), último conteo de LTCD4 < 200 (p = 0,002; OR = 3,35; IC = 1,37-9,20), quejas de disnea y fiebre en la admisión hospitalaria (p < 0,001; OR = 0,74; IC = 0,20-2,67), tiempo de hospitalización hasta siete días (p < 0,001; OR = 0,12; IC = 0,03-0,33), primera admisión en el hospital (p = 0,002; OR = 2,15; IC = 1,31-3,55), por encima de tres internaciones en el hospital (p = 0,003; OR = 3,09; IC = 1,43-6,88), haber sido internado en UCI (p < 0,001; OR = 0,12; IC = 0,04-0,28), haber realizado hemodiálisis (p < 0,001; OR = 0,09; IC = 0,02-0,24), ventilación mecánica (p < 0,001; OR = 0,06; IC = 0,02-0,14) y haber recibido hemocomponentes y/o hemoderivados (p < 0,001; OR = 0,18; IC = 0,10-0,32). Se concluye que los óbitos de adultos con sida ocurrieron mayoritariamente entre personas con condiciones sociodemográficas vulnerables y con una incidencia considerable de enfermedades oportunistas, con demandas de cuidados intensivos.

The European Portuguese version of the Reproductive Concerns After Cancer Scale (RCACS): A psychometric validation for young adult female cancer survivors.

PURPOSE: The purpose of this study was to evaluate the psychometric properties of the Portuguese version of the 18-item Reproductive Concerns After Cancer Scale (RCACS) among young adult female cancer survivors. METHODS: The psychometric validation was conducted based on a convenience sample of 192 cancer survivors aged between 18 and 40 years. An exploratory factor analysis (EFA) was used to test the factor structure of the Portuguese version of RCACS and reliabilities were examined. Convergent and discriminant validity was also used to assess the construct validity. The Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORT QLQ-C30) and the need for parenthood and rejection of child-free lifestyle subscales of the Fertility Problem Inventory (FPI) were used as convergent measures. RESULTS: A five-factor model was obtained with acceptable fit indexes and internal consistencies (.72<α<.89): (1) fertility potential, (2) children's health risk and future life, (3) partner disclosure, (4) barriers to getting pregnant/having children and (5) acceptance. Overall, convergent and discriminant validities were confirmed. Levels of anxiety and depression symptoms as well as health-related quality of life (QoL) had weak-to-moderate associations with reproductive concerns. Women who had a child or did not want a biological child were less concerned. CONCLUSION: This scale proved to be a reliable and valid measure of reproductive concerns for the Portuguese population with potential relevance for application in clinical practice.

Sofrimento emocional relacionado ao diabetes mellitus tipo 2: análise na atenção primária à saúde / Emotional suffering related to type 2 diabetes mellitus: analysis in primary health care

Objective:To analyze the emotional suffering related to type 2 Diabetes Mellitus in people assisted in primary health care. Method:Cross-sectional, quantitative study conducted in two basic health units in Ceará. The Brazilian version of the Problem Areas in Diabetes Scale was used for data collection and assessment of emotional distress. Data were collected from a primary source through home visits. Descriptive and analytical statistics were performed. The ethical principles of research with human beings were respected. Results:One hundred and thirteen (113) people with type 2 Diabetes Mellitus participated in the research. Elderly, mixed race/black women, with incomplete elementary education, sedentary, non-smokers and non-alcoholics predominated. Most participants had a high degree of emotional distress. The concern with future complications and the fear of living with the disease were considered relevant problems by the participants. There was a statistically significant association between the variables sex and place of residence with a high degree of mental suffering. Conclusion:Primary care professionals need to plan nursing care aimed at emotional suffering related to type 2 Diabetes Mellitus, especially among female people who live in rural areas.

Objetivo: Analisar o sofrimento emocional relacionado ao Diabetes Mellitus tipo 2, em pessoas atendidas na atenção primária à saúde. Método: Estudo transversal, quantitativo, realizado em duas unidades básicas de saúde cearenses. Para coleta de dados, utilizou-se da Escala Brazilian version of the Problem Areas in Diabetes para avaliar o sofrimento emocional. Os dados foram coletados com fonte primária, por visitas domiciliares. Realizou-se estatística descritiva e analítica. Os princípios éticos de pesquisa com seres humanos foram respeitados. Resultados: Participaram da pesquisa 113 pessoas com Diabetes Mellitus tipo 2. Predominaram idosas, pardas/ negras, com nível de escolaridade de ensino fundamental incompleto, sedentárias, não tabagistas e não etilistas. Em maioria, os participantes apresentaram alto grau de sofrimento emocional. A preocupação com complicações futuras e o medo de conviver com a doença foram considerados problemas relevantes pelos participantes. Houve associação estatisticamente significante das variáveis sexo e local de residência com alto grau de sofrimento mental. Conclusão: Os profissionais da atenção primária precisam planejar a assistência de enfermagem voltada para o sofrimento emocional relacionado ao Diabetes Mellitus tipo 2, especialmente entre pessoas do sexo feminino e que residem em áreas rurais.

Estratégias de prevenção de quedas em puérperas: revisão integrativa da literatura / Strategies to prevent falls in puerperal women: an integrative literature review

Objective:To identify scientific evidence published from 2009 to July 2020 on strategies to prevent falls in puerperal women. Methods:This is an integrative review of the literature in the electronic databases: The US National Library of Medicine, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature analysis and Retrieval System Online, Cochrane Library and Scientific Electronic Library Online. Results:We found 429 articles, nine of which were selected for analysis. The thematic axes found were based on the use of protocols and tools for the evaluation and prevention of falls in puerperal women, focusing on the importance of guidance and care measures for fall prevention. The limitation of the study lays on the low number of publications that led specifically with falls among puerperal women, which made it difficult to further analyze. Conclusion:The studies demonstrated that the strategies adopted prevented falls in puerperal women. The contribution of this study is based on the reflection of safe professional practice and contributes to the promotion of patient's safety culture. The lack of Brazilian research is highlighted as a knowledge gap, which points to the need to conduct studies that address this theme, especially by nurses.

Objetivo: Identificar evidências científicas, publicadas de 2009 a julho de 2020, sobre estratégias para prevenir quedas em puérperas. Métodos: Revisão integrativa da literatura realizada nas bases eletrônicas: The US National Library of Medicine, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrievel System Online, Cochrane Library e Scientific Eletronic Library Online. Resultados: Encontraram-se 429 artigos, sendo nove selecionados para análise. Os eixos temáticos encontrados se basearam na utilização de protocolos e ferramentas para avaliação e prevenção de quedas em puérperas, com enfoque na importância das orientações e medidas de cuidados para prevenção de quedas. A limitação deste estudo se refere ao baixo número de publicações que trataram especificamente de quedas entre puérperas, o que dificultou análise mais ampla. Conclusão: Os estudos demonstraram que as estratégias adotadas preveniram quedas em puérperas. A contribuição deste estudo se pauta na reflexão da prática profissional segura e promoção da cultura da segurança do paciente. Ademais, aponta-se como lacuna do conhecimento a ausência de pesquisas brasileiras, urgindo, deste modo, condução de estudos que contemplem essa temática, sobretudo, por enfermeiros.

Peritoneal dissemination of ovarian cancer: role of MUC16-mesothelin interaction and implications for treatment.

INTRODUCTION: Peritoneal dissemination is a particular form of malignant progression in ovarian cancer, preceding hematogenic or lymphatic dissemination. Thus, prevention of peritoneal implantation of cancer cells is envisioned to inhibit neoplastic dissemination and therefore prolong disease remission and patient's survival. Areas covered: An extended review on the role of MUC16 (CA125) and mesothelin (MSLN), expressed in a high percentage of ovarian carcinomas, indicate that this duet is relevant for the contact between cancer cells and mesothelial cells in homotypic (cancer cell-cancer cell) and heterotypic (cancer cell-mesothelial cell) interactions. This review discusses the reasons underlying the clinical failure of immunotherapeutic strategies targeting MUC16. Clinical data on MSLN targeting agents such as antibody-based immunotoxins or antibody drug conjugates are also reviewed. The promising anti-tumor effect of CAR-T cells directed to MUC16 or MSLN is emphasized. New emerging strategies specifically disrupting the MUC16-MSLN interaction are at the forefront of this review, including TRAIL ligands bound to MSLN targeting MUC16 expressing cells and single chain monoclonal antibodies and immunoadhesins recognizing MSLN-MUC16 binding domains. Expert commentary: Based on existing evidences the authors advocate that agents targeting MUC16-MSLN may add to the therapeutic armamentarium directed to abrogate peritoneal homing of ovarian cancer.

Análise do controle vetorial da dengue no sertão piauiense entre 2007 e 2011 / Analysis of dengue vector control in the semiarid region of Piauí between 2007 and 2011

Resumo Dois terços da população mundial vivem em áreas infestadas com mosquitos vetores da dengue, especialmente o Aedes aegypti. Este estudo realizou um levantamento de dados sobre casos de dengue no município de Picos, no Estado do Piauí, Brasil, entre os anos de 2007 e 2011, enfatizando alguns fatores envolvidos em sua transmissão. Os dados foram coletados no Centro de Zoonoses de Picos da Secretaria Municipal de Saúde e no Sistema de Informação da Febre Amarela e Dengue (SISFAD) do Programa Nacional do Controle da Dengue (PNCD). Durante os anos de 2007, 2008, 2009, 2010 e 2011, foram visitados, respectivamente, 116.301, 182.024, 181.892, 187.619 e 195.377 imóveis pelos agentes de controle de endemias (ACE). As residências foram os estabelecimentos com maior positividade para focos de larvas de Aedes aegypti (p<0,05). Dentre os depósitos inspecionados, as larvas predominaram em armazenadores de água rebaixados (tambores) e elevados (caixas-d’água). Testes sorológicos confirmaram um total de 85 casos em 2007, 117 em 2008, 221 em 2009, 296 em 2010 e 217 em 2011. A média de casos foi mais expressiva em pacientes com idade entre 20-34 anos (p<0,05). No ano de 2011, foram identificados, pela primeira vez, focos de Aedes albopictus, encontrados principalmente em tambores de água. Portanto, o número de casos vem aumentando, o que sugere que o controle vetorial da transmissão pode sofrer forte impacto a partir da ação de vigilância epidemiológica em âmbito coletivo, uma vez que depósitos de água peri ou intradomiciliares representaram os locais predominantes para a procriação de vetores.

Abstract Two-thirds of the world population live in areas infested with dengue vector mosquitoes, especially Aedes aegypti. This study conducted a survey about dengue cases in Picos (Piauí, Brazil) between 2007 and 2011, emphasizing some transmission factors. Data were collected in the Health Secretary and Municipal Zoonoses Center and in SISFAD Programme (Information System of the National Dengue Control Program). During 2007, 2008, 2009, 2010 and 2011, a total of 116,301; 181,892; 187,619 and 195,377 properties, respectively, were visited by endemic control agents, and presented higher rates of outbreaks for A. aegypti larvae (p<0.05). Among the inspected places, larvae were predominant in lowered (storage tanks) and raised (water tanks) water reservoirs. Serological tests confirmed a total of 85, 117, 221, 296 and 217 cases in 2007, 2008, 2009, 2010 and 2011 and the average number of cases was higher in patients between 20-34 years-old) (p<0.05). In 2011 it was identified, for the first time, Aedes albopictus spots, mainly in storage tanks. Therefore, the number of cases is increasing, suggesting that the transmission vector control may suffer a strong impact by surveillance action based on community contribution, since peri- or household water tanks represented the predominant sites for vectors reproduction.

Exposição ocupacional de trabalhadores rurais a agrotóxicos / Occupational exposure of rural workers to pesticides

Resumo Objetivos Avaliar o perfil dos trabalhadores rurais do município de Picos, no Estado do Piauí e suas práticas e atitudes quanto à utilização de agrotóxicos. Métodos A coleta dos dados (n=159) foi realizada em Picos com levantamento de dados socioeconômicos, utilização de equipamentos de proteção individual (EPIs), armazenamento e destino das embalagens de agrotóxicos, toxicidade e risco ambiental. Resultados A maioria dos agricultores era do sexo feminino (63%), não concluiu o ensino fundamental (55,6%), tinha entre 31 e 50 anos (55,3%), com renda de até um salário mínimo (66%) e possuía água encanada (84,3%). Quanto ao uso, 64,1% (102) utilizavam agrotóxicos, principalmente na agricultura (86,3%). Eles obtiveram informações sobre essas substâncias com vizinhos (44,2%), liam o rótulo para utilizar o produto (64,8%), usavam agroquímicos devido à ação rápida (81,4%), compravam em casas agropecuárias (87,4%), sem receituário agronômico (92%) e armazenavam embalagens dentro da própria casa (33,6%). Mais da metade não usava EPIs (56,8%), embora considerassem os agrotóxicos prejudiciais à saúde humana (94,1%) e ao meio ambiente (80,4%), além de 15% (24 pessoas) terem sentido algum sintoma de envenenamento. Conclusões Os entrevistados, em sua maioria, usavam agrotóxicos inadequadamente, tinham baixa escolaridade e conheciam sobre os riscos individuais e coletivos aos quais estavam expostos, mas não usavam EPIs.

Abstract Objectives To evaluate rural workers’ profile at Picos (Piauí, Brazil) and their practices and attitudes regarding the use of pesticides. Methods Data collection (n=159) was performed in Picos (Piauí, Brazil) to describe socioeconomic information, use of personal protective equipment (PPE), storage and disposal of pesticide packaging, toxicity and environmental risk. Results Most farmers were women (63%), with incomplete primary education (55.6%), age between 31-55 years-old (55.3%), income of up to a 1 minimum wage (66%) and with access to city water (84.3%). In relation to the use, 64.1% (102) use pesticides, especially in agriculture (86.3%). They receive information about pesticides with neighbors (44.2%), read label to use the product (64.8%), use pesticides due to their quick action (81.4%), purchase in agricultural houses (87.4%) without agronomic prescription (92%) and store packages indoors (33.6%). More than half do not use PPE (56.8%), though they consider pesticides damaging products to the human health (94.1%) and environment (80.4%) and 15% (24 persons) reported some poisoning symptoms. Conclusions The majority of the farmers use pesticides incorrectly, has low educational status and know about the individual and collective risks to which they are exposed but do not use PPE.

Investigation and Management of Adnexal Masses in Pregnancy.

Adnexal masses can be found in 0.19 to 8.8% of all pregnancies. Most masses are functional and asymptomatic and up to 70% resolve spontaneously in the second trimester. The main predictors of persistence are the size (>5 cm) and the imagiological morphocomplexity. Those that persist carry a low risk of malignancy (0 to 10%). Most malignant masses are diagnosed at early stages and more than 50% are borderline epithelial neoplasms. Ultrasound is the preferred method to stratify the risk of complications and malignancy, allowing medical approach planning. Pregnancy and some gestational disorders may modify the levels of tumor markers, whereby their interpretation during pregnancy should be cautious. Large masses are at increased risk of torsion, rupture, and dystocia. When surgery is indicated, laparoscopy is a safe technique and should ideally be carried out in the second trimester of pregnancy.

[Ectopic Decidualization: A Forgotten Entity]. / Decidualização Ectópica: Uma Entidade Esquecida.

INTRODUCTION: Although ectopic decidualization is an entity often underdiagnosed, it may have adverse clinical impact on maternal-fetal morbimortality. The objective of this study was to review the scientific evidence regarding the etiology, clinical features, diagnosis and therapeutic approach on this issue. MATERIAL AND METHODS: The search for this literature review was conducted in PubMed, Web of Science and Scopus, through the query ('deciduosis' OR 'ectopic decidualization' OR 'ectopic decidua' OR 'ectopic decidua reaction'), considering articles of all evidence levels published up to 31/06/2014. RESULTS: Ectopic decidualization is, usually, a benign condition, asymptomatic and does not require therapeutic intervention. It occurs mostly during pregnancy, with complete regression in the postpartum period. The frequency of the diagnosis depends on the clinical suspicion and its location, being the omentum and the ovary the most common sites. When symptomatic, the main clinical manifestations are genital bleeding and hemoperitoneum. Differential diagnosis includes malignant disease and histopathological confirmation is essential in these situations. The low index of suspicion may lead to a biopsy, which can have serious adverse outcomes due to the high friability of these lesions. DISCUSSION AND CONCLUSION: The recognition of this entity and its clinical features are essential for the management of these patients. On one side this allows an early and proper medical approach in severe cases, on the other side (the majority of cases) maintaining an expectant attitude avoiding iatrogeny, does not compromise, in most cases, the favorable outcome of ectopic decidualization.

Introdução: Apesar da decidualização ectópica ser uma entidade frequentemente subdiagnosticada, pode ter impacto clínico adverso na morbimortalidade materno-fetal. O objetivo deste trabalho foi rever a evidência científica relativa a etiopatogenia, clínica, abordagem diagnóstica e terapêutica sobre esta temática. Material e Métodos: A pesquisa bibliográfica foi realizada na PubMed, Web of Science e Scopus, através da query ('deciduosis' OR 'ectopic decidualization' OR 'ectopic decidua' OR 'ectopic decidua reaction'), incluindo-se artigos publicados até 31/6/2014 e de todos os níveis de evidência. Resultados: A decidualização ectópica, geralmente, representa uma condição benigna, assintomática e sem necessidade de intervenção terapêutica. Encontra-se, maioritariamente, associada à gravidez, com regressão completa no período pós-parto. A frequência do seu diagnóstico depende da suspeição clínica, bem como do local onde surge, sendo o omento e o ovário os locais mais comuns. Quando sintomática, as principais manifestações clínicas são quadros hemorrágicos, nomeadamente hemorragia genital e hemoperitoneu. Os diagnósticos diferenciais incluem patologia maligna, sendo essencial, nestas situações, a confirmação histopatológica. O baixo índice de suspeição clínica pode levar à realização de biópsia, que pode acarretar impacto adverso grave devido à elevada friabilidade destas lesões. Discussão e Conclusão: O reconhecimento desta entidade e das suas características clínicas torna-se essencial na conduta destas doentes. Tal permite por um lado a abordagem médica precoce e adequada nos casos graves, e por outro lado (na maioria dos casos) manter a atitude expectante minimizando a iatrogenia, mantendo o desfecho favorável da decidualização ectópica.

Efeitos dos programas de exercícios físicos e fisioterapia em indivíduos com Parkinson / Effects of exercise programs and physical therapy in subjects with Parkinson

Introdução: A Doença de Parkinson (DP) ocorre através de uma alteração na via dopaminérgica central da substância negra. Os programas de exercícios físicos e fisioterapia associados aos fármacos e outras diversas formas de tratamento são um meio terapêutico importante para a melhora da qualidade de vida dos indivíduos com DP. Objetivo: Revisar a literatura acerca dos efeitos dos programas de exercícios físicos e fisioterapia em indivíduos com DP. Métodos: Realizou-se uma revisão da literatura de estudos publicados em periódicos indexados na base de dados eletrônica Scientific Electronic Library online (Scielo), sem restrição do período de publicação, que possuíam como tema os efeitos de programas de exercícios físicos e fisioterapia em indivíduos com DP. Resultados: Após a análise dos títulos e resumos, permaneceram ao final 8 artigos, nos quais verificamos efeitos de programas de exercícios físicos sobre a na Qualidade de Vida (QV) (3), equilíbrio (02), função motora (01), funções psicológicas e cognitivas (01), desempenho funcional e capacidade física (01) em indivíduos com DP. O período de intervenções nos estudos variou entre 2 e 6 meses, todos relatando efeitos benéficos quando aplicados em indivíduos com DP. Conclusão: Através da análise dos artigos, pode-se concluir que a utilização de programas de exercícios físicos é benéfica em indivíduos com DP. (AU)

Introduction: Parkinson Disease (PD) occurs over an alteration on the central dopaminergic pathway of black substance. The exercise programs and physical therapy associated with drugs and other various treatments are an important therapeutic method to improve the quality of life of subjects with PD. Objective: To review the literature about the exercise programs effects and physical therapy in subjects with PD. Methods: We performed a review of studies published in periodicals indexed at the Scientific Electronic Library Online (Scielo) database, without restriction on the period of publication, which had as theme the effects of exercise programs and physical therapy in subjects with PD. Results: After analysis of titles and abstracts, 8 articles remained at the end, in which were verified effects of physical exercise programs on the Quality of Life (QL) (3), balance (02), motor function (01), psychological and cognitive functions (01), functional performance and physical capability (01) in subjects with PD. Conclusion: Through analysis of the articles it can be concluded that the use of exercise programs are beneficial in subjects with PD. (AU)

Aspectos biopsicossociais em escolares com atraso no desenvolvimento motor: um estudo longitudinal / Biopsychosocial factors contributing to delayed motor development in children: a longitudinal study

INTRODUCTION: Biopsychosocial conditions may influence childhood motor skill acquisition. OBJECTIVE: To analyse the biopsychosocial profiles of children with delayed motor development. METHODS: Employ quantitative descriptive research under longitudinal analysis. Seventeen students with motor development classified as lower than expected after two evaluations were investigated. A biopsychosocial questionnaire was applied to analyse risk factors in the form of an interview for the parents, and the Motor Development Scale (MDS) was applied to evaluate subject motor patterns. RESULTS: Biological and environmental risk factors, such as difficulties in school learning and low socioeconomic status may have contributed to delays in motor development. CONCLUSION: Childhood motor development may be influenced by biological and environmental risk factors such as gestational age at birth, type of birth, family socioeconomic status, and parental education level.

INTRODUÇÃO: Condições biopsicossociais podem influenciar a aquisição de habilidades motoras na infância. OBJETIVO: analisar o perfil biopsicossocial de escolares com atraso no desenvolvimento motor. MÉTODO: trata-se de uma pesquisa descritiva quantitativa sob análise longitudinal. Foram investigados dezessete escolares que tiveram na segunda avaliação seu desenvolvimento motor classificado como inferior ao esperado. Para análise dos fatores de risco utilizou-se um questionário biopsicossocial em forma de entrevista com os pais das crianças e a Escala de Desenvolvimento Motor (EDM) para avaliação do padrão motor da criança. RESULTADOS: fatores de risco biológico e ambientais, como dificuldades na aprendizagem escolar e baixo nível socioeconômico podem ter contribuído para o atraso no desenvolvimento moto.r CONCLUSÃO: o desenvolvimento motor pode ser influenciado por fatores de risco tanto biológico como ambiental, tais como: tempo de gestação, tipo de parto, condição socioeconômica da família, nível de escolaridade dos pais.

Efeitos da Intervenção Motora em uma Criança com Síndrome de Williams / Effects of Motor Intervention in a Child With Williams Syndrome

RESUMOO objetivo deste estudo foi avaliar o desenvolvimento motor de uma criança com Síndrome de Williams e verificar os efeitos de um programa de intervenção motora. Trata-se de uma pesquisa descritiva do tipo estudo de caso. Para a avaliação do desenvolvimento motor foram utilizados os testes da Escala de Desenvolvimento Motor - EDM. Essa criança participou de avaliação motora, intervenção motora (32 sessões, duas vezes semanais) e reavaliação motora. As intervenções motoras mostraram avanços positivos nas áreas da motricidade fina, equilíbrio e organização espacial. Verificou-se que o esquema corporal e a organização temporal foram as áreas de maior prejuízo. O quociente motor geral foi classificado como muito inferior o que caracteriza déficit motor. Esses dados justificam a relevância de programas de intervenção motora para essa população.

ABSTRACTThe objective of this study was to evaluate the motor development of a child with Williams syndrome and to verify the effect of a motor intervention program. This is a descriptive case study. Motor development was evaluated using the Motor Development Scale - MDS. The child's motor assessment, motor intervention (32 sessions, twice weekly) and motor reevaluation were carried out. Gains were demonstrated in motor intervention in the areas of fine motor skills, balance and spatial organization. Body Schema and temporal organization were found to be the areas of lesser achievement. The motor quotient generally for all items was classified as very low, characterizing motor deficit. The data justifies the relevance of motor intervention programs for children with Williams syndrome.

Perfil do uso populacional de inseticidas domésticos no combate a mosquitos / Profile of the population use of household insecticides against mosquitoes

Esse trabalho descreve a utilização doméstica de inseticidas pela população de Picos (Piauí, Brasil),identifica quais são os tipos de inseticidas mais utilizados e descreve a incidência de intoxicação e a consciência ambiental da população. Após visitas domiciliares (n=700), notou-se que a maioria dos entrevistados foi representada por mulheres (75%), com idade entre 31-55 anos (49%), ensino fundamental incompleto (38,1%) e renda familiar entre 1-2 salários mínimos (64%). A maioria das residências tem entre 1-3 moradores (48%), 85% dos entrevistados usam inseticidas escolhidos principalmente em propagandas de TV e radio e apenas 54% leem o rótulo antes de aplicar o produto. A forma de apresentação mais usada é o aerossol (70,7%). A maioria (79%) reconhece que inseticidas são maléficos à saúde, mas 74% não usam nenhum Equipamento de Proteção Individual (EPI). Sintomas de toxicidade foram relatados por 27%dos entrevistados. Duas mulheres relataram irritação, tonturas e problemas respiratórios e necessidade de intervenção médica e internação hospitalar. Todos os entrevistados descartam as embalagens como lixo comum, uma vez que em Picos não há coleta seletiva. Em conclusão, a maioria das pessoas usam inseticidas, conhecem sobre os riscos individuais e coletivos aos quais estão expostos mas não usam EPI mesmo acreditando que sejam tóxicos. Notou-se que aquisição de conhecimentos não resulta,necessariamente, em mudanças de comportamento, uma vez que o conhecimento não se traduz em atitudes e práticas preventivas adequadas, ressaltando-se a necessidade de campanhas de conscientização quanto à toxicidade e aos riscos ambientais, capacitação de profissionais e política fiscalizatória contra a venda indiscriminada.

This study described the use of household insecticides in Picos (Piauí, Brazil), identify which are the mostused types of insecticides and describes the incidence of poisoning and environmental awareness of the population. After home visits (n = 700), it was seen that the majority of respondents was represented by women (75%), with 31-55 years-old (49%), incomplete primary education (38.1%) and income between 1-2 earnings (64%). Most homes have between 1-3 residents (48%), 85% of the persons use insecticides mainly chosen in TV and radio and only 54% of them read the label before employing the product. The most used form of presentation is the aerosol (70.7%). Majority (79%) recognizes that insecticides are harmful to health, but 74% do not use any Personal Protective Equipment (PPE). Symptoms of toxicity were reported by 27% of people interviewed. Two women reported irritation, dizziness and respiratory problems and need for medical intervention and hospitalization. All interviewed discard the package as regular trash, since Picos does not has selective collection. In conclusion, most people use insecticides, know about the individual and collective risks to which they are exposed but do not use PPE, though they believe insecticides are toxic. It was noted that acquisition of knowledge does not necessarily result in behavioral changes, since learning does not translate into appropriate preventive attitudes and practices, emphasizing the requirement for awareness campaigns about toxicity and environmental risks, preparation of professionals and surveillance policy against indiscriminate sale.

Bleomycin sclerotherapy for severe symptomatic and persistent pelvic lymphocele.

Background. Pelvic lymphoceles are frequently described as a complication of pelvic lymphadenectomy performed for surgical staging of gynaecologic malignancies. Case Report. A 72-year-old woman presented with severe symptomatic and refractory lymphocele associated with persistent lower limb lymphedema and recurrent erysipelas. After four CT fluoroscopy scan guided percutaneous catheter drainages, the lymphocele complicated with infection finally resolved with two sessions of bleomycin sclerotherapy. Conclusion. Symptomatic persistent lymphoceles require treatment and nowadays the first option is interventional radiologic procedures. Bleomycin is a safe and effective sclerosing agent and therefore should be regarded as a first-line treatment choice.

Extra-intestinal malignancies in inflammatory bowel disease: results of the 3rd ECCO Pathogenesis Scientific Workshop (III).

The incidence of lymphoproliferative disorders (LD) is increasing in developed countries. Patients with inflammatory bowel disease (IBD) exposed to thiopurines are at additional risk of three specific forms of LD: Epstein-Barr-Virus-related post-transplant like LD, hepato-splenic T-cell lymphoma and post-mononucleosis lymphoproliferation. The risk of the two latter forms of LD can be reduced when considering specific immunosuppressive strategies in young males. It is still unclear whether the risk of uterine cervix abnormalities is increased in IBD women, irrespective of the use of immunosuppressants. Given the excess risk demonstrated in various other contexts of immunosuppression, it is currently recommended that all women with IBD, particularly those receiving immunosuppressants, strictly adhere to a screening program of cervical surveillance and undergo vaccination against HPV, when appropriate. Patients with IBD receiving immunosuppressants are at increased risk of skin cancers. The risk of non-melanoma skin cancer is notably increased in patients receiving thiopurines. Recent data suggest that the risk of melanoma is mildly increased in patients exposed to anti-TNF therapy. All IBD patients should adhere to a program of sun protection and dermatological surveillance, whose details should take into account the other non-IBD-related risk factors.

Myxomycetes collection preserved in the herbarium of the Federal University of Roraima (Brazil) / Coleção de Myxomycetes conservada no herbário da Universidade Federal de Roraima

First records of myxomycetes in the North region of Brazil go back to the 19th century. Nevertheless, the myxobiota of this region is still largely unexplored, with only 42 species recorded, distributed in 20 genera and seven families. The objectives of this paper were to characterize the Myxomycetes collection of the Herbarium of the Federal University of Roraima (UFRR) and to add new records for the myxobiota of this State. The collection holds specimens collected in fragments of Open Ombrophilous Forest, Seasonal Semi-deciduous Forest, Riparian Forest, deforested areas and urban home gardens in the state of Roraima. The 157 exsiccates were analyzed and identified or redetermined based on identification keys, descriptions and illustrations. The collection is in good conditions of preservation and includes all subclasses of Myxomycetes, 83% of its orders, 50% of its families, and 20 species. Trichiales, with one family, three genera and six species, represents 62% of all exsiccates. Cribraria aff. splendens, Metatrichia vesparia, Physarella oblonga, Stemonaria longa and Stemonitis splendens are new records for Roraima and Arcyria obvelata, Comatricha pulchella, Stemonitis pallida and Stemonitopsis aequalis are referred for the first time in the Northern Region, enlarging the knowledge of the Brazilian geographic distribution of these species.

Os primeiros registros de mixomicetos na Região Norte do Brasil remontam ao Século XIX. Todavia, a mixobiota desta região está ainda muito pouco explorada, com apenas 42 espécies registradas, distribuídas em 20 gêneros e sete famílias. Os objetivos deste estudo foram caracterizar a coleção de Myxomycetes do Herbário da Universidade Federal de Roraima (UFRR) e adicionar novos registros para a mixobiota deste estado. A coleção contém espécimes coletados em fragmentos de Floresta Ombrófila Aberta, Floresta Estacional Semi-decidual, Mata Ciliar, áreas desmatadas e quintais urbanos no estado de Roraima. As 157 exsicatas foram analisadas e identificadas ou redeterminadas com base em chaves de identificação, descrições e ilustrações. A coleção encontra-se em boas condições de conservação e inclui todas as subclasses de Myxomycetes, 83% das ordens, 50% das famílias e 20 espécies. A ordem Trichiales, com uma família, três gêneros e seis espécies, corresponde a 62% das exsicatas. Cribraria aff. splendens, Metatrichia vesparia, Physarella oblonga, Stemonaria longa e Stemonitis splendens são novos registros para o estado de Roraima e Arcyria obvelata, Comatricha pulchella, Stemonitis pallida e Stemonitopsis aequalis são referidas pela primeira vez para a Região Norte, ampliando a distribuição geográfica conhecida para estas espécies no Brasil.