Cost Savings and Effectiveness of Long-Acting Reversible Contraception (LARC) on the Prevention of Pregnancy in Adolescents: A Systematic Review.

Adolescent pregnancy is a major public health issue with profound implications for health and socioeconomic factors. The use of long-acting reversible contraception (LARC) could be an interesting strategy to reduce the unintended pregnancy rate. However, the cost of LARC is still a barrier to widespread adoption. This study aimed to analyze the effectiveness and economic impact of LARC compared with non-LARC methods in preventing unintended pregnancy among adolescent girls. This systematic review was registered in PROSPERO (CRD42023387735) and conducted following the PRISMA guidelines. We included articles covering adolescents aged 10-19 years without language restrictions that evaluated the use of LARC compared with non-LARC in terms of effectiveness and the public health costs of unintended pregnancy. The search for articles included the databases MEDLINE/PubMed, Cochrane Library, Embase, and Lilacs, using the entry terms "Adolescent" and "Long-Acting Reversible Contraception." We evaluated the risk of bias and the certainty of the evidence for each outcome of interest. The search retrieved a total of 1,169 articles and, after the title and abstract, we identified 40 articles for full-text analysis. Out of the 40 studies evaluated, 4 articles met the eligibility criteria for cost evaluation, and 1 met the eligibility criteria for effectiveness as an outcome. In conclusion, LARC emerges as the most effective and cost-effective contraceptive method. The cost of utilizing LARC, especially the copper IUD, is significantly lower than the costs attributable to unintended pregnancies in adolescence.

Influence of Acute Kidney Injury Defined by the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease Score on the Clinical Course of PICU Patients.

OBJECTIVE: To evaluate the predictive value of the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria for disease course severity in patients with or without acute kidney injury admitted to a PICU. DESIGN: Retrospective cohort study. SETTING: A 12-bed PICU at a tertiary referral center in Southern Brazil. PATIENTS: All patients admitted to the study unit over a 1-year period. INTERVENTIONS: A database of all eligible patients was analyzed retrospectively. MEASUREMENTS AND MAIN RESULTS: Patients were classified by pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score at admission and worst pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score during PICU hospitalization. The outcomes of interest were length of PICU stay, duration of mechanical ventilation, duration of vasoactive drug therapy, and mortality. The Pediatric Index of Mortality 2 was used to assess overall disease severity at the time of PICU admission. Of 375 patients, 169 (45%) presented acute kidney injury at the time of admission and 37 developed acute kidney injury during PICU stay, for a total of 206 of 375 patients (55%) diagnosed with acute kidney injury during the study period. The median Pediatric Index of Mortality 2 score predicted a mortality rate of 9% among non-acute kidney injury patients versus a mortality rate of 16% among acute kidney injury patients (p = 0.006). The mortality of patients classified as pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease F was double that predicted by Pediatric Index of Mortality 2 (7 vs 3.2). Patients classified as having severe acute kidney injury (pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease I + F) exhibited higher mortality (14.1%; p = 0.001) and prolonged PICU length of stay (median, 7 d; p = 0.001) when compared with other patients. Acute kidney injury is a very frequent occurrence among patients admitted to PICUs. CONCLUSIONS: The degree of acute kidney injury severity, as assessed by the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria, is a good predictor of morbidity and mortality in this population. Pediatric Index of Mortality 2 tends to underestimate mortality in pediatric patients with severe acute kidney injury.

Criança com traumatismo crânio-encefálico na emergência hospitalar: quando tomografar? / Emergency room head trauma evaluation in a child: when is a computedtomography indicated?

O traumatismo crânio-encefálico (TCE) tem grande prevalência nas emergências pediátricas. O grande desafio do pediatra é detectar precocemente aquelas crianças que apresentam lesões associadas ao TCE. Atualmente, a principal ferramenta diagnóstica utilizada tem sido a Tomografia Computadorizada (TC) de Crânio. Considerando que menos de 10% das crianças com TCE leve apresentam lesões cerebrais traumáticas e que a TC de crânio apresenta riscos de malignidade induzida por radiação em crianças, principalmente naquelas menores de 2 anos, é importante para o pediatra racionalizar o uso da TC nesse contexto. O objetivo desse artigo é auxiliar o pediatra no manejo da criança vitima de TCE leve (Escala de Coma Glasgow: 14-15), sobretudo orientando as principais indicações de solicitação de TC.

The traumatic brain injury (TBI) has a high prevalence in pediatric emergencies. The greatest challenge to the pediatrician is early detection of those children with injuries related to head trauma. Currently, the most widely used diagnostic tool has been head computed tomography (CT). Considering that less than 10% of children with mild TBI have brain injuries and the risk of radiation-induced cancer in children, especially those younger than 2 years, it is important for pediatricians the rational use of head CT. This paper aim to assist the pediatrician in the management of pediatric mild TBI (Glasgow Coma Scale: 14-15), especially focusing on the main indications for head CT.

Intoxicação por etanol na criança / Ethanol intoxication in children

A intoxicação por álcool em crianças e adolescentes pode manifestar-se desde a forma mais leve de embriaguez até casos graves de coma hipoglicêmico, podendo em alguns casos levar a morte. Este trabalho visa revisar a farmacologia e a toxicologia do etanol, bem como os seus efeitos clínicos e o manejo do paciente pediátrico nessa situação.

Alcohol intoxication in children and adolescents can range from mild forms of inebriation to severe cases of ethanol-induced hypoglycemia, which in some cases may lead to death. This paper aims to review the pharmacology and toxicology of ethanol, as well as its clinical features and management of the pediatric patient in this situation.

Community-acquired staphylococcal pneumonia.

OBJECTIVE: Staphylococcal pneumonia typically presents high rates of morbidity and mortality. It typically occurs in cases of influenza (airborne transmission) or during episodes of bacteremia (blood-borne transmission). METHODS: A retrospective and descriptive study was conducted in patients admitted to our hospital between January of 1992 and December of 2003. All of he patients included had been diagnosed with community-acquired pneumonia caused by Staphylococcus aureus. All were older than 14 years of age, and none were intravenous drug users. RESULTS: Community-acquired pneumonia was identified in 332 cases, of which 24 (7.3%) were identified as cases of staphylococcal pneumonia. Age ranged from 14 to 89 years. Fifteen patients were male, and nine were female. Twelve patients met the criteria for severe pneumonia. Chest X-rays showed unilateral consolidation in 14 cases, bilateral consolidation in 10, pleural effusion in 15, rapid radiological progression of pulmonary lesions in 14, cavitation in 6 and pneumothorax in 1. Most of the patients presented comorbidities, of which diabetes mellitus was the most common. Twelve patients presented complications such as empyema and septic shock. Four patients died, translating to a mortality rate of 16.6% in our sample. CONCLUSIONS: The clinical presentation of pneumonia caused by S. aureus is similar to that of pneumonia caused by other etiological agents. Radiological findings, epidemiological data and risk factors provide important clues to the diagnosis. These factors are important for clinical suspicion, since S. aureus is not typically addressed in empirical treatment.

Pneumonia estafilocócica adquirida na comunidade / Community-acquired staphylococcal pneumonia

OBJETIVO: A pneumonia estafilocócica geralmente apresenta uma elevada taxa de morbidade e mortalidade. Normalmente ocorre em infecções por influenza (via aerógena) ou durante episódios de bacteremia (via hematogênica). MÉTODOS: Um estudo retrospectivo e descritivo foi realizado com os pacientes que foram admitidos em nosso hospital entre janeiro de 1992 e dezembro de 2003 com diagnóstico de pneumonia adquirida na comunidade causada por Staphylococcus aureus. Todos eles eram maiores de 14 anos e não usuários de drogas endovenosas. RESULTADOS: De um total de 332 casos de pneumonia adquirida na comunidade, foram encontrados 24 pacientes (7,3 por cento) com pneumonia estafilocócica. A idade mínima e máxima eram de, respectivamente, 14 anos e 89 anos. Quinze pacientes eram homens e nove eram mulheres. Doze pacientes preenchiam critérios para pneumonia grave. O radiograma de tórax evidenciou consolidação unilateral em 14 casos, bilateral em 10, derrame pleural em 15, rápida progressão radiológica das lesões pulmonares em 14, presença de cavitação em 6 e pneumotórax em 1 paciente. A maioria dos pacientes apresentou co-morbidades e diabetes mellitus foi a mais freqüente. Doze pacientes apresentaram complicações como empiema e choque séptico. Houve quatro óbitos, o que representou 16,6 por cento da amostra. CONCLUSÕES: A apresentação clínica da pneumonia causada por S. aureus é similar à apresentação das pneumonias originadas por outros agentes etiológicos. Os achados radiológicos, os dados epidemiológicos e os fatores de risco fornecem importantes indícios para o diagnóstico. Estes fatores são importantes para uma suspeição clínica, já que o S. aureus normalmente não é incluído nos tratamentos empíricos.

OBJECTIVE: Staphylococcal pneumonia typically presents high rates of morbidity and mortality. It typically occurs in cases of influenza (airborne transmission) or during episodes of bacteremia (blood-borne transmission). METHODS: A retrospective and descriptive study was conducted in patients admitted to our hospital between January of 1992 and December of 2003. All of he patients included had been diagnosed with community-acquired pneumonia caused by Staphylococcus aureus. All were older than 14 years of age, and none were intravenous drug users. RESULTS: Community-acquired pneumonia was identified in 332 cases, of which 24 (7.3 percent) were identified as cases of staphylococcal pneumonia. Age ranged from 14 to 89 years. Fifteen patients were male, and nine were female. Twelve patients met the criteria for severe pneumonia. Chest X-rays showed unilateral consolidation in 14 cases, bilateral consolidation in 10, pleural effusion in 15, rapid radiological progression of pulmonary lesions in 14, cavitation in 6 and pneumothorax in 1. Most of the patients presented comorbidities, of which diabetes mellitus was the most common. Twelve patients presented complications such as empyema and septic shock. Four patients died, translating to a mortality rate of 16.6 percent in our sample. CONCLUSIONS: The clinical presentation of pneumonia caused by S. aureus is similar to that of pneumonia caused by other etiological agents. Radiological findings, epidemiological data and risk factors provide important clues to the diagnosis. These factors are important for clinical suspicion, since S. aureus is not typically addressed in empirical treatment.

Hereditary hemorrhagic telangiectasia: a rare cause of severe anemia.

Hereditary hemorrhagic telangiectasia is an autosomal dominant disease in which arteriovenous communications are typically seen in the skin, mucosal surfaces, lungs, brain and gastrointestinal tract. This disease typically presents as epistaxis, gastrointestinal bleeding and arteriovenous malformations (in the brain and lungs). Although the epistaxis and gastrointestinal bleeding can result in anemia, patients diagnosed with hereditary hemorrhagic telangiectasia rarely present severe anemia. Herein, we report the case of a 49-year-old man with severe anemia and undiagnosed hereditary hemorrhagic telangiectasia.

Telangiectasia hemorrágica hereditária: uma causa rara de anemia grave / Hereditary hemorrhagic telangiectasia: a rare cause of severe anemia

Telangiectasia hemorrágica hereditária é uma doença autossômica dominante na qual comunicações arteriovenosas afetam comumente pele, superfícies mucosas, pulmões, cérebro e trato gastrointestinal. As manifestações comuns desta doença são epistaxe, sangramento gastrointestinal, e malformações arteriovenosas cerebrais e pulmonares. Apesar de a epistaxe e o sangramento gastrointestinal poderem causar anemia, a telangiectasia hemorrágica hereditária raramente é diagnosticada com anemia grave. Neste artigo é relatado o caso de um homem de 49 anos de idade com telangiectasia hemorrágica hereditária não diagnosticada e anemia grave.

Hereditary hemorrhagic telangiectasia is an autosomal dominant disease in which arteriovenous communications are typically seen in the skin, mucosal surfaces, lungs, brain and gastrointestinal tract. This disease typically presents as epistaxis, gastrointestinal bleeding and arteriovenous malformations (in the brain and lungs). Although the epistaxis and gastrointestinal bleeding can result in anemia, patients diagnosed with hereditary hemorrhagic telangiectasia rarely present severe anemia. Herein, we report the case of a 49-year-old man with severe anemia and undiagnosed hereditary hemorrhagic telangiectasia.

Infarto pulmonar por tromboembolia simulando pneumonia adquiridana comunidade / Pulmonary infarction following thromboembolism simulating community-acquired pneumonia

Tromboembolia pulmonar é uma afecção aguda que causa uma múltipla variedade deanormalidades clínicas, laboratoriais e radiográficas. A doença pode tanto acompanharcomo mimetizar outras enfermidades cardiopulmonares. Um caso de infarto pulmonarapós tromboembolia simulando pneumonia adquirida na comunidade em uma paciente de42 anos, previamente hígida, é relatado. Este relato de caso visa a confirmar a importânciade incluir tromboembolia pulmonar no diagnóstico diferencial de processos cardiopulmonaresagudos, mesmo se um diagnóstico alternativo é evidente.

Pulmonary thromboembolism is an acute disease that causes a multitude of clinical,laboratorial and radiographics abnormalities. The disease can accompany as well asmimic other cardiopulmonary illnesses. A case of pulmonary infarction following thromboembolismsimulating community-acquired pneumonia, in a previously healthy 42-yearold woman, is described. This article intends to demonstrate, by presenting this case, theimportance of include pulmonary thromboembolism in the differential diagnosis of acutecardiopulmonary diseases, even if an alternative diagnosis is evident.