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1.
Rev. Flum. Odontol. (Online) ; 2(67): 1-12, mai-ago.2025.
Article in Portuguese | LILACS, BBO - Dentistry | ID: biblio-1572519

ABSTRACT

A comunicação buco-sinusal, uma conexão direta entre boca e seios maxilares, ocorre comumente pela extração de dentes próximos ao seio maxilar e outros procedimentos. O diagnóstico precoce é crucial para prevenir complicações graves. A abordagem terapêutica varia conforme o tamanho do defeito, presença de infecção e localização específica. Realizou-se uma breve revisão de literatura qualitativa abordando as principais complicações da comunicação buco sinusal na cirurgia bucal e como intervi-las. Buscou-se artigos científicos indexados nas seguintes bases de dados: Google Scholar, Pubmed e Biblioteca Scielo com lapso temporal de 2013 a 2023. Foram utilizados para esta busca os seguintes descritores: Comunicação buco-sinusal; Complicações; Seio maxilar. Os critérios de inclusão desta pesquisa foram artigos em inglês, português e espanhol, sendo selecionados 26 trabalhos. Os principais critérios de exclusão foram artigos com mais de 10 anos de publicação. A prevenção e gestão eficaz das complicações na comunicação oral em cirurgias são essenciais. Identificar fatores de risco, usar técnicas cirúrgicas precisas e agir imediatamente diante de sinais de comunicação com os seios da face são medidas cruciais para garantir a segurança do paciente e aprimorar os resultados cirúrgicos.


Oral-sinusal communication, a direct connection between the mouth and maxillary sinuses, commonly occurs due to the extraction of teeth close to the maxillary sinus and other procedures. Early diagnosis is crucial to prevent serious complications. The therapeutic approach varies according to the size of the defect, presence of infection and specific location. A brief qualitative literature review was carried out looking at the main complications of oral sinus communication in oral surgery and how to intervene. We searched for scientific articles indexed in the following databases: Google Scholar, Pubmed and Scielo Library with a time span from 2013 to 2023. The following descriptors were used for this search: Oral-sinus communication; Complications; Maxillary sinus. The inclusion criteria for this study were articles in English, Portuguese and Spanish, and 26 papers were selected. The main exclusion criteria were articles published more than 10 years ago. The prevention and effective management of oral communication complications during surgery are essential. Identifying risk factors, using precise surgical techniques and acting immediately in the event of signs of communication with the sinuses are crucial measures to ensure patient safety and improve surgical outcomes.


Subject(s)
Surgery, Oral , Risk Factors , Early Diagnosis , Patient Safety , Maxillary Sinus
2.
Clinics (Sao Paulo) ; 80: 100565, 2025.
Article in English | MEDLINE | ID: mdl-39752996

ABSTRACT

INTRODUCTION: People Living with Human Immunodeficiency Virus (PLHIV) appear to be at a higher risk of developing sarcopenia. Various factors seem to influence the risk of sarcopenia, and its prevalence may differ depending on the screening tool used. This study aimed to (i) Screen the risk of sarcopenia in PLHIV using the SARC-F and SARCCalf and identify associated factors; (ii) Analyze the agreement between the instruments in PLHIV. METHODS: Cross-sectional study including PLHIV taking antiretroviral therapy. The authors assessed sarcopenia risk using the SARC-F and SARCCalf tools with ≥4 and ≥11 cutoff points, respectively, and a wide spectrum of variables was analyzed. RESULTS: Participated 76 patients (44.9 ± 12.7 years). Sarcopenia risk, according to the SARC-F, was 27.6 % and was associated with socioeconomic status (p = 0.004), smoking (p = 0.001), disease status (p < 0.001), opportunistic infections (p = 0.001), CD4 T-cell count (p < 0.001), Handgrip Strength (HGS) (p < 0.001), and Gait Speed (GS) (p = 0,001). Using the SARCCalf, sarcopenia risk was 36.8 % and was associated with work activity (p = 0.029), socioeconomic status (p = 0.004), smoking (p = 0.009), disease status (p < 0.001), opportunistic infections (p = 0.015), CD4 T-cell count (p = 0.002), HGS (p = 0.001), Appendicular Skeletal Muscle Mass Index (ASMMI) (p = 0.009), and GS (p < 0.001). The agreement between tools was moderate (k = 0.49). CONCLUSION: Sarcopenia risk, as determined by both tools, was higher in low-income PLHIV with opportunistic infections, CD4 T-cell count ≤ 200 cells/mm3, low HGS, and low GS, and lower in asymptomatic and non-smoking individuals. The authors recommend investigating these factors in hospital and outpatient settings. The SARCCalf proved to be more appropriate for screening sarcopenia risk in PLHIV.


Subject(s)
HIV Infections , Sarcopenia , Humans , Sarcopenia/diagnosis , Male , Female , Cross-Sectional Studies , HIV Infections/complications , Adult , Middle Aged , Risk Factors , Risk Assessment , Hand Strength/physiology , Mass Screening/methods , Socioeconomic Factors , CD4 Lymphocyte Count , Reproducibility of Results , Prevalence , Reference Values
3.
Clinics (Sao Paulo) ; 80: 100533, 2025.
Article in English | MEDLINE | ID: mdl-39752997

ABSTRACT

INTRODUCTION: This study aimed to investigate the associations among seizures, clinical characteristics, and brain injury on Magnetic Resonance Imaging (MRI) in infants with Hypoxic Ischemic Encephalopathy (HIE), and to determine whether these findings can predict unfavorable neurodevelopmental outcomes. METHOD: Clinical and electrographic seizures were assessed by amplitude-integrated electroencephalogram, and the extent of brain injury was evaluated by using MRI. At 12‒24 months of age, developmental impairment or death was assessed. Between 2012 and 2020, 143 newborns were admitted for HIE, and 8 infants were excluded from the study. RESULTS: Eighty-five infants were diagnosed with greater than moderate HIE and 65 infants underwent therapeutic hypothermia. In addition, 38 infants experienced clinical seizures (clinical seizure group, CSG), 49 infants had electrographic seizures (Electrographic Seizure Group, ESG), and 48 infants had no seizures (no seizure group, NSG). The proportion of infants with neurodevelopmental impairment or death was significantly higher in the CSG than in the NSG (57.7 % and 26.1 %, p = 0.026). A risk factor analysis indicated that cord blood pH (adjusted Odds Ratio [aOR = 0.01]; 95 % Confidence Interval [95 % CI 0.001‒0.38]; p = 0.015) and MRI findings (aOR = 4.37; 95 % CI 1.25‒15.30; p = 0.012) were independently associated with abnormal neurodevelopment, after adjustment. DISCUSSION: Clinical seizures in infants with HIE were independently associated with abnormal neurodevelopment. However, cord blood pH and abnormal brain MRI findings were consistently linked to long-term neurodevelopmental outcomes.


Subject(s)
Electroencephalography , Hypoxia-Ischemia, Brain , Magnetic Resonance Imaging , Seizures , Humans , Hypoxia-Ischemia, Brain/diagnostic imaging , Hypoxia-Ischemia, Brain/complications , Male , Female , Infant, Newborn , Seizures/etiology , Seizures/diagnostic imaging , Infant , Risk Factors , Neurodevelopmental Disorders/etiology , Neurodevelopmental Disorders/diagnostic imaging , Brain/diagnostic imaging , Retrospective Studies , Hypothermia, Induced
4.
BMJ Open ; 15(1): e085631, 2025 Jan 04.
Article in English | MEDLINE | ID: mdl-39755567

ABSTRACT

INTRODUCTION: Until now, the thyroid cancer case number has increased, and it is not entirely possible to attribute this continuous growth to more meticulous thyroid nodule selection and more accurate diagnostic techniques. While there is currently no conclusive evidence linking dietary factors to thyroid cancer, certain dietary patterns seem to have an impact on the development of the disease. There are interesting connections among diet, environment, metabolism and thyroid carcinogenesis; a deeper comprehension of the underlying mechanisms should help the identification of modifiable risk factors for thyroid cancer. This protocol aims to guide a systematic review and meta-analysis of the literature to search for an association between dietary pattern and risk of thyroid cancer. METHODS AND ANALYSIS: The databases to search for observational studies will be PubMed, Embase, Scopus, Web of Science and LILACS, from inception to 10 December 2024. No language limitation or publication period will be imposed. The outcome will be the patients with thyroid cancer. Three impartial reviewers will choose the studies and extract data from the original publications. The Newcastle-Ottawa Quality Scale will assess the risk of bias, and the certainty of the evidence will be achieved by using the Grading of Recommendations Assessment, Development and Evaluation. The R (V.4.3.1) will be performed for data synthesis, and to measure heterogeneity, we will compute the I2 statistics. Additionally, a quantitative synthesis will be performed if the included studies are sufficiently homogenous. ETHICS AND DISSEMINATION: It is not necessary to acquire ethical approval, as this study will be a review of the published data. A peer-reviewed publication will publish the systematic review's findings. PROSPERO REGISTRATION NUMBER: International Prospective Register of Systematic Reviews (PROSPERO) CRD 42023463802.


Subject(s)
Diet , Meta-Analysis as Topic , Systematic Reviews as Topic , Thyroid Neoplasms , Humans , Thyroid Neoplasms/epidemiology , Thyroid Neoplasms/etiology , Risk Factors , Research Design , Dietary Patterns
5.
Article in Spanish | PAHO-IRIS | ID: phr-64099

ABSTRACT

[RESUMEN]. Objetivo. Validar la aplicabilidad de la prueba de rosa de bengala (RB), enzimoinmunoensayo (ELISA) indirecto IgG o IgM y la prueba Brucellacapt® al contexto local, determinar la seroprevalencia de brucelosis y evaluar el conocimiento sobre la enfermedad en personas a riesgo en una zona lechera de La Maica, Cochabamba (Estado Plurinacional de Bolivia). Métodos. La validación de las pruebas se realizó inicialmente en un grupo de 76 personas, la población de estudio final fue de 330 personas, que además participaron en una encuesta socioepidemiológica. Resultados. De 330 muestras analizadas, 12,7 % fueron positivas, ya sea por la prueba de rosa de bengala (RB) o por Brucellacapt®. El ELISA indirecto IgG dio resultados falsos positivos, lo que indica que se debe adaptar el punto de corte a la situación epidemiológica local. Casi la totalidad de casos positivos por RB fueron asintomáticos. La encuesta socioepidemiológica resalta la falta de información y de conciencia sobre la naturaleza zoonótica, el modo de transmisión y los síntomas de la brucelosis. Conclusión. Este estudio reveló una seroprevalencia elevada de brucelosis en la zona lechera La Maica en Cochabamba (Estado Plurinacional de Bolivia), con muchos casos asintomáticos y un número elevado de falsos positivos con ELISA indirecto IgG. Se recomienda realizar campañas de concientización sobre los riesgos de esta enfermedad y desalentar el consumo de leche cruda.


[ABSTRACT]. Objective. To validate the applicability of the Rose Bengal (RB) test, indirect IgG or IgM enzyme-linked immunosorbent assay (ELISA), and the Brucellacapt test® to the local context, determine the seroprevalence of brucellosis, and evaluate knowledge of the disease in people at risk in a dairy-producing area of La Maica, Cochabamba (Plurinational State of Bolivia). Method. The tests were initially validated with a group of 76 people; the final study population was 330 people, who also participated in a socio-epidemiological survey. Results. Of 330 samples tested, 12.7% were positive, using either the RB or Brucellacapt test®. The indirect IgG ELISA gave false positive results, indicating that the cut-off point should be adapted to the local epidemiological situation. Almost all RB-positive cases were asymptomatic. The socio-epidemiological survey highlights a lack of information and awareness about brucellosis, with regard to its zoonotic nature, mode of transmission, and symptoms. Conclusion. This study revealed a high seroprevalence of brucellosis in the La Maica dairy-producing area in Cochabamba (Plurinational State of Bolivia), with many asymptomatic cases and a high number of false positives from IgG indirect ELISA. It is recommended to conduct awareness-raising campaigns on the risks of this disease and to discourage the consumption of raw milk.


[RESUMO]. Objetivos. Validar a aplicabilidade do teste de rosa bengala (RB), do ensaio imunoenzimático (ELISA) indireto de IgG ou IgM e do teste Brucellacapt® no contexto local, determinar a soroprevalência da brucelose e avaliar o conhecimento sobre a doença entre pessoas em risco em uma área de produção de laticínios de La Maica, Cochabamba (Estado Plurinacional da Bolívia). Métodos. A validação dos testes foi feita inicialmente em um grupo de 76 pessoas, e a população final do estudo foi de 330 pessoas. As pessoas incluídas também participaram de uma pesquisa socioepidemiológica. Resultados. Das 330 amostras analisadas, 12,7% apresentaram resultado positivo, seja pelo teste de rosa bengala ou pelo Brucellacapt®. O ELISA indireto de IgG apresentou resultados falso-positivos, o que indica que o ponto de corte deve ser adaptado à situação epidemiológica local. Quase todos os casos positivos no RB eram assintomáticos. A pesquisa socioepidemiológica destaca a falta de informações e de conscientização sobre a natureza zoonótica, o modo de transmissão e os sintomas da brucelose. Conclusão. Este estudo revelou uma alta soroprevalência de brucelose na área de produção de laticínios de La Maica, Cochabamba (Estado Plurinacional da Bolívia), com muitos casos assintomáticos e um número elevado de falso-positivos pelo ELISA indireto de IgG. Recomenda-se realizar campanhas de conscientização sobre os riscos da doença e desestimular o consumo de leite cru.


Subject(s)
Brucellosis , Seroepidemiologic Studies , Health Behavior , Risk Factors , Bolivia , Brucellosis , Seroepidemiologic Studies , Health Behavior , Risk Factors , Brucellosis , Seroepidemiologic Studies , Health Behavior , Risk Factors , Bolivia
6.
Alerta (San Salvador) ; 8(1): 63-72, ene. 22, 2025. ilus, tab.
Article in Spanish | BISSAL, LILACS | ID: biblio-1586636

ABSTRACT

En El Salvador la neumonía asociada a ventilación mecánica es la tercera infección más frecuente asociada a la atención sanitaria, con un alto impacto por sus costos de atención. Objetivo. Analizar los factores de riesgo para desarrollar neumonía asociada a ventilación mecánica en hospitales de tercer nivel de El Salvador durante el 2022. Metodología. Estudio de casos y controles, la muestra se calculó para un nivel de confianza del 95%, potencia del 80%, Odds ratio (OR) de 2,5, y con una relación de tres controles por caso. Los criterios de inclusión para casos fueron pacientes ventilados que se diagnosticaron como neumonía durante el 2022 con confirmación bacteriológica por cultivo de secreción respiratoria, los controles fueron pacientes con ventilación mecánica mayor a 48 horas sin neumonía posterior a 72 horas de extubación, la información se obtuvo de los expedientes clínicos. Se utilizó un modelo de regresión logística para determinar los factores de riesgo. Resultados. Se revisaron 206 expedientes, 52 casos y 154 controles, el dato de laboratorio más frecuente fue la leucocitosis con un 78,6% de los casos, y el patógeno aislado con mayor frecuencia fue Acinetobacter baumannii con 27,8% de aislamientos; el sexo masculino (OR: 4,94; IC95%: 1,56-15,66), el trauma (OR: 10,52; IC95%: 2,73-40,59) y los días de intubación (OR: 1,24; IC95%: 1,14-1,36) fueron factores independientes de riesgo estadísticamente significativos. Conclusión. El sexo masculino, el antecedente de trauma y los días de intubación fueron factores de riesgo para neumonía asociada a ventilación mecánica en hospitales de tercer nivel de El Salvador.


In El Salvador ventilator associated pneumonia is the third most frequent health care associated infection, it has a high impact because it raises attention costs. Objective. Analize the risk factor for the development of ventilator associated pneumonia in tertiary care hospitals in El Salvador during 2022. Methodology. It was a case-control study, we calculated the sample with a 95% confidence level, 80% statistical power, Odds ratio (OR) of 2.5 and a 3controls per case ratio. Cases were ventilated patients diagnosed with pneumonia between January and December 2022 who have a confirmed microbiological isolation in a respiratory sample, Controls were patients without pneumonia for at least 72 hours after extubation, the information was obtain from the clinical files. We used a logistic regression model to determine risk factors. Results. We reviewed 206 clinical files, 52 cases and 154 controls, the most frequent sign of infection was leukocytosis, it was present in 78.6% of cases. The most isolated pathogen was Acinetobacter baumannii, reported in 27.8% of cultures. Male sex (OR: 4.94 CI95%:1.56-15.66), history of trauma (OR:10.52 CI95%: 2.73-40.59) and intubation days (OR: 1.24; CI95%: 1.14-1.36) were statistically significant independent risk factors. Conclusion. Male gender, history of trauma and intubation days were risk factors for ventilator associated pneumonia in tertiary care hospitals from El Salvador during 2022


Subject(s)
Pneumonia , Respiration, Artificial , Ventilators, Mechanical , Risk Factors , Hospitals , Cross Infection , El Salvador
7.
Rev. Inst. Adolfo Lutz (Online) ; 84: 40382, 08 jan. 2025.
Article in Portuguese | LILACS, CONASS, Coleciona SUS, Sec. Est. Saúde SP, SESSP-ACVSES, SESSP-IALPROD, Sec. Est. Saúde SP, SESSP-IALACERVO | ID: biblio-1585457

ABSTRACT

A dermatofitose é uma infecção micótica superficial dos tecidos queratinizados como pelos, unhas e o estrato córneo da epiderme. Nos cães e gatos, esta enfermidade é comumente causada por fungos dermatófitos dos gêneros Microsporum, Nannizzia e Trichophyton que podem acometer quaisquer pacientes, sendo os filhotes, os animais idosos e imunocomprometidos os mais propensos. Embora seja uma doença altamente contagiosa, sua mortalidade é baixa e, em alguns casos, pode haver remissão espontânea. A dermatofitose afeta cerca de 4-15% dos caninos e 20% dos felinos, sendo a principal infecção fúngica das espécies citadas. Além disso, a dermatofitose é uma antropozoonose que afeta cerca de 25% da população humana e está amplamente difundida pelos centros urbanos. Sabe-se que os cães e gatos são importantes carreadores da doença e que tanto os animais sintomáticos, quanto os assintomáticos, são capazes de transmitir os agentes entre si e para os seres humanos. Os portadores assintomáticos têm grande importância para disseminação da zoonose, devido à falta de informação e ao fato de não apresentarem lesões, o que aumenta os riscos de exposição em decorrência do estreito contato dos tutores com seus animais.(AU)


Dermatophytosis is a superficial mycotic infection of keratinized tissues such as hair, nails, and the stratum corneum of the epidermis. In dogs and cats, this disease is commonly caused by dermatophyte fungi of the genera Microsporum, Nannizzia, and Trichophyton, that can affect any patient, with puppies, and elderly, and immunocompromised animals being the most prone. Although it is a highly contagious disease, its mortality is low and in some cases, there can be spontaneous remission. It is estimated that it affects about 4-15% of canines and 20% of felines, being the most common fungal infection in the mentioned species. In addition, dermatophytosis is an anthropozoonosis that affects about 40% of the human population and is widespread in urban centers. It is known that dogs and cats are important carriers of the disease and that both symptomatic and asymptomatic animals are capable of transmitting the agents to each other and humans. Asymptomatic carriers are of great importance for the dissemination of the zoonosis, due to the lack of information and the fact that they do not present lesions, which increases the risks of exposure due to the close contact between tutors and their animals. (AU)


Subject(s)
Animals , Cats , Dogs , Tinea , Cats , Public Health , Risk Factors , Review , Dogs , One Health
8.
Expert Rev Gastroenterol Hepatol ; 19(1): 5-14, 2025 Jan.
Article in English | MEDLINE | ID: mdl-39753508

ABSTRACT

INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a critical manifestation of ulcerative colitis (UC), often necessitating colectomy when medical management fails. Despite advancements in therapeutic interventions such as corticosteroids, biologics, and JAK inhibitors, a significant proportion of patients require surgery, with colectomy rates ranging from 10% to 15%. AREAS COVERED: This paper reviews the factors influencing the timing and necessity of colectomy in ASUC management, emphasizing the importance of multidisciplinary decision-making involving gastroenterologists and surgeons. EXPERT OPINION: Key surgical indications include failure of medical therapy, toxic megacolon, perforation, uncontrolled bleeding, and systemic deterioration. Delays in surgery can result in higher morbidity and mortality rates, making timely intervention essential. This review highlights surgical techniques, including total colectomy and end ileostomy, and discusses potential complications, urging a balanced approach to optimize patient outcomes.


Subject(s)
Colectomy , Colitis, Ulcerative , Severity of Illness Index , Humans , Colitis, Ulcerative/surgery , Colitis, Ulcerative/drug therapy , Colectomy/adverse effects , Acute Disease , Treatment Outcome , Risk Factors , Ileostomy/adverse effects , Time-to-Treatment , Clinical Decision-Making , Time Factors , Patient Selection , Postoperative Complications/etiology
9.
Am J Infect Control ; 53(1): 13-21, 2025 Jan.
Article in English | MEDLINE | ID: mdl-39128485

ABSTRACT

BACKGROUND: Analyze the incidence, risk factors, and fatality rates of bloodstream infections by Gram-negative bacteria (GNB-BSIs) in a Neonatal Intensive Care Unit. METHODS: This study employs a retrospective cohort design utilizing records of neonates admitted to the Neonatal Intensive Care Unit between January 2015 and June 2022. RESULTS: Among 1,495 neonates, 5.2% developed GNB-BSIs. The average incidence of infection per 1,000 patient-days was 2.9. Primary risk factors for infection that included preceeding carbapenem use were significant risk factors (odds ratio=514.4; P < .01) and fourth-generation cephalosporins (odds ratio=66; P < .01). Among the 85 GNB, 75.3% were fermenters, and 24.7% were non-fermenters. Of the isolates, 14.1% produced extended-spectrum beta-lactamase, and 2.3% carbapenem-resistant. Infection correlated with prolonged hospital stays (10-39days) and increased mortality (10%-29.9%). CONCLUSIONS: The high incidence of GNB-BSIs was exacerbated by the preceeding use of broad-spectrum antimicrobials, increasing the presence of multidrug-resistant isolates and fatality rates. These findings emphasize the importance of active surveillance.


Subject(s)
Gram-Negative Bacteria , Gram-Negative Bacterial Infections , Intensive Care Units, Neonatal , Humans , Infant, Newborn , Retrospective Studies , Gram-Negative Bacterial Infections/epidemiology , Gram-Negative Bacterial Infections/microbiology , Male , Female , Incidence , Intensive Care Units, Neonatal/statistics & numerical data , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Risk Factors , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology , Bacteremia/epidemiology , Bacteremia/microbiology , Bacteremia/mortality
10.
Sports Health ; 17(1): 104-110, 2025.
Article in English | MEDLINE | ID: mdl-39535079

ABSTRACT

BACKGROUND: Many questions persist regarding the relationship between training load and injuries in volleyball, as well as the best method for calculating acute:chronic workload ratio (ACWR). This study aimed to investigate the relationship between different metrics of training load and risk of injury in male professional volleyball players. HYPOTHESIS: ACWR, as a training load measure, is useful for identifying injury risk in volleyball players, regardless of calculation method. STUDY DESIGN: Longitudinal, prospective, and observational design conducted over 3 seasons of professional male volleyball. LEVEL OF EVIDENCE: Level 3. METHODS: The study included 43 male volleyball players. Internal training load was quantified using the Session Rating of Perceived Exertion. From daily training load values, absolute measures and relative measures were computed. For relative measures, 7 days were employed for acute training load, and 21 and 28 days for chronic training load. A distinction was made between coupled calculation and uncoupled calculation. Injuries were documented using the Injury Surveillance Form proposed by the International Volleyball Federation. RESULTS: ACWR calculated in a coupled manner and by a rolling average demonstrated higher injury risks when analyzing the complete periods (odds ratio [OR] ACWR 7:28 = 2.040; ACWR 7:21 = 1.980) and competitive period (OR ACWR 7:28 = 2.044; ACWR 7:21 = 2.087). In contrast, during the preseason, the coupled exponential averages were more sensitive to the risk of injury (OR ACWR 7:28 = 4.370; ACWR 7.504). CONCLUSION: Both measures using rolling averages and those calculated from exponential averages can be employed to identify the risk of injuries in volleyball athletes. CLINICAL RELEVANCE: The findings of this study can be useful to coaching staff, fitness trainers, and healthcare professionals involved in the challenge of reducing the risk of injury in volleyball athletes. The need for continuous monitoring and real-time adjustments of training load is emphasized.


Subject(s)
Athletic Injuries , Physical Conditioning, Human , Volleyball , Volleyball/injuries , Humans , Male , Prospective Studies , Physical Conditioning, Human/methods , Physical Conditioning, Human/adverse effects , Athletic Injuries/prevention & control , Longitudinal Studies , Young Adult , Workload , Risk Factors , Physical Exertion/physiology , Adult
11.
J Pediatr Orthop B ; 34(1): 9-13, 2025 Jan 01.
Article in English | MEDLINE | ID: mdl-38687624

ABSTRACT

Clubfoot is a common musculoskeletal congenital abnormality, with a prevalence of 5-20 cases per 10 000 live births in low to middle-income countries. If left untreated, clubfoot causes severe consequences for the child: gait disturbances, reduced quality of life, and limited work opportunities. Our objective was to characterize clubfoot and determine its prevalence and associated risk factors in Bogotá and Cali, Colombia, from 2002 to 2020. A retrospective case-control study design was employed, analyzing data from birth defect reports provided by the Program for the Prevention and Follow-up of Congenital Defects and Orphan Diseases surveillance system. Cases included live births or stillbirths with clubfoot, while controls consisted of infants without congenital abnormalities, matched in terms of birth date and hospital. Prevalence was calculated considering a 95% confidence interval using Poisson distribution, and risk factors were assessed through adjusted odds ratios obtained by logistic regression model. Of 558 255 births, 861 cases of clubfoot were identified, 48.20% were postural clubfoot, and 15 cases were syndromic clubfoot. In Bogota, prevalence rate was 15.1 per 10 000 live births, whereas in Cali it was 17.29 per 10 000 live births. Family history of clubfoot within first-degree relatives was identified as a risk factor for clubfoot. Investigating risk factors for clubfoot holds significant importance in terms of preventing and reducing morbidity within this population. Helping to drive government and healthcare initiatives aimed at providing timely and effective treatment.


Subject(s)
Clubfoot , Humans , Clubfoot/epidemiology , Colombia/epidemiology , Female , Male , Retrospective Studies , Case-Control Studies , Prevalence , Risk Factors , Infant, Newborn , Infant , Population Surveillance/methods
12.
Liver Transpl ; 31(1): 45-57, 2025 Jan 01.
Article in English | MEDLINE | ID: mdl-39297745

ABSTRACT

Explant-based models for assessing HCC recurrence after liver transplantation serve as the gold standard, guiding post-liver transplantation screening and immunosuppression adjustment. Incorporating alpha-fetoprotein (AFP) levels into these models, such as the novel R3-AFP score, has notably enhanced risk stratification. However, validation of these models in high-evidence data is mandatory. Therefore, the aim of the present research was to validate the R3-AFP score in a randomized clinical trial. We analyzed the intention-to-treat population from the 2-arm SiLVER trial (NCT00355862), comparing calcineurin-based ([calcineurin inhibitors]-Group A) versus mammalian target of rapamycin inhibitors-based (sirolimus-Group B) immunosuppression for post-liver transplantation HCC recurrence. Competing risk analysis estimated sub-hazard ratios, with testing of discriminant function and calibration. Overall, 508 patients from the intention-to-treat analysis were included (Group A, n = 256; Group B, n = 252). The R3-AFP score distribution was as follows: 42.6% low-risk (n = 216), 35.7% intermediate-risk (n = 181), 19.5% high-risk (n = 99), and 2.2% very-high-risk (n = 11) groups. The R3-AFP score effectively stratified HCC recurrence risk, with increasing risk for each stratum. Calibration of the R3-AFP model significantly outperformed other explant-based models (Milan, Up-to-7, and RETREAT), whereas discrimination power (0.75 [95% CI: 0.69; 0.81]) surpassed these models, except for the RETREAT model ( p = 0.49). Subgroup analysis showed lower discrimination power in the mammalian target of rapamycin group versus the calcineurin inhibitors group ( p = 0.048). In conclusion, the R3-AFP score accurately predicted HCC recurrence using high-quality evidence-based data, exhibiting reduced performance under mammalian target of rapamycin immunosuppression. This highlights the need for further research to evaluate surveillance schedules and adjuvant regimens.


Subject(s)
Carcinoma, Hepatocellular , Liver Neoplasms , Liver Transplantation , Neoplasm Recurrence, Local , alpha-Fetoproteins , Humans , Liver Transplantation/adverse effects , Carcinoma, Hepatocellular/surgery , Carcinoma, Hepatocellular/blood , Carcinoma, Hepatocellular/immunology , Liver Neoplasms/surgery , Liver Neoplasms/blood , Liver Neoplasms/immunology , Male , Female , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/prevention & control , Neoplasm Recurrence, Local/diagnosis , Middle Aged , Risk Assessment/statistics & numerical data , Risk Assessment/methods , alpha-Fetoproteins/analysis , alpha-Fetoproteins/immunology , Immunosuppressive Agents/therapeutic use , Immunosuppressive Agents/adverse effects , Sirolimus/therapeutic use , Risk Factors , Calcineurin Inhibitors/administration & dosage , Calcineurin Inhibitors/adverse effects , Aged , Intention to Treat Analysis , TOR Serine-Threonine Kinases/antagonists & inhibitors , Predictive Value of Tests
13.
Gen Thorac Cardiovasc Surg ; 73(1): 12-22, 2025 Jan.
Article in English | MEDLINE | ID: mdl-39361225

ABSTRACT

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) are established interventions for alleviating symptoms and enhancing survival in individuals with severe aortic stenosis (AS). However, the long-term outcomes and incidence of reintervention associated with TAVI and SAVR remain uncertain. METHODS: We conducted a systematic review and meta-analysis to compare the incidence of reintervention in TAVI versus SAVR. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs). Risk ratios (RR) and 95% confidence intervals (CI) were pooled with a random-effects model. A p-value < 0.05 was considered statistically significant. RESULTS: Nine RCTs were included, with 5144 (50.9%) patients randomized to TAVI. Compared with SAVR, TAVI increased reinterventions (RR 1.89; 95% CI 1.29-2.76; p < 0.01) and the need for pacemakers (RR 1.91; 95% CI 1.49-2.45; p < 0.01). In addition, TAVI significantly reduced the incidence of new-onset atrial fibrillation (RR 0.43; 95% CI 0.32- 0.59; p < 0.01). There were no significant differences in all-cause mortality (RR 1.04; 95% CI 0.92-1.16; p = 0.55), cardiovascular mortality (RR 1.04; 95% CI 0.94-1.17; p = 0.44), stroke (RR 0.97; 95% CI 0.80-1.17; p = 0.76), endocarditis (RR 0.96; 95% CI 0.70-1.33; p = 0.82), and myocardial infarction (RR 1.06; 95% CI 0.79-1.41; p = 0.72) between groups. CONCLUSIONS: In patients with severe AS, TAVI significantly increased the incidence of reinterventions and the need for pacemakers as compared with SAVR.


Subject(s)
Aortic Valve Stenosis , Aortic Valve , Heart Valve Prosthesis Implantation , Randomized Controlled Trials as Topic , Transcatheter Aortic Valve Replacement , Humans , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/mortality , Transcatheter Aortic Valve Replacement/methods , Transcatheter Aortic Valve Replacement/adverse effects , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Incidence , Risk Factors , Treatment Outcome , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/methods , Postoperative Complications/epidemiology , Aged , Female , Male
14.
J Gastrointest Surg ; 29(1): 101850, 2025 Jan.
Article in English | MEDLINE | ID: mdl-39488458

ABSTRACT

BACKGROUND: Peritoneal recurrence (PR) remains the most common pattern of relapse in gastric cancer (GC), even after curative resection. Given its dismal prognosis, the identification of risk factors for PR is essential for developing new treatment modalities and selecting a more appropriate subgroup of patients. This study aimed to evaluate the risk factors and survival outcomes of patients with GC who had PR and to develop a risk score to predict PR. METHODS: All patients with GC who underwent curative gastrectomy were included. For analysis, patients were divided into no recurrence (NR), recurrence in other sites (ROS), and PR. Risk factors for PR were analyzed to build a risk score. RESULTS: Among 622 patients with GC, 460 (74.0%) had NR, 98 (15.7%) had ROS, and 64 (10.3%) had PR. Female patients, linitis on computed tomography, depth of tumor invasion, and diffuse/mixed type were associated with PR. Patients with PR had worse overall survival than those with ROS (22.0 vs 29.8 months, respectively; P = .008). The median survival estimates after recurrence were 5.0 months in the PR group and 9.9 months in the ROS group (P < .001). The scoring system developed with 8 variables had an accuracy of 81% in predicting PR. Accordingly, 385 patients (61.9%) were classified as low risk, and 237 patients (38.1%) were classified as high risk. Among the 64 patients with PR, 53 (82.8%) were correctly classified as high risk (P < .001). CONCLUSION: Patients with PR had distinct clinicopathologic characteristics and extremely restricted survival compared with patients with recurrence in other sites. The risk-scoring model was able to identify patients at higher risk of PR.


Subject(s)
Gastrectomy , Neoplasm Recurrence, Local , Peritoneal Neoplasms , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Stomach Neoplasms/mortality , Female , Gastrectomy/methods , Gastrectomy/adverse effects , Male , Middle Aged , Peritoneal Neoplasms/secondary , Peritoneal Neoplasms/mortality , Peritoneal Neoplasms/surgery , Risk Factors , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/pathology , Aged , Retrospective Studies , Risk Assessment/methods , Neoplasm Invasiveness , Adult , Survival Rate , Prognosis , Sex Factors , Aged, 80 and over
15.
An Bras Dermatol ; 100(1): 63-86, 2025.
Article in English | MEDLINE | ID: mdl-39551672

ABSTRACT

BACKGROUND: Cancer is an important cause of morbidity and mortality after solid organ transplants. Skin cancer is the most prevalent non-lymphoid malignancy occurring during heart transplantation follow-up. Due to the complexity of immunosuppressive therapy and the high prevalence and incidence of skin cancer in this population, dermatologists play an important role in the short and long-term follow-up of heart transplant recipients. OBJECTIVES: The goal of this study is to present data from a systematic literature review focusing on the occurrence of skin cancer in patients who have undergone heart transplantation. METHODS: The authors conducted a systematic review of the literature in the EMBASE and PubMed databases from August to September 2021 to investigate the incidence of skin cancer in heart transplant patients. The authors selected retrospective and prospective cohort studies presenting data on the frequency of skin cancer in patients following heart transplantation. Exclusion criteria included articles that did not stratify the organ transplant type and studies that did not evaluate the frequency of skin cancer in the specific population. RESULTS: Based on the search strategy, the authors found 2589 studies, out of which 37 were eligible for inclusion in this study. Provided data are from 20 different countries, over the period 1974 to 2015. Incidence of non-melanoma skin cancer (NMSC) ranges from 0.97% to 52.8%. The incidence of squamous cell carcinoma (SCC) ranges from 1.19% to 89% and the incidence of basal cell carcinoma (BCC) ranges from 2% to 63%. Malignant Melanoma (MM) incidence ranges from 0.94% to 4.6% STUDY LIMITATIONS: The analysis involved an exclusive focus on heart transplant patients, and the statistical analysis of the sample may have been hampered. The significant heterogeneity among the studies emerged as a challenge during the analysis of the results. Furthermore, the study is limited by variations in follow-up periods among the included studies. CONCLUSION: Although gathering methodologically heterogeneous data, this systematic review was able to show the epidemiological importance of skin cancer in heart transplant patients. This study reinforces the important role dermatologists play in the short and long-term follow-up of heart transplant patients.


Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Heart Transplantation , Skin Neoplasms , Heart Transplantation/adverse effects , Humans , Skin Neoplasms/epidemiology , Skin Neoplasms/etiology , Carcinoma, Basal Cell/epidemiology , Carcinoma, Basal Cell/etiology , Incidence , Carcinoma, Squamous Cell/epidemiology , Carcinoma, Squamous Cell/etiology , Melanoma/epidemiology , Melanoma/etiology , Risk Factors , Prevalence
16.
Lupus ; 34(1): 28-33, 2025 Jan.
Article in English | MEDLINE | ID: mdl-39556029

ABSTRACT

OBJECTIVE: To assess the relationship between smoking exposure and organ damage accrual measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus score (SLICC-SDI) in consecutive patients with systemic lupus erythematosus (SLE) from Argentina. METHODS: 623 consecutive SLE patients (fulfilling ≥4, 1997 ACR criteria) were included in this cross-sectional study. Sociodemographic and disease related variables including SLICC-SDI score and smoking status were collected. Patients currently smoking were considered "smokers", and "non-smokers" those who never smoked and former smokers. SLICC-SDI was divided into two categories: <3 and ≥3 was defined as severe damage. RESULTS: Six hundred and 23 patients were included in the analysis, 89% women. Eighty-four per cent were non-smokers and 16 % were current smokers 83 percent of patients had SLICC-SDI <3 and 17 % had SLICC-SDI ≥3. Twenty one percent of patients with SLICC-SDI ≥3 and 15% with <3 SLICC-SDI were current smokers (p 0.081). In the multiple regression analysis, current smoking (OR 1.82, CI 95% 1.01-3.31, p 0.046), older age (OR 1.04, CI 95% 1.00-1.05, p 0.034), disease duration (OR 1.03, CI 95% 1.00-1.07, p 0.021) and cyclophosphamide exposure (OR 2.97, CI 95% 1.49-5.88, p 0.002) were related to SLICC-SDI ≥3. CONCLUSION: In our sample of patients, current smoking, older age, disease duration and cyclophosphamide were related to severe damage (SLICC-SDI ≥3).


Subject(s)
Lupus Erythematosus, Systemic , Smoking , Humans , Male , Female , Adult , Lupus Erythematosus, Systemic/complications , Risk Factors , Severity of Illness Index , Smoking/adverse effects , Argentina/epidemiology , Cross-Sectional Studies , Cyclophosphamide/adverse effects , Cyclophosphamide/therapeutic use , Immunosuppressive Agents/therapeutic use , Retrospective Studies
17.
Int J Nurs Knowl ; 36(1): 73-80, 2025 Jan.
Article in English | MEDLINE | ID: mdl-38403971

ABSTRACT

PURPOSE: To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women.  METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity. FINDINGS: The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed. CONCLUSIONS: A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid. IMPLICATIONS FOR NURSING PRACTICE: NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.


OBJETIVO: Analisar evidências de validade de conteúdo do diagnóstico de enfermagem (DE) Risco de Pressão Arterial Instável em mulheres encarceradas. MÉTODO: Estudo metodológico de validade de conteúdo de um DE, realizado no Brasil, entre junho e setembro de 2022, tendo 49 enfermeiros como experts. Foram avaliados o título, a definição e a relevância dos 19 fatores de risco do DE Risco de Pressão Arterial Instável. Com base no modelo de diversidade preditiva, foram calculados o Índice de Validade de Conteúdo (IVC) e respectivos intervalos de confiança de 95% para cada fator de risco. IVC ≥ 0,8 foi considerado evidência adequada de validade de conteúdo. RESULTADOS: A relevância de 19 fatores etiológicos mostrou IVC ≥ 0,8. De acordo com a recomendação do painel de experts, um dos fatores etiológicos foi dividido em dois e dois rótulos de fatores etiológicos foram alterados. O título e a definição do diagnóstico foram reformulados. CONCLUSÃO: Foram considerados válidos um novo título (Risco de pressão arterial desequilibrada), nova definição e 20 fatores etiológicos (11 fatores de risco, cinco condições associadas e quatro populações de risco) do DE Risco de Pressão Arterial Instável em mulheres encarceradas. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: A NANDA­I aceitou a proposta deste diagnóstico de enfermagem; portanto, este estudo contribuiu para a atualização da classificação baseada em evidências científicas. Essas evidências favorecerão o raciocínio diagnóstico e o reconhecimento do diagnóstico durante a avaliação clínica, além de subsidiar estudos que avaliem a validade clínica desses elementos em mulheres encarceradas.


Subject(s)
Nursing Diagnosis , Humans , Female , Risk Factors , Brazil , Adult , Middle Aged , Blood Pressure , Prisoners , Reproducibility of Results
18.
J Arthroplasty ; 40(2): 443-448, 2025 Feb.
Article in English | MEDLINE | ID: mdl-39159877

ABSTRACT

BACKGROUND: We aimed to determine the association between lower extremity arterial calcification (LEAC) and referral to a closed unit (CU), length of stay, 90-day readmissions, and 1-year mortality in primary total hip arthroplasty (THA) patients. METHODS: We retrospectively analyzed 705 patients who underwent primary THA, identifying 64 patients (9.13%) who had LEAC and 641 who did not have LEAC. Patients who had LEAC were older (77 ± 10.0 versus 67 ± 11.5 years; P < 0.001) and had more comorbidities, except for a history of thromboembolic and oncologic diseases (P > 0.05). A preoperative antero-posterior pelvic radiograph was used to assess the presence of LEAC. Admission to CU, length of stay, 90-day readmissions, and 1-year mortality were recorded. A logistic regression model was used to identify risk factors for referral to CU. RESULTS: Patients who had LEAC had a higher incidence of admission to the intensive care unit (8 of 64 [12.5%] versus 8 of 641 [1.09%]; P < 0.001), a longer hospital stay (4.7 ± 1.8 versus 4.2 ± 1.3 days; P = 0.006), more readmissions (16 of 64 [25%] versus 33 of 641 [5.15%]; P < 0.001), and a higher 1-year mortality rate (6 of 64 [9.3%] versus 0 of 641 [0%]; P < 0.001) than patients who did not have LEAC. Of the patients who had LEAC admitted to CU, only 3 of 8 had a previous indication to do so in the preoperative assessment performed by the Department of Anesthesiology, while all non-LEAC ones referred to CU did so. Logistic regression analysis showed that LEAC was a risk factor for admission to CU (odds ratio = 4.77; 95% confidence interval: 1.12 to 20.25; P = 0.034). CONCLUSIONS: The presence of LEAC was a risk factor for transfer to CU, longer in-hospital stays, more readmissions, and a higher 1-year mortality rate. Identifying patients who have LEAC can aid in the preoperative assessment and risk stratification of patients planned for primary THA.


Subject(s)
Arthroplasty, Replacement, Hip , Length of Stay , Lower Extremity , Patient Readmission , Referral and Consultation , Humans , Aged , Male , Female , Retrospective Studies , Middle Aged , Patient Readmission/statistics & numerical data , Length of Stay/statistics & numerical data , Aged, 80 and over , Lower Extremity/blood supply , Lower Extremity/surgery , Vascular Calcification/diagnostic imaging , Vascular Calcification/mortality , Vascular Calcification/complications , Risk Factors , Postoperative Complications/epidemiology , Postoperative Complications/etiology
19.
Ann Vasc Surg ; 110(Pt A): 91-98, 2025 Jan.
Article in English | MEDLINE | ID: mdl-39341558

ABSTRACT

BACKGROUND: Multicenter studies conducted in developed countries demonstrated that custom-made devices are safe, effective, and durable for treating complex abdominal aneurysms. However, the situation in developing countries, such as Brazil, is different. Funding and time to have the endoprosthesis delivered are the major concerns. In order to overcome these conditions, high-volume Brazilian university hospitals started gaining experience with a custom-made device produced in the country. OBJECTIVE: The present study aimed to describe the practice of 2 tertiary centers and report the early results of fenestrated and branched endovascular repair of complex aortic aneurysms with a custom-made national device available in the Brazilian public health system. METHODS: Retrospective analysis of all consecutive patients that underwent fenestrated and branched endovascular aneurysm repair (F/BEVAR) of complex aortic aneurysms using custom-made manufactured endoprosthesis in 2 tertiary centers from January 2020 to July 2022. RESULTS: Thirteen cases were included (10 male, mean age 69 ± 9 years). 70% were complex abdominal aneurysms, and 30% were type II, III, and IV thoracoabdominal aneurysms (mean aneurysm diameter 69.2 ± 8.12 mm). F/BEVAR included 33 visceral arteries. The Apolo® device was used in all cases. Technical success was achieved in 12 out of 13 patients (92.3%). Thirty-day major adverse events included one death (7.7%), 5 acute renal failure (38.4%), 2 spinal cord ischemia (15.4%). The 1-year survival rate was 92.3%. CONCLUSIONS: Fenestrated and branched endovascular repair of complex aortic aneurysms with the custom-made Apolo® device has proven safe and effective in high-volume tertiary centers in the Brazilian public health system. Considering the complexity of the cases, the early patency of vessels and low initial mortality support this device continuation and expansion to treat complex aortic aneurysms in a developing country.


Subject(s)
Aortic Aneurysm, Abdominal , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Blood Vessel Prosthesis , Endovascular Procedures , Prosthesis Design , Humans , Endovascular Procedures/instrumentation , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Male , Retrospective Studies , Aged , Female , Brazil , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/mortality , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/mortality , Aortic Aneurysm, Abdominal/diagnostic imaging , Treatment Outcome , Time Factors , Middle Aged , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/mortality , Risk Factors , Postoperative Complications/etiology , Aged, 80 and over , Stents , Tertiary Care Centers
20.
J Pediatr (Rio J) ; 101(1): 54-60, 2025.
Article in English | MEDLINE | ID: mdl-39128828

ABSTRACT

OBJECTIVE: When the expectant mother is faced with an unforeseen event during pregnancy, she may experience emotional fragility and depression. This study was carried out to test the association between the time of diagnosis of critical congenital heart disease (CCHD) and depressive symptoms in puerperal women. METHOD: A case-control study. All mothers answered a semi-structured questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). Pearson's correlation and multiple linear regression analysis were used to determine factors associated with depression. RESULTS: 50 puerperal women, 23 cases and 27 controls. The proportion of puerperal depressive symptoms was 26.1 % among mothers of infants prenatally diagnosed with CCHD and 77.8 % among mothers of infants postnatally diagnosed (p = 0.001 [OR] 9.917; 95 % CI 2.703-36.379). Multiple linear regression analysis showed that the use of psychotropic drugs and time of diagnosis were significantly associated with puerperal depressive symptoms. CONCLUSION: Prenatal diagnosis of CCHD was associated with significantly lower levels of depressive symptoms.


Subject(s)
Depression, Postpartum , Heart Defects, Congenital , Prenatal Diagnosis , Humans , Female , Heart Defects, Congenital/psychology , Depression, Postpartum/diagnosis , Depression, Postpartum/psychology , Adult , Pregnancy , Prenatal Diagnosis/methods , Case-Control Studies , Young Adult , Psychiatric Status Rating Scales , Risk Factors , Surveys and Questionnaires
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