Relationship between nocturnal enuresis and sleep in children and adolescents.

BACKGROUND: Nocturnal enuresis (NE) is a multifactorial and complex condition. One less understood factor in its pathophysiology is the enuretic inability to wake up when the bladder is full (impaired arousal). OBJECTIVE: We aimed to investigate the relationship between sleep and NE in children and adolescents. METHODS: A systematic review was performed following the PRISMA guidelines, and the electronic databases MEDLINE (via PubMed) and SCOPUS were searched until March 2022. Eligibility criteria were studies that recruited patients aged five-17 years with a diagnosis of NE according to the International Child Continence Society (ICCS), Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), or International Classification Criteria of Sleep Disorders-Third edition (ICSD-3) who had their sleep assessed using validated questionnaires and/or polysomnography. The tool used to analyze the risk of bias in the included studies was the risk of bias in non-randomized studies of exposure. RESULTS: Of 1582 citations screened, nine were included, giving 1685 participants, 581 with NE. All studies were observational and half had a low risk of bias. Four studies evaluated sleep by questionnaires only; two used questionnaires and polysomnography; two used only polysomnography, and one used sleep logs and actigraphy. Sleep questionnaires showed that children with enuresis had more sleep problems than controls, especially parasomnias, breathing disorders, and daytime sleepiness. Among the polysomnography parameters, the sleep stage architecture and periodic limb movements during sleep had conflicting data between the two studies. LIMITATIONS: The studies evaluated sleep through heterogeneous tools. They used different questionnaires; even those considered by polysomnography did not record the same channels. CONCLUSION: It seems that enuretic children and adolescents sleep differently from those who are non-enuretic. More studies are needed to clarify the best way to assess sleep and better understand this relationship. The review protocol was registered with PROSPERO, CRD42021266338. There was no funding.

Lung function of patients hospitalized with COVID-19 at 45 days after hospital discharge: first report of a prospective multicenter study in Brazil.

OBJECTIVE: Because SARS-CoV-2 infection can severely affect the lungs and persistent functional changes can occur after severe disease, we aimed to determine lung function parameters of COVID-19 patients at 45 days after hospital discharge and compare changes according to the severity of the disease. METHODS: This was a prospective descriptive analytical multicenter study. The participants were allocated into three groups: ward admission (WA) group; ICU admission not on mechanical ventilation (ICU/MV-) group; and ICU admission on MV (ICU/MV+) group. Lung volumes, DLco, MIP, MEP, and six-minute walk distance (6MWD) were measured 45 days after discharge. RESULTS: The sample comprised 242 patients (mean age = 59.4 ± 14.8 years; 52.1% of males), and 232 (96%) had altered lung function. In the total cohort, restrictive disorder was observed in 96%, as well as reductions in DLco (in 21.2% of the patients), FEV1/FVC (in 39.7%), and PEmax (in 95.8%), with no differences between the groups. Comparing the groups, the ICU/MV+ group had reduced DLco in 50% of the patients (p < 0.001) and a lower mean 6MWD % of the predicted value (p = 0.013). Oxygen desaturation in the six-minute walk test was observed in 32.3% of the cohort and was less frequent in the IE group. CONCLUSIONS: This is the first South American study involving severe COVID-19 survivors whose lung function was assessed 45 days after hospital discharge. Changes were frequent, especially in those on MV, which highlights the importance of lung function evaluation after severe COVID-19.

Improving the Management of High-Risk Pregnancies with the Use of the Robson Classification.

OBJECTIVE: To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification. METHODS: Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases. RESULTS: There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups, while the rate among the higher-risk groups remained stable. CONCLUSION: The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.

OBJETIVO: Analisar longitudinalmente as taxas de parto cesáreo em um hospital universitário usando a classificação de Robson. MéTODOS: Foram analisados, por meio da classificação de Robson, dados relacionados a partos realizados entre 2014 e 2018 e armazenados no Sistema de Informações em Saúde Materna e Neonatal (Sismater). Para auxílio, foram utilizados artigos publicados nos últimos cinco anos que abordavam o mesmo tema em outras maternidades brasileiras, tendo como fonte as bases de dados LILACS, MEDLINE, CINAHL, Scopus, Web of Science e Cochrane Library. RESULTADOS: A taxa total de cesárea variou pouco no período; no entanto, alterou-se o perfil de cada grupo ao longo dos anos. Foi possível constatar redução significativa da participação de grupos de contendo gestantes de risco habitual e aumento das gestações de alto risco, atribuíveis à diminuição de leitos na instituição, com maior transferência de pacientes. Além disso, houve uma redução na taxa de cesáreas nos grupos de mais baixo risco, enquanto a taxa dos grupos de risco mais elevado se manteve estável. CONCLUSãO: A utilização da classificação de Robson para estratificar os partos cesáreos contribui para uma análise melhor das indicações do parto cesáreo, o que permite o estabelecimento de estratégias para a redução das taxas, gerando um impacto positivo na gestão hospitalar e na qualidade assistencial.

Improving the management of high-risk pregnancies with the use of the Robson classification / Melhorando a gestão da gravidez de alto risco com o uso da classificação de Robson

Abstract Objective To analyze the rates of cesarean delivery longitudinally in a university hospital using the Robson classification. Methods Data related to births performed between 2014 and 2018 and recorded in the Maternal and Neonatal Health Information System (Sistema de Informações em Saúde Materna e Neonatal, SISMATER, in Portuguese) were analyzed using the Robson classification. As an aid, we used articles published in the last five years that approach the same topic in other Brazilian maternity hospitals; they were retrieved from the LILACS, MEDLINE, CINAHL, Scopus, Web of Science and Cochrane Library databases. Results There was little variation in the total rate of cesarean sections in the period; however, the profile of each group changed over the years. It was possible to verify a significant reduction in the participation of groups of pregnant women with lower risk and an increase in high-risk pregnancies, attributable to the decrease in beds in the institution, with a greater transfer of patients. In addition, there was a reduction in cesarean sections among the lower-risk groups,while the rate among the higher-risk groups remained stable. Conclusion The use of the Robson classification to stratify cesarean deliveries contributes to a better analysis of the indications for cesarean delivery, enabling the establishment of strategies to reduce the rates, generating a positive impact on hospital management and quality of care.

Resumo Objetivo Analisar longitudinalmente as taxas de parto cesáreo em um hospital universitário usando a classificação de Robson. Métodos Foram analisados, por meio da classificação de Robson, dados relacionados a partos realizados entre 2014 e 2018 e armazenados no Sistema de Informações em Saúde Materna e Neonatal (Sismater). Para auxílio, foram utilizados artigos publicados nos últimos cinco anos que abordavam o mesmo tema em outras maternidades Resultados A taxa total de cesárea variou pouco no período; no entanto, alterou-se o perfil de cada grupo ao longo dos anos. Foi possível constatar redução significativa da participação de grupos de contendo gestantes de risco habitual e aumento das gestações de alto risco, atribuíveis à diminuição de leitos na instituição, com maior transferência de pacientes. Além disso, houve uma redução na taxa de cesáreas nos grupos de mais baixo risco, enquanto a taxa dos grupos de risco mais elevado se manteve estável. Conclusão A utilização da classificação de Robson para estratificar os partos cesáreos contribui para uma análise melhor das indicações do parto cesáreo, o que permite o estabelecimento de estratégias para a redução das taxas, gerando um impacto positivo na gestão hospitalar e na qualidade assistencial.