Effects of antenatal corticosteroids on fetal hemodynamics: a longitudinal study.

Objective: To study the effect of antenatal corticosteroid administration on fetal hemodynamics using longitudinal analysis of Doppler waveforms in the umbilical artery (UA) and middle cerebral artery (MCA). Materials and Methods: This was a retrospective study that included 30 fetuses at risk for preterm birth. Twenty-eight pregnant women were treated with betamethasone for fetal lung maturation. Doppler examinations of the UA and MCA were performed once before and three or eight times after corticosteroid administration. We used a Bayesian hierarchical linear model. Reference ranges were constructed, and associations between variables (gestational age and pre-eclampsia) were tested. Results: The mean maternal age, gestational age at betamethasone administration, and gestational age at delivery were 32.6 ± 5.89 years, 30.2 ± 2.59 weeks, and 32.9 ± 3.42 weeks, respectively. On UA Doppler, there was a significant decrease in the pulsatility index (PI) after corticosteroid administration, with a mean of 0.1147 (credibility interval: 0.03687-0.191) in three observations and a median of 0.1437 (credibility interval: 0.02509-0.2627) in eight observations. However, there was no significant change in the Doppler MCA PI, regardless of gestational age and the presence or absence of pre-eclampsia. Conclusion: Although antenatal corticosteroid administration induced a significant decrease in the Doppler UA PI, we observed no change in the cerebral vasculature.

Objetivo: Estudar o efeito da administração antenatal de corticosteroides na hemodinâmica fetal mediante análise longitudinal do Doppler na artéria umbilical (AU) e artéria cerebral média (ACM). Materiais e Métodos: Este foi um estudo retrospectivo que incluiu 30 fetos com risco de nascimento pré-termo. Vinte e oito gestantes foram tratadas com betametasona para maturação pulmonar fetal. Os exames de Doppler da AU e da ACM foram realizados uma vez antes e depois da administração de corticosteroides, num total de três ou oito observações. Utilizamos o modelo linear hierárquico com abordagem Bayesiana. Foram construídos os intervalos de referência e testadas associações entre variáveis (idade gestacional e pré-eclâmpsia). Resultados: A média ± desvio-padrão da idade materna, idade gestacional na administração de betametasona e idade gestacional no parto foram 32,6 ± 5,89 anos, 30,2 ± 2,59 semanas e 32,9 ± 3,42 semanas, respectivamente. No Doppler da AU, verificou-se diminuição significativa do índice de pulsatilidade (IP) com a terapêutica com corticosteroides (média: 0,1147 [0,03687-0,191]; em três observações) (mediana: 0,1437 [0,02509-0,2627]; em oito observações). No entanto, não foi observada alteração significativa no IP do Doppler da ACM, independentemente da idade gestacional e do diagnóstico de pré-eclâmpsia. Conclusão: Os corticosteroides pré-natais induziram diminuição significativa no IP do Doppler da AU, mas não houve alteração na vasculatura cerebral.

Cervical length measurement between 11 and 13 + 6 weeks of pregnancy: Comparison of maternal and ultrasonographic characteristics between term and preterm deliveries.

OBJECTIVE: The aim of this study was to evaluate the maternal and ultrasonographic characteristics of pregnant women who underwent cervical length (CL) measurement by transvaginal ultrasound between 11 and 13 + 6 weeks of gestation and who delivered at term or preterm. METHODS: A retrospective cohort study was carried out between March 2013 and December 2018 by analyzing ultrasound data of singleton pregnant women who underwent CL measurement by transvaginal ultrasound during the first trimester scan. CL was compared between the two groups (full-term and preterm birth [PB]) using Student's t-test. RESULTS: A total of 5097 pregnant women were enrolled, of whom 5061 (99.3%) had term and 36 (0.7%) had PB < 34 weeks. CL measurements did not differ between the term and preterm groups (36.62 vs. 37.83 mm, p = 0.08). Maternal age showed a significant and linear association with CL (r = 0.034, p = 0.012) and CRL (r = 0.086, p < 0.001). Smoking status was associated with shorter CL (36.64 vs. 35.09 mm, p = 0.003). When we analyzed the CL of the pregnant women in the term and preterm groups, according to the gestational age cut-offs for prematurity (28, 30, 32, and 34 weeks), we found that there was no significant difference between the measurements in all groups (p > 0.05). CONCLUSION: We observed no significant differences between CL measurements between 11 and 13 + 6 weeks in pregnant women who had preterm and term deliveries. Gestational age and CRL showed a significant and linear association with CL measurement.

Relationship Between Maternal Age and Macronutrient Content of Colostrum.

BACKGROUND: Little is known about the relationship between maternal age and the macronutrient content of colostrum. RESEARCH AIMS: This study aimed to evaluate the relationship between maternal age and human milk macronutrient content by comparing the concentrations of lactose, proteins, and lipids in the colostrum of women with younger, moderate, and advanced maternal age. METHODS: An observational, cross-sectional study was designed to compare the macronutrient concentrations in the colostrum of women aged < 20 years, 20 to 34 years, and > 34 years (younger, moderate, and advanced maternal age, respectively; n = 33 per group). For each participant, 3 ml of colostrum was collected by manual extraction from the right breast at 10 am, 39-48 hr after delivery, and analyzed using a Miris Human Milk Analyzer. Macronutrient concentrations were compared between the groups using analysis of variance. P < 0.05 was considered significant. RESULTS: Mothers with moderate maternal age had a higher colostrum lipid concentration than those with younger or advanced maternal age (2.3 mg, SD = 1.4 mg vs. 1.5 mg, SD = 1.0 mg vs. 1.6 mg, SD = 0.9 mg, respectively; p = 0.007). Lactose and protein contents in the analyzed samples did not differ among the three study groups. CONCLUSION: This study lends support to the potential variation of lipids in colostrum by maternal age and suggests individual adaptation to the nutritional components of milk to the needs of the infant may be beneficial.

Effects of antenatal corticosteroids on fetal hemodynamics: a longitudinal study / Efeitos do corticoide antenatal na hemodinâmica fetal: um estudo longitudinal

Abstract Objective: To study the effect of antenatal corticosteroid administration on fetal hemodynamics using longitudinal analysis of Doppler waveforms in the umbilical artery (UA) and middle cerebral artery (MCA). Materials and Methods: This was a retrospective study that included 30 fetuses at risk for preterm birth. Twenty-eight pregnant women were treated with betamethasone for fetal lung maturation. Doppler examinations of the UA and MCA were performed once before and three or eight times after corticosteroid administration. We used a Bayesian hierarchical linear model. Reference ranges were constructed, and associations between variables (gestational age and pre-eclampsia) were tested. Results: The mean maternal age, gestational age at betamethasone administration, and gestational age at delivery were 32.6 ± 5.89 years, 30.2 ± 2.59 weeks, and 32.9 ± 3.42 weeks, respectively. On UA Doppler, there was a significant decrease in the pulsatility index (PI) after corticosteroid administration, with a mean of 0.1147 (credibility interval: 0.03687-0.191) in three observations and a median of 0.1437 (credibility interval: 0.02509-0.2627) in eight observations. However, there was no significant change in the Doppler MCA PI, regardless of gestational age and the presence or absence of pre-eclampsia. Conclusion: Although antenatal corticosteroid administration induced a significant decrease in the Doppler UA PI, we observed no change in the cerebral vasculature.

Resumo Objetivo: Estudar o efeito da administração antenatal de corticosteroides na hemodinâmica fetal mediante análise longitudinal do Doppler na artéria umbilical e artéria cerebral média (ACM). Materiais e Métodos: Este foi um estudo retrospectivo que incluiu 30 fetos com risco de nascimento pré-termo. Vinte e oito gestantes foram tratadas com betametasona para maturação pulmonar fetal. Os exames de Doppler da AU e da ACM foram realizados uma vez antes e depois da administração de corticosteroides, num total de três ou oito observações. Utilizamos o modelo linear hierárquico com abordagem Bayesiana. Foram construídos os intervalos de referência e testadas associações entre variáveis (idade gestacional e pré-eclâmpsia). Resultados: A média ± desvio-padrão da idade materna, idade gestacional na administração de betametasona e idade gestacional no parto foram 32,6 ± 5,89 anos, 30,2 ± 2,59 semanas e 32,9 ± 3,42 semanas, respectivamente. No Doppler da AU, verificou-se diminuição significativa do índice de pulsatilidade (IP) com a terapêutica com corticosteroides (média: 0,1147 [0,03687-0,191]; em três observações) (mediana: 0,1437 [0,02509-0,2627]; em oito observações). No entanto, não foi observada alteração significativa no IP do Doppler da ACM, independentemente da idade gestacional e do diagnóstico de pré-eclâmpsia. Conclusão: Os corticosteroides pré-natais induziram diminuição significativa no IP do Doppler da AU, mas não houve alteração na vasculatura cerebral.

Clinical and serological findings in pregnant women and newborns: patterns of coronavirus disease 2019 placental histopathology.

OBJECTIVE: The objective of this study was to evaluate the correlation between clinical and serological findings of pregnant women and newborns with patterns of histopathologic changes of the placenta diagnosed with coronavirus disease 2019. METHODS: A prospective descriptive study was conducted with pregnant women who were positive for SARS-CoV-2 by reverse transcription polymerase chain reaction or serology (IgG and IgM). Clinical analyses were performed using ELISA to detect anti-SARS-CoV-2 IgG and IgA antibodies using the S1 spike protein domain with the Euroimmun kit. Histopathologic analyses of placentas were performed by two expert pathologists. RESULTS: Maternal SARS-CoV-2 infection was associated with increased neonatal hospital length of stay (p=0.03), increased preterm birth (p=0.04), and Apgar score<7 at 1st min (p=0.00) and 5th min (p=0.02). Pregnant women with positive IgG and/or IgA at delivery had a higher incidence of placental histopathologic changes in addition to a greater likelihood of having an IgG-positive fetus (p<0.0001). Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion changes (p=0.00). CONCLUSION: Maternal SARS-CoV-2 infection was associated with adverse perinatal outcomes. Pregnant women with positive IgG at delivery had a higher incidence of placental histopathologic changes. Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion.

Evaluation and monitoring of eye findings in children exposed to Zika virus during gestation: 3 years of follow-up.

INTRODUCTION: Congenital Zika syndrome (CZS) is a recently described disease. Our main objective was to evaluate and monitor, over 3 years, the ophthalmoscopic findings in children exposed to zika virus (ZIKV) during gestation. METHODS: This prospective observational study was conducted in Rio de Janeiro, Brazil, between April 2016 and May 2019. We evaluated two groups with exanthema serving as a proxy for viremia: (i) children whose mothers had exanthema during pregnancy and (ii) children who had microcephaly without maternal exanthema during pregnancy. We performed indirect ophthalmoscopy at recruitment and every 6 months thereafter. We also tested the association between ocular findings with maternal exanthema, microcephaly, CZS and maternal infection confirmed by reverse transcriptase quantitative polymerase chain reaction and gender. RESULTS: Of the 72 children included, 16 (22.2%) had optic nerve and/or retinal lesions. All 16 had CZS and 15 (93.7%) had microcephaly (14 at birth and 1 postnatally). The child with postnatally acquired microcephaly was born to a mother without exanthema during pregnancy. Fifty-six (77.8%) of the 72 children were followed for a median time of 24 months and none exhibited differences between admission and follow-up examinations. After logistic regression, only microcephaly at birth was associated with eye abnormalities (odds ratio, 77.015; 95% confidence interval, 8.85-670.38; p < 0.001). CONCLUSION: We observed that there was no progression of the lesions over the follow-up period. We also showed that the eye findings were associated only with microcephaly at birth. Attention should be paid to all children born during a ZIKV epidemic, regardless of maternal exanthema and/or microcephaly at birth.

Prática de avaliação da dor na unidade de terapia intensiva neonatal: estudo transversal / Práctica de evaluación del dolor en las unidades de cuidados intensivos neonatales: un estudio transversal / Pain assessment practice in a neonatal intensive care unit: a cross-sectional study

Objetivo: Analisar a prática dos profissionais de enfermagem quanto à avaliação da dor do recém-nascido internado na unidade neonatal. Métodos: Estudo transversal, analítico, realizado com profissionais de enfermagem no período de março a maio de 2018. Utilizou-se questionário autoaplicável. Fez-se análise da associação de variáveis categóricas com a prática profissional utilizando-se os testes Qui-quadrado e Exato de Fisher, com adoção do nível de significância de 5%. Resultados: Participaram do estudo 35 profissionais de enfermagem. O tempo de trabalho na unidade, a experiência profissional e a satisfação com as condições de trabalho influenciaram estatisticamente a prática adequada. O uso de escalas para avaliar a dor em recém-nascidos foi informado por 17,1% dos profissionais. Conclusão: A avaliação da dor neonatal ainda não está sedimentada na prática profissional de enfermagem. Recomendam-se ações de intervenção na prática, com avaliação de resultados de forma contínua, alinhados com os gestores e as diretrizes institucionais

Objective: To analyze the practice of nursing professionals regarding pain assessment in newborns hospitalized in a neonatal care unit. Method: This cross-sectional, analytical study was conducted with nursing professionals from March to May 2018. A self-administered questionnaire was applied. The association of categorical variables with professional practice was analyzed considering both the chi-squared and Fisher's exact tests, at a 0.05 significance level. Results: In total, 35 nursing professionals participated in the study. Factors such as time working in the unit, length of professional experience and satisfaction with working conditions statistically showed influence on appropriate practice. We found that 17,1% of professionals reported using scales to assess pain in newborns. Conclusion: Professional nursing practices still lack the required assessment of neonatal pain. This study recommends interventions in work practice in accordance with institutional guidelines and managers, as well as continuous evaluation of its results

Objetivo: analizar la práctica de los profesionales de enfermería con relación a la evaluación del dolor del recién nacido internado en unidad neonatal. Método: estudio transversal, analítico, realizado con profesionales de enfermería en el periodo de marzo a mayo de 2018. Se utilizó un cuestionario autoaplicado. La asociación de variables categóricas con la práctica profesional se analizó mediante las pruebas de chi cuadrado y exacta de Fisher, con adopción del nivel de significancia del 5%. Resultados: en el estudio participaron 35 profesionales de enfermería. El tiempo de trabajo en la unidad, el tiempo de experiencia profesional y la satisfacción con las condiciones de trabajo influenciaron estadísticamente en una práctica adecuada. El uso de escalas para evaluar el dolor en recién nacidos fue relatado por el 17,1% de los profesionales. Conclusión: La evaluación del dolor neonatal aún no está establecida em la práctica profesional de enfermería. Se recomiendan acciones de intervención en la práctica, con evaluación continua de resultados, alineadas con los gestores y directrices institucionales

Incidence of bradycardia during noradrenaline or phenylephrine bolus treatment of postspinal hypotension in cesarean delivery: A randomized double-blinded controlled trial.

The treatment of choice for spinal anesthesia-induced hypotension during cesarean section is phenylephrine. As this vasopressor can cause reflex bradycardia, noradrenaline is a suggested alternative. This randomized double-blinded controlled trial included 76 parturients undergoing elective cesarean delivery under spinal anesthesia. Women received noradrenaline in bolus doses of 5 mcg or phenylephrine in bolus doses of 100 mcg. These drugs were used intermittently and therapeutically to maintain systolic blood pressure ≥ 90% of its baseline value. The primary study outcome was bradycardia incidence (<60 bpm) with intermittent bolus administration of these drugs. Secondary outcomes included extreme bradycardia (<40 bpm), number of bradycardia episodes, hypertension (systolic blood pressure > 120% of baseline value), and hypotension (systolic blood pressure < 90% of baseline value and requiring vasopressor use). Neonatal outcomes per the Apgar scale and umbilical cord blood gas analysis were also compared. The incidence of bradycardia in both groups (51.4% and 70.3%, respectively; p = 0.16) were not significantly different. No neonates had umbilical vein or artery pH values below 7.20. The noradrenaline group required more boluses than phenylephrine group (8 vs. 5; p = 0.01). There was no significant intergroup difference in any of the other secondary outcomes. When administered in intermittent bolus doses for the treatment of postspinal hypotension in elective cesarean delivery, noradrenaline, and phenylephrine have a similar incidence of bradycardia. When treating hypotension related to spinal anesthesia in obstetric cases, strong vasopressors are commonly administered, thought these can also have side effects. This trial assessed bradycardia after bolus administration of noradrenaline or phenylephrine, and found no difference in risk for clinically meaningful bradycardia.

Prática dos profissionais da saúde em aleitamento materno e fatores associados: estudo transversal / Health professionals' breastfeeding practices and associated factors: a cross-sectional study

OBJETIVO: Analisar a prática dos profissionais da saúde da atenção básica quanto ao aleitamento materno e fatores associados. MÉTODO: Estudo transversal, analítico, realizado com todos os profissionais da saúde atuantes em aleitamento materno de cinco unidades da atenção básica através de questionário autoaplicável. Para análise da associação das variáveis categóricas com a prática profissional, utilizou-se teste Qui-quadrado com nível de significância de 5%. RESULTADOS: Participaram 38 profissionais. Houve associação estatística significativa (p=0.04597) entre a variável atualização em aleitamento materno nos últimos cinco anos e a prática de implementação em grupos de apoio. O manejo clínico, a orientação quanto aos direitos maternos e o apoio para a resolução de dificuldades na amamentação foram menos informados. CONCLUSÃO: A prática dos profissionais da saúde apresentou fragilidades evidenciando a necessidade de valorização do tema por profissionais e gestores através de estratégias que incluam capacitação contínua e monitoramento do aleitamento materno na rede de atenção básica.

OBJECTIVE: To analyze primary care health professionals' breastfeeding practices and associated factors. METHOD: A cross-sectional and analytical study was carried out with all health professionals working in breastfeeding support in five primary healthcare units, through a self-administered questionnaire. The chi-square test was used with a significance level of 5% to analyze the association of categorical variables with professional practice. RESULTS: Thirty-eight professionals participated. There was a statistically significant association (p=0.04597) between the variable update on breastfeeding in the last five years and the practice of implementing breastfeeding through support groups. Clinical management, guidance on maternal rights, and support for resolving difficulties in breastfeeding were less reported. CONCLUSION: The practice of health professionals showed weaknesses, highlighting the need for professionals and managers to value the breastfeeding issue through strategies that include continuous training and monitoring of breastfeeding in the primary healthcare network.

The Hip of Children with Congenital Zika Syndrome: A Prospective Observational Study.

OBJECTIVE: To assess the clinical and radiographic characteristics of hip joint deformities in children with congenital Zika syndrome (CZS), and the evolution of hip joint deformities in affected infants for the first 3 years of life. STUDY DESIGN: This prospective observational study evaluated orthopedic clinical examinations performed every 3 months to assess hip flexion and extension, lateral and medial rotation, and abduction and adduction, as well as lower limb muscle length and tone. The biannual radiograph comprised anteroposterior panoramic pelvic radiographs with the lower limbs in extension. Percentage of migration was used as a radiographic study tool to measure and evaluate linear hip displacement. RESULTS: From November 2018 to March 2020, we followed 30 children with CZS, of whom 15 (50%) had normal pelvic radiographs on admission; 5 (33.3%) developed hip displacement by the second radiograph examination. During follow-up radiographic examinations, 20 of the 30 children (66.7%) were diagnosed with hip displacement and/or dislocation of at least 1 side, and 10 of the 30 (33.3%) remained normal. Among 30 affected patients, 13 (43.3%) had hip displacement on the right side and 9 (30%) on the left side. Logistic regression analysis revealed that spasticity (P = .0033; OR, 15.9) and ophthalmologic abnormalities (P = .0163; OR, 16.9) were associated with hip dislocation during follow-up. CONCLUSIONS: Pelvic radiographic follow-up for all children with CZS will complement physical examination, diagnosis, and monitoring for hip joint deformities.

Clinical and serological findings in pregnant women and newborns: patterns of coronavirus disease 2019 placental histopathology

SUMMARY OBJECTIVE: The objective of this study was to evaluate the correlation between clinical and serological findings of pregnant women and newborns with patterns of histopathologic changes of the placenta diagnosed with coronavirus disease 2019. METHODS: A prospective descriptive study was conducted with pregnant women who were positive for SARS-CoV-2 by reverse transcription polymerase chain reaction or serology (IgG and IgM). Clinical analyses were performed using ELISA to detect anti-SARS-CoV-2 IgG and IgA antibodies using the S1 spike protein domain with the Euroimmun kit. Histopathologic analyses of placentas were performed by two expert pathologists. RESULTS: Maternal SARS-CoV-2 infection was associated with increased neonatal hospital length of stay (p=0.03), increased preterm birth (p=0.04), and Apgar score<7 at 1st min (p=0.00) and 5th min (p=0.02). Pregnant women with positive IgG and/or IgA at delivery had a higher incidence of placental histopathologic changes in addition to a greater likelihood of having an IgG-positive fetus (p<0.0001). Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion changes (p=0.00). CONCLUSION: Maternal SARS-CoV-2 infection was associated with adverse perinatal outcomes. Pregnant women with positive IgG at delivery had a higher incidence of placental histopathologic changes. Placentas with positive reverse transcription polymerase chain reaction for SARS-CoV-2 had a higher incidence of histopathologic changes such as maternal vascular hypoperfusion.

Evaluation of the bioimpedance technique in newborns with a focus on electrode positioning: A prospective, randomized, crossover study.

BACKGROUND: Bioelectrical impedance analysis (BIA) is a good alternative for assessing total body water in newborns. However, the lack of standardization of the method for its use in the neonatal population raises doubts about its reliability and external validation. OBJECTIVE: To compare resistance (R) and reactance (Xc) values measured by BIA with electrodes placed in the anatomical position and with electrodes placed at 5-cm intervals. METHOD: Prospective, randomized, crossover study, in which R and Xc values were measured using monofrequency BIA. The choice of the first position of the electrodes to be analyzed in each NB was performed by a simple randomization, and subsequent measurements were performed in rapid succession. The calculated sample size was 203 evaluations. The paired t test was used to compare the means of R and Xc, and the Bland-Altman plot and linear regression were used to analyze how much the measured values were influenced by the electrode position. RESULTS: Significant differences were found in the R (855.25 ± 147.79 vs 618.95 ± 93.28 Ω) and Xc (50.94 ± 17.34 vs 39.76 ± 18.35 Ω) values measured with electrodes in the anatomical position and at 5-cm intervals, respectively. The electrodes in the anatomical position produced R and Xc values 37.7% and 16.6%, respectively, higher on average when compared with 5-cm intervals. CONCLUSIONS: The distance between the electrodes influences the measurement of R and Xc by BIA. These results highlight the importance of defining a standard for the placement of electrodes in newborns for the use of these measures in neonatal clinical practice.

Limitation of cytology and the impact on reduction of cervical cancer / Limitação da citologia e o impacto na redução do câncer de colo uterino

Introduction: Cervical cancer is the third most common malignant tumor in the female population and the fourth cause of death from cancer in women in Brazil. The squamocolumnar junction and the transformation zone concentrate 90% of pre-invasive and invasive cervical lesions. Objective: To evaluate the prevalence of cytology without cells of the squamocolumnar junction and feasibility of active search. Methods: Cross-sectional study at a university hospital between 2017 and 2018. The prevalence of cytology without squamocolumnar junction cells was calculated. A convenience sample was obtained and mean age and relationship with presence of transformation zone cells were calculated. An active search was performed and cytology collected, with estrogen preparation if indicated. Medical records of the other women were analyzed. Results: Squamocolumnar junction cells were not found in 28.84% of samples. Mean age was 53 years, without association with presence of squamocolumnar junction cells (p=0.409). Seventy-six women returned, 36 of which (47.37%) used estrogen. Level 2 or 3 cervical intraepithelial neoplasia, microinvasive carcinoma or cancer was not identified. A total of 134 medical records were analyzed; only 36 women (26.87%) completed screening. Conclusions: The presence of squamocolumnar junction cells indicates quality of cytology; the use of estrogen in postmenopausal women favors its collection. There were difficulties in active search. An immediate repetition of cytology should be considered.

Introdução: O câncer de colo uterino é o terceiro tumor maligno mais frequente na população feminina e a quarta causa de morte de mulheres por câncer no Brasil. A junção escamo-colunar e a zona de transformação concentram 90% das lesões pré-invasoras e invasoras cervicais. Objetivo: Avaliar prevalência de colpocitologias sem células da junção escamo-colunar e a viabilidade de busca ativa. Métodos: Estudo transversal em hospital universitário entre 2017 e 2018. Calculada prevalência de citologias sem células da junção escamo-colunar. Obtida amostra por conveniência, calculada média de idade e relação com a presença da junção escamo-colunar. Realizada busca ativa e colhidas citologias com preparo estrogênico, se indicado. Analisados os prontuários das demais mulheres. Resultados: A prevalência de ausência de células da junção escamo-colunar foi de 28,84%. A média de idade foi 53 anos, sem associação com presença da junção escamo-colunar (p=0,409). Retornaram 76 mulheres e 36 (47,37%) usaram estrogênio. Não identificamos neoplasia intraepitelial cervical graus 2 ou 3, carcinoma microinvasor e câncer. Analisados 134 prontuários, dos quais apenas 36 mulheres (26,87%) concluíram o rastreio. Conclusões: A presença de células da junção escamo-colunar indica qualidade da coleta, e o uso de estrogênio na pós-menopausa favorece sua obtenção. Houve dificuldade de busca ativa. A repetição imediata da citologia deve ser considerada.

Dietary Intake of Flaxseed Oil since Early Stages of Life Promotes Femur Quality in Male Rats.

BACKGROUND: Flaxseed oil (FO) is an alpha linolenic acid source important for growth and body development. However, there is little literature on the role of FO in critical stages of bone development and formation. OBJECTIVE: This study evaluated the influence of a diet containing FO on rat femurs. METHODS: After birth, mothers and pups were divided into control and flaxseed groups (n = 6 pups each) fed diets containing 7% soybean oil (C) or 7% FO. At 21 days, pups were weaned and separated from the mothers, and control or experimental diets were continued. At 67 days, the following were analyzed: osteocalcin and osteoprotegerin (OPG) levels, bone mineral density (BMD) and content, and bone area; the dimension, BMD, head radiodensity, and biomechanical proprieties of the right femur; and histomorphometric parameters of the left femur. RESULTS: Compared to the C group, the FO group presented (p < 0.05) a lower body mass (-3.7%) and medullary area (-10.1%) and higher osteocalcin (+36.7%), OPG (+52.5%), femur width (+3.8%), absolute mass (+2.3%), femur BMD (+3.6%), head radiodensity (+6.1%), maximum force (+7.4%), breaking strength (+17.3), and cortical thickness (+7.0). CONCLUSION: The FO diet contributed to femur quality in healthy male Wistar rats.

Educating diabetic patients through an SMS intervention: a randomized controlled trial at a Brazilian public hospital

ABSTRACT Objective: Diabetes mellitus (DM) has a high healthcare system cost worldwide. Educational strategies are important to improve self-care and control this disease. This study aimed to evaluate satisfaction and clinical efficacy of a Short Message Service (SMS) educational intervention in self-care and nutrition at a Brazilian university hospital. Materials and methods: We conducted a trial of educational intervention and assigned eligible patients with DM to either receive weekly educational SMS for 6 months (intervention group [IG]) or no SMS at all (control group). A satisfaction questionnaire was applied before and after the intervention in both groups. Laboratory (fasting glucose, hemoglobin [Hb] A1c, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein) and clinical (blood pressure) data were also collected. Data were analyzed using nonparametric tests with the Statistical Package for the Social Sciences. Results: We included 128 patients (64 in each group). Responses to the satisfaction questionnaire with self-care and healthcare professionals from 112 patients revealed an improvement in the perception of receiving information regarding helpful eating habits and in healthy eating behavior and an improvement in satisfaction with their diabetes care in the IG. In the post-intervention period, improved systolic blood pressure and HbA1c levels were observed in the IG as illustrated by delta % (post-intervention minus pre-intervention data divided by pre-intervention data multiplied by 100) reductions of 2.3% and 3.9%, respectively Conclusion: SMS intervention was useful as an educational tool for improving satisfaction and glycemic and blood pressure control of patients with DM observed at a Brazilian university hospital.

Evaluation of Chlamydia trachomatis and HR-HPV infection in women living with HIV: a cross-sectional study / Avaliação da infecção por Chlamydia trachomatis e HR-HPV em mulheres vivendo com HIV: um estudo transversal

Introduction: Infections caused by Chlamydia trachomatis (CT) and Human Papilloma Virus (HPV) are among the most prevalent sexually transmitted infections (STIs) worldwide. CT infection in women living with the human immunodeficiency virus (HIV) can facilitate HIV transmission by increasing HIV shedding in cervicovaginal secretions. The prevalence of Human papillomavirus (HPV) infection is higher in women living with HIV when compared to HIVnegative women, even when comparing those with the same sociodemographic characteristics. Generally, they have a high viral load and a higher persistence of viral infection, which increases the risk of developing premalignant and malignant lesions in the lower genital tract. Objective: To evaluate the frequency of CT and High-Risk HPV (HR-HPV) infection among women living with HIV and the association with sociodemographic, behavioral and clinical characteristics. Methods: Cross-sectional study carried out with a population of 66 non-pregnant women aged between 18 and 70 years living with HIV and/or acquired immunodeficiency syndrome (AIDS) at the Hospital Universitário Antônio Pedro, Universidade Federal Fluminense (UFF), Niterói (RJ), Brazil, between the period of March 1, 2018 and October 31, 2018. A standardized questionnaire was applied including sociodemographic and behavioral characteristics, and clinical information (use of oral contraceptives, Antiretroviral Therapy (ART), cluster of differentiation 4 (CD4) cell count, and viral load). Endocervical samples were collected for CT (COBAS 4800® system, Roche) and HPV (COBAS® HPV test, Roche) detection. Fisher's Exact Test was used to assess the association between variables. Regression analyses were performed using the logistic model in order to identify the factors associated with the outcomes of interest. Results: A frequency of 1.5% for CT and 21.2% for HR-HPV was found. Age was the single factor that presented statistical significance associated with HR-HPV infection. Conclusion: Our study showed that some women living with HIV promote risky behavior which could facilitate the acquisition of other STIs, such as HPV and CT infection. Some of them, with detected viral load, were not using condoms even with HIV-negative partners. These results may suggest that in addition to treatment and follow-up of women living with HIV, STIs counseling and guidance may play an important role in the control of STIs in this population

Introdução: As infecções causadas por Chlamydia trachomatis e por papilomavírus humano (HPV) estão entre as infecções sexualmente transmissíveis (IST) mais prevalentes em todo o mundo. A infecção por Chlamydia trachomatis em mulheres que vivem com HIV pode facilitar a transmissão do HIV, aumentando a disseminação do HIV cérvico-vaginal. A prevalência da infecção pelo HPV é maior em mulheres vivendo com HIV quando comparadas às mulheres HIV negativas, mesmo quando comparadas àquelas com as mesmas características sociodemográficas. Geralmente apresentam carga viral elevada e maior persistência de infecção viral, o que aumenta o risco de desenvolver lesões pré-malignas e malignas no trato genital inferior. Objetivo: Avaliar a frequência de infecção por Chlamydia trachomatis e HPV de alto risco (HR-HPV) em mulheres vivendo com HIV e sua associação com características sociodemográficas, comportamentais e clínicas. Métodos: Estudo transversal realizado com uma população de 66 mulheres não gestantes de 18 a 70 anos vivendo com HIV e/ou AIDS no Hospital Universitário Antônio Pedro, Universidade Federal Fluminense ­ Niterói (RJ), Brasil, entre 1º de março e 31 de outubro de 2018. Aplicou-se um questionário padronizado incluindo características sociodemográficas e comportamentais e informações clínicas (uso de anticoncepcionais orais, terapia antirretroviral, contagem de células CD4 e carga viral). Amostras endocervicais foram coletadas para detectar Chlamydia trachomatis (COBAS 4800® Roche) e HPV (COBAS ® HPV Roche). O teste exato de Fisher avaliou a associação entre as variáveis. As análises de regressão foram realizadas por meio do modelo logístico, a fim de identificar os fatores associados aos desfechos de interesse. Resultados: Encontrou-se frequência de 1,5% para Chlamydia trachomatis e 21,2% para HR-HPV. A idade foi o único fator que apresentou significância estatística associada à infecção por HR-HPV. Conclusão: Nosso estudo mostra que algumas mulheres vivendo com HIV praticam comportamentos de risco que podem facilitar a aquisição de outras IST, como a infecção por HPV e Chlamydia trachomatis. Algumas delas com carga viral detectada não usavam preservativo, mesmo com parceiros HIV negativos. Esses resultados podem sugerir que, além do tratamento e acompanhamento de mulheres vivendo com HIV, o aconselhamento e a orientação para IST podem desempenhar um papel importante no controle das IST nessa população.

Premature rupture of membranes - A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis.

OBJECTIVE: The present study aimed to analyse the frequency of premature rupture of membranes (PROMs) among 190 women with systemic lupus erythematosus (SLE) followed up at the Hospital Universitário Pedro Ernesto from 2011 to 2018 and to review the literature on PROM in patients with SLE. METHODS: A cohort study of SLE patients was conducted by analysing the following variables: sociodemographic characteristics, clinical manifestations of lupus, modified disease activity index for pregnancy, drugs used during pregnancy, intercurrent maternal infections and obstetric outcomes. Additionally, seven electronic databases (PubMed, Embase, Cochrane, Scielo, Scielo Brazil, Virtual Health Library Regional Portal and Google Scholar) were systematically searched. The search was updated on 3 February 2020. RESULTS: Infections (relative risk (RR): 3.26, 95% confidence interval (CI): 1.5-6.7, p = .001), history of serositis (RR: 2.59, 95% CI: 1.31-5.11, p = .006) and anti-RNP positivity (RR: 3.08, 95% CI: 1.39-6.78, p = .005) were associated risk factors for PROM, while anti-RNP positivity (RR: 3.37, 95% CI: 1.35-8.40; p = .009) were associated with premature PROM (PPROM). The prevalence of PROM and PPROM was 28.7% and 12.9%, respectively. In the systematic review, the prevalence of PROM and PPROM was 2.7%-35% (I2 = 87.62%) and 2.8%-20% (I2 = 79.56%), respectively. CONCLUSIONS: PROM, both at term and preterm, occurs more frequently in women with lupus than in the general population. A history of serositis, anti-RN, infections and immunosuppression during pregnancy may increase the susceptibility to PROM. The systematic review did not find any study with the main objective of evaluating PROM/PPROM in women with lupus.

Pain assessment of preterm newborns in peripheral venipuncture and diaper changes / Avaliação da dor do recém-nascido pré-termo submetido a punção venosa periférica e a troca de fraldas

ABSTRACT BACKGROUND AND OBJECTIVES: Pain and stress are the main factors stimulating behavioral, physiological, and hormonal changes in preterm newborns (PTNB) admitted to a Neonatal Intensive Care Unit (NICU); therefore, the systematic multidimensional assessment of pain at the bedside becomes an essential tool for reducing the impact of brain stimulation, as it guides the appropriate treatment. The objectives of this study were to assess the pain at the bedside of PTNB submitted to peripheral venipuncture or diaper change and to describe the measures for pain relief. METHODS: Longitudinal study, with a prospective cohort of 25 PTNB, carried out in an NICU in the city of Rio de Janeiro. Pain assessment at the bedside was performed at three different times, using the Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile (PIPP), when subjected to peripheral venipuncture for infusion therapy and diaper changes. The scores of the scales were analyzed using the Chi-square test. RESULTS: In the puncture group, there was pain and increased intensity. In the diaper group, three PTNB showed pain at the third assessment. During peripheral venipuncture, the non-pharmacological measures were used: oral 25% glucose, non-nutritive suction and a combination of the two. CONCLUSION: Assessing pain at the bedside using scales helps nursing professionals in pain prevention and treatment, avoiding altered responses of newborns in the face of procedures.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor e o estresse são os principais fatores de estímulo às alterações comportamentais, fisiológicas e hormonais dos recém-nascidos pré-termos (RNPT) internados na Unidade de Terapia Intensiva Neonatal (UTIN); portanto, a avaliação multidimensional sistemática da dor se torna uma ferramenta imprescindível para a redução do impacto da estimulação cerebral, visto que direciona para o adequado tratamento. Os objetivos deste estudo foram avaliar a dor à beira do leito de RNPT submetidos à punção venosa periférica ou à troca de fraldas e descrever as medidas para o alívio da dor. MÉTODOS: Estudo longitudinal, com uma coorte prospectiva de 25 RNPT, realizado em uma UTIN no município do Rio de Janeiro. Foi realizada avaliação da dor à beira do leito em três momentos distintos, com a Neonatal Infant Pain Scale e Premature Infant Pain Profile, quando submetidos à punção venosa periférica para terapia infusional e troca de fraldas. As pontuações das escalas foram analisadas por meio do teste Qui-quadrado. RESULTADOS: No grupo punção, houve presença de dor e aumento da intensidade. No grupo fralda, três RNPT mostraram presença de dor na terceira avaliação. Durante a punção venosa periférica, foram utilizadas as medidas não farmacológicas; glicose oral a 25%, sucção não nutritiva e a combinação das duas. CONCLUSÃO: A avaliação da dor à beira do leito por meio de escalas auxilia os profissionais de enfermagem na prevenção e tratamento da dor, evitando respostas alteradas do recém-nascido diante de procedimentos.

Educating diabetic patients through an SMS intervention: a randomized controlled trial at a Brazilian public hospital.

OBJECTIVE: Diabetes mellitus (DM) has a high healthcare system cost worldwide. Educational strategies are important to improve self-care and control this disease. This study aimed to evaluate satisfaction and clinical efficacy of a Short Message Service (SMS) educational intervention in self-care and nutrition at a Brazilian university hospital. METHODS: We conducted a trial of educational intervention and assigned eligible patients with DM to either receive weekly educational SMS for 6 months (intervention group [IG]) or no SMS at all (control group). A satisfaction questionnaire was applied before and after the intervention in both groups. Laboratory (fasting glucose, hemoglobin [Hb] A1c, total cholesterol, triglycerides, high-density lipoprotein, and low-density lipoprotein) and clinical (blood pressure) data were also collected. Data were analyzed using nonparametric tests with the Statistical Package for the Social Sciences. RESULTS: We included 128 patients (64 in each group). Responses to the satisfaction questionnaire with self-care and healthcare professionals from 112 patients revealed an improvement in the perception of receiving information regarding helpful eating habits and in healthy eating behavior and an improvement in satisfaction with their diabetes care in the IG. In the post-intervention period, improved systolic blood pressure and HbA1c levels were observed in the IG as illustrated by delta % (post-intervention minus pre-intervention data divided by pre-intervention data multiplied by 100) reductions of 2.3% and 3.9%, respectively. CONCLUSION: SMS intervention was useful as an educational tool for improving satisfaction and glycemic and blood pressure control of patients with DM observed at a Brazilian university hospital.

Effect of glucose and non-nutritive sucking on puncture pain in premature infants: a crossover clinical trial. / Efeito da glicose e sucção não nutritiva na dor de prematuros na punção: ensaio clínico crossover.

OBJECTIVE: To compare the effect of non-nutritive sucking, 25% oral glucose and 25% oral glucose combined with non-nutritive sucking in pain relief in premature infants submitted to heel puncture for blood glucose monitoring. METHOD: This is a randomized crossover clinical trial with 34 preterm infants who randomly received interventions: non-nutritive sucking, 25% oral glucose and the two interventions combined for three consecutive days in heel puncture for blood glucose monitoring. Assessment by the Premature Infant Pain Profile for 30 seconds before the intervention, called the baseline period and for 5 minutes after puncture. RESULTS: The combination of interventions made the premature infants return to baseline, with 1 minute and 30 seconds after heel puncture, promoting a 2.2% percentage reduction in the scale. CONCLUSION: Comparing the effect of isolated and combined interventions showed that, when offered in combination, preterm infants were able to return to baseline parameters more quickly. Brazilian Clinical Trials Registry: RBR-3gm6w5.