RESUMO
Introduction Congenital malformations of the right atrium are rare heart defects with only a few cases described prenatally. Early diagnosis of these anomalies is becoming increasingly important for proper follow-up and due to the possibility of serious complications such as supraventricular arrhythmia, thromboembolic events, and sudden death. Objective The atrial appendage aneurysm (AAA) is a dilatation of the atrial appendage. It is considered an extremely rare congenital anomaly. However, this condition is clinically significant because it leads to atrial arrhythmias, recurrent emboli, heart failure, and chest pain. In addition, it is possible to recognize AAA prenatally with fetal echocardiography, even if it rarely happens. However, few fetal AAA cases have been reported in the literature. Study Design We report a case of a fetal AAA; diagnosed prenatally and with postnatal confirmation. We undertook a systematic review of studies on fetal AAA to synthesize available knowledge on diagnosing and managing this rare condition. Results A total of eight studies describing 24 patients were identified and analyzed. Conclusion Despite their rarity, fetal atrial appendage aneurysms necessitate early detect on due to associated severe complications. Our findings emphasize the importance of prenatal diagnosis through fetal echocardiography and highlight the need for further research to optimize management strategies and improve outcomes for affected individuals.
RESUMO
OBJECTIVE: To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. METHODS: A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. RESULTS: The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. CONCLUSION: Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.
Assuntos
Saúde Global , Mortalidade Infantil , Mortalidade Materna , Humanos , Feminino , Recém-Nascido , Gravidez , Mortalidade Materna/tendências , Mortalidade Infantil/tendências , Serviços de Saúde Materna/organização & administração , Países em Desenvolvimento , Lactente , Atenção à Saúde/organização & administraçãoRESUMO
OBJECTIVE: To compare maternal and perinatal outcomes of migrant Venezuelan women with local pregnant patients in a Colombian institution in the context of a migratory crisis. STUDY DESIGN: This cross-sectional study included 11 304 deliveries from the Clínica de Maternidad Rafael Calvo in Cartagena de Indias, Colombia, a tertiary referral center on the north coast of Colombia. Data on maternal demographics and perinatal outcomes were obtained by chart review. RESULTS: In total, 595 patients were identified as Venezuelan migrants, and their perinatal outcomes were compared against those of 10 709 local pregnant patients. Despite similar baseline maternal conditions in both groups, poorer prenatal follow-up care (3 [1-5] vs. 5 [4-7] visits; P < 0.001) and severe complications were more common in Venezuelan migrant pregnant patients and their children. In addition, maternal hypertension was significantly more common in migrants (11.4% [68/595] vs. 8.3% [887/10709]; P = 0.009). Furthermore, in the group of pregnant migrant patients, the rates of severe maternal morbidity (13.4% [80/575] vs. 9.45%, [1013/10709]; P = 0.002), neonatal respiratory distress syndrome (22/595 [3.7%] vs. 237/10709 [2.23%]; P = 0.03), and perinatal mortality (11/586 [1.88%] vs. 67/10651 [0.63%]; P = 0.003) were significantly higher than in the local pregnant population. CONCLUSION: Forced migration during pregnancy may be associated with poorer prenatal care, which may predispose women and their newborns to more frequent adverse maternal and perinatal outcomes.
Assuntos
Saúde Materna , Parto , Assistência Perinatal , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Transversais , Morte Perinatal , Mortalidade Perinatal , Resultado da Gravidez/epidemiologia , Cuidado Pré-NatalRESUMO
Since SARS-COV-2 appeared in Wuhan City, China and rapidly spread throughout Europe, a real revolution occurred in the daily routine and in the organization of the entire health system. While non-urgent clinical services have been reduced as far as possible, all kind of specialists turned into COVID-19 specialists. Obstetric assistance cannot be suspended and, at the same time, safety must be guaranteed. In addition, as COVID-19 positive pregnant patients require additional care, some of the clinical habits need to be changed to face emerging needs for a vulnerable but unstoppable kind of patients. We report the management set up in an Obstetrics and Gynecology Unit during the COVID-19 era in a University Hospital in Milan, Italy.
Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitais Universitários/organização & administração , Obstetrícia/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Parto Obstétrico/métodos , Feminino , Ginecologia/métodos , Ginecologia/organização & administração , Humanos , Itália/epidemiologia , Obstetrícia/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Cuidado Pós-Natal/métodos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos , SARS-CoV-2RESUMO
INTRODUCTION: Cushing's syndrome (CS) is a clinical condition characterized by excessive cortisol production, associated with metabolic complications, such as diabetes mellitus, dyslipidemia, metabolic syndrome, hypertension, and cardiovascular diseases. Nowadays, the occurrence of autoimmune diseases in CS have not been completely evaluated in the previous studies. OBJECTIVE: The aim of this study was to evaluate the occurrence of autoimmune diseases in CS patients after successfully treated. MATERIALS AND METHODS: From January 2001 to December 2017, in our Secondary Hypertension Unit, we evaluated 147 CS patients (91 with ACTH-independent disease, 54 with ACTH-dependent disease, and 2 patients with ectopic ACTH production. RESULTS: 109 CS patients (74.1%) were surgically treated (67 ACTH-independent CS patients (61.5%) undergone adrenalectomy and 42 ACTH-dependent CS (38.5%) undergone transsphenoidal surgery) and evaluated after 6, 12, and 24 months after clinical and biochemical remission of disease. In 9 (8.3%) of overall treated CS patients (8.3%), during follow-up, we observed the onset of some manifestations of autoimmune diseases. In particular, one patient had a systemic lupus erythematosus, one patient had rheumatoid arthritis, 4 patients reported autoimmune thyroiditis (Basedow-Graves' disease and Hashimoto's thyroiditis), one patient had clinical features of psoriasis, one patient showed myasthenia gravis, and one patient had giant cell arteritis. CONCLUSIONS: Our results demonstrate that patients successfully treated for CS could develop autoimmune diseases. Therefore, after treatment, CS patients need to be strictly monitored in order to evaluate the possible onset of autoimmune diseases.