RESUMO
Heart rate variability (HRV), oxygen saturation variability (OSV) and skin conductance activity (SCA) are recognized physiological markers of acute pain. In order to verify which of them has the best correlation with psychophysical parameters of pain (intensity, reactivity, direction, regulation and slope), an observational prospective study was performed, including 41 healthy full term newborns. The measurements studied were the HRV, the OSV, and the following SCA variables: number of waves per second (NWps) and relative area under the curve of waves (AUC). The measurements were performed in periods labeled before, during, and after a heel prick. The variation measured for intensity between periods was significant for the NWps (p=0.001), AUC (p=0.03), HRV (p=0.001) and OSV (p=0.004). Also, the reactivity and direction were significant for all variables, except AUC. The regulation parameter was significant for the variables NWps (p<0.01), AUC (p<0.05), HRV (p<0.01) and OSV (p<0.01). The slope was statistically significant only for the OSV variable (p=0.000). We concluded that the responses of the SCA, HRV and OSV to painful events fit the psychophysical parameters of a physiological marker and serve as valuable measures for pain diagnostic working the use in accordance with the needs of the context.
Assuntos
Dor Aguda/diagnóstico , Dor Aguda/fisiopatologia , Diagnóstico por Computador/métodos , Resposta Galvânica da Pele , Frequência Cardíaca , Oxigênio/sangue , Brasil , Feminino , Humanos , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estatística como AssuntoRESUMO
OBJECTIVE: Our objective was to develop an easy, safe, pragmatic, clinical scoring system that would allow decreases in unnecessary treatment with antimicrobial agents in low-resource settings. METHODS: Children with pharyngitis were enrolled prospectively from 2 public hospitals and 1 medical unit in Brasilia, Brazil, over 17 months. Attending clinicians completed a questionnaire and a previously published scoring system for pharyngitis before performing throat swabs and group A streptococcus (GAS) rapid antigen-detection tests. Data from this study were added to those collected in 2004, to assess the performance of each item of the scoring system. The performance of the new clinical decision rule was determined with a receiver operating characteristic curve. The final outcome of the model was assessed on the basis of sensitivity, specificity, and positive likelihood ratio for non-GAS infections with the clinical approach, compared with throat culture or rapid antigen-detection test results. RESULTS: A total of 576 children were included, among whom 400 had non-GAS pharyngitis. The use of our new clinical decision rule would allow for 35% to 55% antibiotic reduction, with 88% specificity. CONCLUSIONS: This clinical decision rule could reduce unnecessary antibiotic treatment significantly in low-resource settings.
Assuntos
Faringite/diagnóstico , Faringite/microbiologia , Adolescente , Brasil , Criança , Pré-Escolar , Técnicas de Apoio para a Decisão , Feminino , Recursos em Saúde , Humanos , Lactente , Masculino , Estudos ProspectivosRESUMO
OBJECTIVE: To compare the need for positive pressure ventilation (PPV) by bag and mask and by bag and endotracheal tube in newly born term infants with vertex presentation delivered by non-urgent caesarean section under regional anaesthesia or non-instrumental vaginal delivery. DESIGN: Cross-sectional study. SETTING: 35 public hospitals in 20 Brazilian state capitals. PATIENTS: 6929 inborn infants without congenital anomalies, with gestational ages from 37(0/7) to 41(6/7) weeks with vertex presentation, born between 1 and 30 September 2003. INTERVENTION: Non-urgent caesarean versus non-instrumental vaginal delivery. Non-urgent caesarean was defined as delivery occurring in the absence of prolapsed cord, third trimester haemorrhage, failure of labour induction, fetal distress or non-clear amniotic fluid. MAIN OUTCOME MEASURES: PPV with bag and mask and with bag and endotracheal tube. Both outcomes were adjusted for potential confounding variables by logistic regression analysis. RESULTS: 2087 infants were born by non-urgent caesarean and 4842 by non-instrumental vaginal delivery. Non-urgent caesarean delivery under regional anaesthesia compared to vaginal delivery under local or no anaesthesia increased the risk of bag and mask ventilation (OR 1.42, 95% CI 1.07 to 1.89) adjusted for number of gestations, maternal hypertension and birth weight. Ventilation with bag and endotracheal tube was associated only with low birth weight, adjusted for delivery mode and twin gestation. CONCLUSIONS: Term neonates with vertex presentation and clear amniotic fluid born by non-urgent caesarean section under regional anaesthesia need to be assisted at birth by health professionals skilled in PPV.
Assuntos
Cesárea , Respiração com Pressão Positiva/estatística & dados numéricos , Adolescente , Adulto , Anestesia por Condução/métodos , Anestesia Obstétrica/métodos , Peso ao Nascer , Brasil , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Intubação Intratraqueal/estatística & dados numéricos , Assistência Perinatal/métodos , Respiração com Pressão Positiva/métodos , Gravidez , Adulto JovemRESUMO
INTRODUCTION: Scarce data are available on Group A Streptococcus (GAS) antibiotic resistance in South America. METHODOLOGY: The antibiotic susceptibility patterns of GAS recovered from symptomatic children living in the central part of Brazil during a prospective epidemiological study were analyzed. RESULTS: No isolates were resistant to penicillin or macrolides. Sixty-one percent of the isolates were highly resistant to tetracycline, of which 85% harboured the tetM resistance gene. Ninety-five percent of these tetracycline resistant isolates were also resistant to minocycline. Thirty different emm-types were associated with tetracycline resistance. Phylogenetic analysis indicates that tetracycline resistance arose independently in distantly related emm-types. CONCLUSIONS: A high level of GAS tetracycline resistance has been observed in the central part of Brazil due to the polyclonal dissemination of resistant emm-types.
Assuntos
Antibacterianos/farmacologia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes/efeitos dos fármacos , Resistência a Tetraciclina/genética , Adolescente , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Brasil/epidemiologia , Proteínas de Transporte/genética , Criança , Pré-Escolar , Farmacorresistência Bacteriana/genética , Humanos , Lactente , Macrolídeos/farmacologia , Testes de Sensibilidade Microbiana , Minociclina/farmacologia , Penicilinas/farmacologia , Filogenia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
BACKGROUND: Group A Streptococcus (GAS) clinical and molecular epidemiology varies with location and time. These differences are not or are poorly understood. METHODS AND FINDINGS: We prospectively studied the epidemiology of GAS infections among children in outpatient hospital clinics in Brussels (Belgium) and Brasília (Brazil). Clinical questionnaires were filled out and microbiological sampling was performed. GAS isolates were emm-typed according to the Center for Disease Control protocol. emm pattern was predicted for each isolate. 334 GAS isolates were recovered from 706 children. Skin infections were frequent in Brasília (48% of the GAS infections), whereas pharyngitis were predominant (88%) in Brussels. The mean age of children with GAS pharyngitis in Brussels was lower than in Brasília (65/92 months, p<0.001). emm-typing revealed striking differences between Brazilian and Belgian GAS isolates. While 20 distinct emm-types were identified among 200 Belgian isolates, 48 were found among 128 Brazilian isolates. Belgian isolates belong mainly to emm pattern A-C (55%) and E (42.5%) while emm pattern E (51.5%) and D (36%) were predominant in Brasília. In Brasília, emm pattern D isolates were recovered from 18.5% of the pharyngitis, although this emm pattern is supposed to have a skin tropism. By contrast, A-C pattern isolates were infrequently recovered in a region where rheumatic fever is still highly prevalent. CONCLUSIONS: Epidemiologic features of GAS from a pediatric population were very different in an industrialised country and a low incomes region, not only in term of clinical presentation, but also in terms of genetic diversity and distribution of emm patterns. These differences should be taken into account for designing treatment guidelines and vaccine strategies.
Assuntos
Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes , Adolescente , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Técnicas de Tipagem Bacteriana , Sequência de Bases , Bélgica/epidemiologia , Brasil/epidemiologia , Proteínas de Transporte/genética , Criança , Pré-Escolar , Primers do DNA/genética , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Genes Bacterianos , Humanos , Impetigo/epidemiologia , Impetigo/microbiologia , Lactente , Recém-Nascido , Masculino , Epidemiologia Molecular , Faringite/epidemiologia , Faringite/microbiologia , Fatores de Risco , Streptococcus pyogenes/classificação , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificaçãoRESUMO
OBJECTIVE: Existing scoring systems for the diagnosis of group A streptococcus pharyngitis are insensitive or inapplicable in low-resources settings. Bacterial cultures and rapid tests can allow for antibiotic prescription abstention in high-income regions. These techniques are not feasible in many low-resources settings, and antibiotics often are prescribed for any pharyngitis episode. However, judicious antibiotics prescription in the community also is of concern in low-income countries. The objective of this study was to develop a clinical decision rule that allows for the reduction of empirical antibiotic therapy for children with pharyngitis in low-resources settings by identifying non-group A streptococcus pharyngitis. PATIENTS AND METHODS: We prospectively included children with pharyngitis in 3 public hospitals of Brazil during 9 months in 2004. We filled out clinical questionnaires and performed throat swabs. Bilateral chi2 (2-tailed test) and multivariate analysis were used to determine score categories. The outcome measures were sensitivity, specificity, positive likelihood ratio, and posttest probability of non-group A streptococcus infection with the clinical approach as compared with throat culture. RESULTS: A total of 163 of the 220 children had non-group A streptococcus pharyngitis (negative culture). We established a 3-questions decision rule (age and viral and bacterial signs) with 3 possible answers. The use of this score would prevent 41% to 55% of unnecessary antimicrobial prescriptions. The specificity of the score for non-group A streptococcus pharyngitis was >84%. CONCLUSION: Such a clinical decision rule could be helpful to reduce significantly unnecessary antibiotic prescriptions for pharyngitis in children in low-resources settings.
Assuntos
Antibacterianos/uso terapêutico , Faringite/tratamento farmacológico , Faringite/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Criança , Pré-Escolar , Uso de Medicamentos/normas , Feminino , Humanos , Lactente , Masculino , Pobreza , Estudos ProspectivosRESUMO
OBJECTIVES: Determine the risk factors involved in toxoplasmosis transmission and determine whether pregnancy is a risk factor for toxoplasmosis infection. STUDY DESIGN: Cross-sectional study carried out on 2,242 women at childbearing age. An indirect immunofluorescence reaction was used to identify immunity to Toxoplasma gondii. Previous gestations were also analyzed as a possible risk factor. The results were analyzed by chi2 and OR tests, and by variance analysis. The sample was statistically balanced according to social-economic risk factors. RESULTS: Previously pregnant women were 1.74 times more frequently infected with toxoplasmosis, regardless of environmental conditions. Pregnant women living under unfavorable environmental conditions had an approximately two times increased risk of being infected for each risk factor (contact with host animals, presence of vehicles of oocyst transmission). Previous pregnancy was the risk factor that had the strongest influence on acquiring toxoplasmosis (variance analysis and statistical balancing). DISCUSSION: The prevalence of this zoonosis is high in Goiânia-GO, Brazil (65.8%). Inadequate environmental sanitation was not significantly correlated with toxoplasmosis infection, except when associated with previous pregnancy, showing that the fundamental cause for infection is not environmental. CONCLUSION: The finding that pregnancy makes women more vulnerable to this protozoan, makes it important to implement prophylactic control of at-risk pregnant women.
Assuntos
Anticorpos Antiprotozoários/sangue , Complicações Parasitárias na Gravidez/epidemiologia , Toxoplasma/imunologia , Toxoplasmose/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Animais , Brasil/epidemiologia , Criança , Métodos Epidemiológicos , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/parasitologia , Toxoplasmose/diagnósticoRESUMO
OBJECTIVE: To evaluate the effect of zinc on the appetite for salt foods in children aged 8 months to 5 years. METHOD: Double-blind, placebo-controlled study. Two groups of 20 children refusing to eat salt foods were followed during 6 months. The children in the first group received zinc chelate 1 mg/kg daily for 3 months. The second group received a placebo solution. The two groups were similar in terms of age, sex, weight, duration of breastfeeding, age at weaning, biochemical and hematological data. The response of children to treatment was informed by their mothers. RESULTS: 17/20 (85%) of the children receiving zinc chelate and 10/20 (50%) of the children receiving placebo improved their appetite for salt foods. The difference was statistically significant (p < 0.05, chi-square test). CONCLUSION: Zinc supplementation may improve the acceptance of salt foods by children.
Assuntos
Apetite/efeitos dos fármacos , Suplementos Nutricionais , Cloreto de Sódio na Dieta , Zinco/administração & dosagem , Pré-Escolar , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Lactente , Masculino , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To test the hypothesis that pregnancy is a risk factor for toxoplasmosis seroconversion. MATERIALS AND METHODS: A prospective observational study of women at child-bearing age vulnerable to Toxoplasma gondii. Serological reactions with indirect immunofluorescent antibody and immunoenzyme tests were used. The risk estimate used limits of reliability at 95%, and the results were validated by chi(2) and RR tests. RESULTS: Acute infection among pregnant women was 8.6% (45/522), and pregnancy was confirmed to be a risk factor for seroconversion (P=0.001). Living in close contact with host animals and vehicles of oocyst transmission proved to be a statistical risk for pregnant women to seroconvert, which was aggravated in adolescents. CONCLUSION: Gestation, potentiating susceptibility to this infection, points to the need of primary and secondary prevention for all pregnant women at risk.