RESUMO
RESUMEN Introducción: el embarazo en la adolescencia constituye un problema de salud en el mundo, repercute en la sociedad y compromete la salud de la madre y del feto. Objetivo: describir los factores de riesgos y complicaciones asociados al embarazo en la adolescencia. Métodos: se realizó una revisión bibliográfica sobre el embarazo en la adolescencia. Se expresó criterios de autores y resultados de investigaciones disponibles en las bases de datos SciELO, Medline, PubMED. Se empleó un total de 30 referencias bibliográficas, más del 75 % de la literatura consultada corresponde a los últimos cinco años. Desarrollo: el embarazo en la adolescencia no tiene causa específica. En su desarrollo inciden factores de riesgos individuales, familiares y socioeconómicos. Las complicaciones del embarazo en edades tempranas son frecuentes, constituyen un alto riesgo obstétrico pues compromete la vida de la madre y el feto. Las complicaciones se asocian fundamentalmente a las características biológicas de la madre y a la edad gestacional que presenta. Conclusiones: los principales factores de riesgos asociados con el embarazo adolescente están relacionados con el inicio precoz de las relaciones sexuales, la deficiente educación sexual y los conflictos con la familia. Las complicaciones más significativas asociadas a gestantes adolescentes son la enfermedad hipertensiva gestacional, los traumas obstétricos del parto, el recién nacido pretérmino y el bajo peso. La prevención de los factores de riesgos, desarrollar una correcta educación sexual por la familia, la sociedad y los profesionales de la salud, favorecerá a la disminución de los embarazos en edades tempranas.
ABSTRACT Introduction: pregnancy in adolescent age constitutes a health problem all over the world, having repercussion throughout the society and affecting the health of the mother and the fetus. Objective: to describe the risk factors and complications associated with pregnancy in adolescent age. Methods: a bibliographic review with reference to pregnancy in adolescent age was carried out. The criteria of the authors and the results of the available researches in SciELO, Medline, PubMED databases were expressed; using a total of 30 bibliographic references, more than 75 % of the consulted literature corresponded to the last 5 years. Development: pregnancy in adolescent ages has not a specific cause. In its increase individual, familial and socioeconomic risk factors influence. Complications in pregnancy at early ages are frequent, and constitute a high obstetric risk affecting the life of the mother and the fetus. Complications are mainly associated with the biological characteristics of the mother and her gestational age. Conclusions: the main risk factors associated with pregnancy in adolescent ages are related to early initiation of sexual relations, poor sexual education and conflicts with the family. The most significant complications associated with pregnancy in adolescent ages are gestational hypertensive disease, obstetric trauma of delivery, preterm newborn and low birth weight (LBW). The prevention of risk factors, to develop a correct sexual education by the family, the society and the healthcare professionals will favor to decrease the rates of pregnancy in early ages.
RESUMO
OBJECTIVES: To perform a multicenter study to assess growth failure in hospitalized infants with gastroschisis. STUDY DESIGN: This study included neonates with gastroschisis within sites in the University of California Fetal Consortium. The study's primary outcome was growth failure at hospital discharge, defined as a weight or length z score decrease >0.8 from birth. Regression analysis was performed to assess changes in z scores over time. RESULTS: Among 125 infants with gastroschisis, the median gestational age was 37 weeks (IQR 35-37). Length of stay was 32 days (23-60); 55% developed weight or length growth failure at discharge (28% had weight growth failure, 42% had length growth failure, and 15% had both weight and length growth failure). Weight and length z scores at 14 days, 30 days, and discharge were less than birth (P < .01 for all). Weight and length z scores declined from birth to 30 days (-0.10 and -0.11 z score units/week, respectively, P < .001). Length growth failure at discharge was associated with weight and length z score changes over time (P < .05 for both). Lower gestational age was associated with weight growth failure (OR 0.70 for each gestational age week, 95% CI 0.55-0.89, P = .004). CONCLUSIONS: Growth failure, in particular linear growth failure, is common in infants with gastroschisis. These data suggest the need to improve nutritional management in these infants.
Assuntos
Gastrosquise/epidemiologia , Transtornos do Crescimento/epidemiologia , Estatura , Peso Corporal , California/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido/crescimento & desenvolvimento , Masculino , Prevalência , Estudos RetrospectivosRESUMO
In the PDA-TOLERATE trial, persistent (even for several weeks) moderate to large patent ductus arteriosus (PDA) was not associated with an increased risk of BPD when the infant required <10 days of intubation. However, in infants requiring intubation for ≥10 days, prolonged PDA exposure (≥11 days) was associated with an increased risk of moderate/severe BPD.
Assuntos
Displasia Broncopulmonar/etiologia , Permeabilidade do Canal Arterial/terapia , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/métodos , Respiração Artificial , Displasia Broncopulmonar/epidemiologia , Permeabilidade do Canal Arterial/complicações , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
The PDA: TO LEave it alone or Respond And Treat Early trial compared the effects of 2 strategies for treatment of patent ductus arteriosus (PDA) in infants <280/7 weeks of gestation; however 137 potentially eligible infants were not recruited and received treatment of their PDA outside the PDA-TOLERATE trial due to "lack-of-physician-equipoise" (LPE). Despite being less mature and needing more respiratory support, infants with LPE had lower rates of mortality than enrolled infants. Infants with LPE treated before day 6 had lower rates of late respiratory morbidity than infants with LPE treated ≥day 6. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958320.
Assuntos
Esquema de Medicação , Permeabilidade do Canal Arterial/tratamento farmacológico , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Displasia Broncopulmonar/complicações , Feminino , Humanos , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Doenças do Prematuro/terapia , Masculino , Idade Materna , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Risco , Resultado do TratamentoRESUMO
OBJECTIVE: To compare early routine pharmacologic treatment of moderate-to-large patent ductus arteriosus (PDA) at the end of week 1 with a conservative approach that requires prespecified respiratory and hemodynamic criteria before treatment can be given. STUDY DESIGN: A total of 202 neonates of <28 weeks of gestation age (mean, 25.8 ± 1.1 weeks) with moderate-to-large PDA shunts were enrolled between age 6 and 14 days (mean, 8.1 ± 2.2 days) into an exploratory randomized controlled trial. RESULTS: At enrollment, 49% of the patients were intubated and 48% required nasal ventilation or continuous positive airway pressure. There were no differences between the groups in either our primary outcome of ligation or presence of a PDA at discharge (early routine treatment [ERT], 32%; conservative treatment [CT], 39%) or any of our prespecified secondary outcomes of necrotizing enterocolitis (ERT, 16%; CT, 19%), bronchopulmonary dysplasia (BPD) (ERT, 49%; CT, 53%), BPD/death (ERT, 58%; CT, 57%), death (ERT,19%; CT, 10%), and weekly need for respiratory support. Fewer infants in the ERT group met the rescue criteria (ERT, 31%; CT, 62%). In secondary exploratory analyses, infants receiving ERT had significantly less need for inotropic support (ERT, 13%; CT, 25%). However, among infants who were ≥26 weeks gestational age, those receiving ERT took significantly longer to achieve enteral feeding of 120 mL/kg/day (median: ERT, 14 days [range, 4.5-19 days]; CT, 6 days [range, 3-14 days]), and had significantly higher incidences of late-onset non-coagulase-negative Staphylococcus bacteremia (ERT, 24%; CT,6%) and death (ERT, 16%; CT, 2%). CONCLUSIONS: In preterm infants age <28 weeks with moderate-to-large PDAs who were receiving respiratory support after the first week, ERT did not reduce PDA ligations or the presence of a PDA at discharge and did not improve any of the prespecified secondary outcomes, but delayed full feeding and was associated with higher rates of late-onset sepsis and death in infants born at ≥26 weeks of gestation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01958320.
Assuntos
Acetaminofen/uso terapêutico , Tratamento Conservador , Inibidores de Ciclo-Oxigenase/uso terapêutico , Permeabilidade do Canal Arterial/terapia , Ibuprofeno/uso terapêutico , Indometacina/uso terapêutico , Pressão Positiva Contínua nas Vias Aéreas , Permeabilidade do Canal Arterial/classificação , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Masculino , Estudos Prospectivos , Método Simples-Cego , Resultado do TratamentoRESUMO
Introdução: O uso abusivo de substâncias psicoativas é um dos maiores problemas de saúde pública da atualidade. Apesar da sua proibição e combate, a forma contraditória como a sociedade aceita algumas delas, as tensões existenciais e a busca pelo prazer a qualquer custo, apanágios da sociedade moderna, podem explicar o crescimento acelerado e contínuo do uso de substâncias psicoativas, com impactos sobre a saúde individual e coletiva. Por conta disto, as estatísticas hospitalares são fontes úteis para avaliar este problema, auxiliando na formulação de políticas públicas de prevenção e recuperação. Objetivo: Analisar os padrões de internação hospitalar por drogadição em Santa Catarina entre 1998 2015. Métodos: Estudo observacional ecológico, com análise do perfil populacional e tendência temporal. Foram analisadas 108.721 internações hospitalares por ''Transtornos mentais e comportamentais devido ao uso de substâncias psicoativas'' em SC entre 1998 e 2015 segundo o Sistema de Informações Hospitalares - SIH. A análise estática foi realizada por regressão linear. O nível de significância estabelecido foi valor p<0,05. O projeto foi aprovado pelo CEP-UNISUL. Resultados: As maiores taxas médias de internação anual para cada 100.000 habitantes foram associadas ao uso de álcool (87), múltiplas drogas (16,72) e cocaína (8,57). Houve uma taxa média muito maior de internações no sexo masculino (198,42) do que no sexo feminino (22,98). A taxa de mortalidade média foi de 21,5 pacientes hospitalizados a cada 100.000 habitantes. Conclusão: Os homens, a dependência do álcool e a faixa etária entre 35 e 44 anos compõe o perfil predominante das internações estudadas.
Introduction: The abuse of psychoactive substances is one of the most significant public health problems. With the popularity of drugs in the XIX century, several countries took measures relating to the field of security and justice about illicit drugs. Given the relative youth of the new drugs combat policy, there is a rapid and continued growth of the use of psychoactive substances. Hospital statistics are useful sources of data for future socio-economic assessments to formulate effective treatment and prevention policies. Objective: To assess hospital standards for drug addiction in Santa Catarina between 1998 - 2015. Methods: ecological observational study, analyzing the population profile and temporal trend. 108,721 hospital admissions were analyzed by ''mental and behavioral disorders due to use of psychoactive substances'' in SC between 1998 and 2015 for access to the Hospital Information System. The static analysis was performed by linear regression. The significance level was p <0.05. Approved by CEP-UNISUL. Results: The highest average annual hospitalization per 100,000 inhabitants were due to alcohol (87), multidrug (16.72) and cocaine (8.57). Notes a higher average admissions in males (198.42) compared to females (22.98). The average mortality rate was 21.5 per 100,000 inhabitants. Conclusion: The highest hospitalization rates were due to alcohol dependence, profiles found most of the hospitalized patients were men between 35 and 44 years.
RESUMO
Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care.
El desarrollo de miocarditis ocurre con más frecuencia durante el tratamiento con clozapina (CLZ) que durante el uso de otros antipsicóticos (APs). En el presente estudio observacional evaluamos la presencia de miocarditis mediante un protocolo transversal comparando 132 sujetos tratados con CLZ con 371 pacientes tratados con otro AP, y en 21 sujetos tratados con CLZ y 18 pacientes tratados con otro AP en un protocolo longitudinal mayor 1 año de duración. La evaluación incluyó: a) detección de síntomas como disnea, taquicardia, malestar torácico, fiebre, tos y edema; b) presión arterial y auscultación cardiaca; c) electrocardiograma estándar luego de un reposo de 5 minutos; d) contaje de glóbulos blancos y determinación cualitativa de troponina I, creatin-kinasa-MB y mioglobina, y e) evaluación por un cardiólogo en sujetos sospechosos para miocarditis. Detectamos un solo caso de miocarditis, lo que permite una aproximación sobre la frecuencia de miocarditis de 1,6 % durante el primer mes de tratamiento. Se trató de un sujeto masculino con esquizofrenia que desarrolló síntomas durante el día 6 después de haber iniciado el tratamiento con CLZ a la dosis de 200 mg por día sin titulación. No se detectaron sujetos sospechosos de miocarditis durante el tratamiento prolongado con CLZ u otro AP. Estos resultados sustentan la recomendación de comenzar el tratamiento con clozapina a dosis bajas, y la factibilidad de utilizar un protocolo sencillo para detectar miocarditis en la atención psiquiátrica primaria.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Miocardite/induzido quimicamente , Estudos Transversais , Estudos LongitudinaisRESUMO
Myocarditis occurs more frequently during clozapine (CLZ) administration than during treatment with other antipsychotic drugs (APs). In this observational study, we transversally screened outpatients for myocarditis by comparing a CLZ group of 132 subjects, with a non-CLZ group taking other APs (n = 371) only, and in 21 CLZ-treated patients and 18 subjects treated with other APs who had been followed for more than one year. The protocol included a) assessment of symptoms such as dyspnea, tachycardia, chest discomfort, fever, cough, and edema, b) blood pressure and heart auscultation; c) a standard electrocardiogram after a 5-minute rest, d) white cell count, and qualitative determination of troponin I, creatine-kinase-MB and myoglobin, and e) a cardiologist evaluation of subjects with suspected myocarditis. Only one case of myocarditis was detected, providing an approximation of the frequency of myocarditis of 1.6% in the first month of treatment. This was a 30-year-old man with schizophrenia who developed symptoms at day 6 after starting a treatment with 200 mg of CLZ a day without titration. Myocarditis was not observed during prolonged CLZ or other AP administration. These results support the proposal of starting CLZ treatment with a low dose and the feasibility of a simple protocol for myocarditis detection in psychiatry primary care.
Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Miocardite/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
AIMS: Chronic inflammation in obesity is associated with co-morbidities such as, hyperglycemia, hypertension and hyperlipidemia. Leukocytes play an important role in this inflammation and C-reactive protein (CRP) and Interleukin-2 (IL-2) can be important effectors during the immune response in obesity; however, the initial inflammatory events in obesity remain unclear. The aim of this study was to determine the circulating levels of CRP, IL-2, insulin and adiponectin, their association and the association with leukocyte count in obese individuals without co-morbidities and with or without insulin resistance (IR). MATERIALS AND METHODS: Nineteen obese non-diabetic and 9 lean subjects were studied for serum levels of CRP, IL-2, insulin, adiponectin, lipids, glycated hemoglobin, glycemia, for homeostasis model assessment of insulin resistance (HOMA-IR), arterial pressure and anthropometric parameters, and for leukocyte counts. Neutrophil/lymphocyte ratio (N/L) was calculated using the loge of leukocyte counts. Associations were determined by Pearson's correlation. RESULTS: None of the studied groups presented co-morbidities and two groups of obese individuals with normal or high levels of insulin (IR) were found. Increased CRP concentration and decreased IL-2 and adiponectin concentrations in obese were observed. Positive correlation between leukocyte type counts with CRP in obese with IR was found; however, no correlations with IL-2 in obese were observed. Insulin in obese were positively correlated with CRP and negatively correlated with IL-2 in IR obese individuals. Adiponectin in obese was negatively correlated with CRP. CONCLUSION: CRP and IL-2 may represent two important effectors in the early inflammatory events in obese individuals without co-morbidities. Adiponectin and insulin may be involved in anti-inflammatory events.
Assuntos
Adiponectina/sangue , Proteína C-Reativa/metabolismo , Resistência à Insulina , Insulina/sangue , Interleucina-2/sangue , Obesidade/sangue , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/metabolismo , Magreza/sangue , Magreza/metabolismo , Adulto JovemRESUMO
OBJECTIVE: Evidence points to a high prevalence of metabolic dysfunction in bipolar disorder (BD), but few studies have evaluated the relatives of subjects with BD. We conducted a cross-sectional study in an extended family of patients with BD type I. METHODS: The available relatives of the same family were interviewed (DSM-IV-R) and assessed in fasting conditions for body mass index, constituent variables of the metabolic syndrome (MS), leptin levels, insulin resistance index, and single nucleotide polymorphisms (SNPs) for the leptin receptor and promoter and PPAR-γ2 genes. The frequency of MS was compared with that recorded in the local general population. RESULTS: Ninety-three relatives of three adults with BD were evaluated (30 aged < 18 years, 63 aged > 18 years). The frequency of MS was similar to that of the general population. Significantly higher frequencies of abnormal glucose, total and low density cholesterol (LDL-c) levels (all p < 0.05), waist circumference (p = 0.057), and leptin and insulin resistance values (in adults only) were observed in the family. Adults with the QQ genotype of the leptin receptor displayed higher LDL-c levels than carriers of the R allele. CONCLUSIONS: The associations among BD consanguinity, familial hypercholesterolemia, and leptin receptor SNPs reported herein should be replicated and extended in other pedigrees.