Maria Luiza Dória Almeida

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil.

BackgroundThe aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil.MethodsA survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use.ConclusionPrenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Is adolescent pregnancy a risk factor for low birth weight

OBJETIVO: Evaluar el embarazo en la adolescencia como factor de riesgo para bajo peso al nacer. METODOS: Estudio transversal incluido en una cohorte de puerperas y sus respectivos recien nacidos, en las cuatro maternidades de Aracaju, SE (Brasil), de marzo a julio de 2005. Se estudiaron 4.646 pares de madres/recien nacidos. Los datos se colectaron consecutivamente durante cuatro meses. Variables sociales, biologicas y asistenciales se obtuvieron por medio de cuestionario estandarizado. Se realizo regresion logistica multiple, con control de factores de confusion y de modificacion. RESULTADOS: Del total analizadas, 20,6% eran adolescentes (<20 anos). Las madres adolescentes presentaron peores condiciones socioeconomicas, reproductivas y resultados perinatales mas adversos, al compararse con otros grupos etarios. Se identificaron como factores de riesgo asociados al bajo peso al nacer, la ausencia de asistencia en el prenatal y tabaquismo en la gestacion. Se identifico interaccion de la edad materna con la situacion conyugal: madres adolescentes sin companero tuvieron mayores proporciones de bajo peso al nacer. CONCLUSIONES: La adolescencia se mostro como factor de riesgo para bajo peso al nacer entre las madres sin companero. Tabaquismo durante la gestacion y ausencia de asistencia prenatal se asocian al bajo peso al nacer.

Tuberculosis of the cystic duct lymph node

Tuberculosis of the cystic duct lymph node associated with cholelithiasis is rare. We report a case of a 40 year-old woman with this pathology. She presented with anorexia, biliary colic, postprandial fullness and fever. Imaging studies revealed cholelithiasis and several visible portal lymph nodes. Cholecystectomy was performed and histopathological examination showed tuberculosis of the cystic duct lymph node without affecting the gallbladder. The presence of gallstones and lymphadenopathy in computed tomography, associated with persistent fever and symptoms that resemble cholecystitis, should cause suspicion of tuberculosis. However, diagnosis is usually achieved by microscopic appearance of caseating granulomas and isolation of Mycobacterium tuberculosis. The treatment in this case consisted of cholecystectomy and antitubercular chemotherapy.

α1-Acid glycoprotein and α1-antitrypsin as early markers of treatment response in patients receiving the intensive phase of tuberculosis therapy.

The identification of early markers that predict the response to anti-tuberculosis treatment would facilitate evaluation of new drugs and improve patient management. This study aimed to determine whether selected acute phase proteins and micronutrients measured at the time of diagnosis and during the first weeks of treatment could predict treatment responses during the 2-month standard intensive phase of therapy. For this purpose, alpha1-antitrypsin, alpha1-acid glycoprotein, alpha2-macroglobulin, C-reactive protein, C3, C4, zinc, copper and selenium concentrations were measured in Brazilian patients with smear-positive tuberculosis at the time of diagnosis and 1, 3, 5 and 8 weeks after initiation of therapy. Patients were classified into fast (n=29), intermediate (n=18) and slow responders (n=10) if they were smear-negative at 3, 5 or 8 weeks of treatment. alpha1-acid glycoprotein on enrolment and 1 week of treatment, alpha1-antitrypsin at week 1 and C-reactive protein and C3 after 3 weeks of therapy were higher in slow responders than in fast responders. alpha1-antitrypsin and alpha1-acid glycoprotein may be helpful in predicting treatment response at the time of initiation of therapy, and could be used as early markers to identify patients with an increased likelihood of treatment failure.

Asma e gravidez: repercussões no recém-nascido

OBJETIVO: Descrever, numa coorte de nascimentos, aspectos socioeconomicos e comportamentais de gestantes com asma e analisar as repercussoes desta sobre alguns parâmetros perinatais. METODOS: Estudo observacional, transversal e analitico a partir de informacoes de parturientes da coorte de nascimentos ocorridos no periodo entre 8 de marco e 15 de julho de 2005 nas maternidades da Grande Aracaju (SE). A identificacao de asma nas gestantes foi obtida segundo informacao destas a partir do diagnostico emitido anteriormente por um medico. Foram analisadas variaveis epidemiologicas, obstetricas e perinatais. RESULTADOS: Das 4.757 parturientes incluidas no estudo, 299 (6,3%) eram asmaticas. As maes asmaticas tinham menor renda familiar e mais frequentemente procuraram assistencia no pre-natal e no parto em servicos publicos que as maes sem asma. Embora somente 9,4% das gestantes asmaticas fumaram, e 27,6% ingeriram bebidas alcoolicas, as proporcoes em relacao ao grupo controle foram significativamente maiores. Nao se detectou associacao entre asma e problemas obstetricos ou do recem-nascido. Nao foi encontrada associacao entre asma e parto cesariano, prematuridade ou recem-nascido sendo pequeno para a idade gestacional. CONCLUSOES: O nivel socioeconomico inferior parece ser um fator de risco para a asma.

Spirometry with FEV 0.75 Increases the Sensitivity for the Diagnosis of Obstructive Disorder in Children of Asthmatic Mothers

Objective: To evaluate and compare the sensitivity of spirometry in children of asthmatic mothers by the parameters FEV1 and FEV0.75. Methods: An observational cross-sectional analytical study nested in a cohort of 4,757 pregnant women. Clinical evaluation was performed for the diagnosis of asthma, besides the realization of spirometry in the children of asthmatic mothers, evaluating the following parameters and relationships: FEV1, FVC, FEV1/FVC, FEV0.75 and FEV0.75/FVC. Results: A total of 86 children of asthmatic mothers were included in the study, with age mean of 79.8 ± 1.1 month old. Regarding the breathing pattern there was a predominance of normality. When using FEV1, changes were observed in 26 children, representing 30.3% of the sample. Of these, 17 were classified as restrictive and nine as obstructive. Using the FEV0.75 instead of the FEV1 (and its consequent FEV0.75/FVC) 29 ventilatory tests found changed, representing 33.7%. Of these, 27 were classified as obstructive and only two were restrictive. Of the 16 children diagnosed with asthma, only five had presented obstructive pattern when FEV1 customization spirometry was used. In contrast, when we used FEV0.75, 12 of these patients were considered obstructive. The sensitivity was higher in the spirometric test that used FEV0.75, with even greater negative predictive value. On the other hand the test set for the parameter FEV1 showed greater specificity and higher positive predictive value. Conclusions: Spirometry, though with recognized value in the complementary diagnosis of obstructive disturbance, classically presents limitations in the pediatric population, especially in younger children. We observed a significantly higher sensitivity and negative predictive value when we used FEV0.75 in substitution to the FEV1. As a consequence, the parameter FEV0.75 is probably more effective for the diagnosis of obstructive disorder in patients with clinical history or family history of asthma.

Stomatognathic evaluation at five years of age in children born premature and at term.

BackgroundThe high frequency of alterations of the stomatognathic system associated with premature birth may suggest that prematurity is an important risk factor in the development of this system. Prematurity has an incidence between 6-11% of births and is associated with factors such as genetic, maternal conditions (obstetric problems, nutritional status, infections) and antenatal care. In addition, undesirable situations, such as changes in enamel and the development of the skeletal structure, also appears to be associated with prematurity. This study aimed to look for changes in the stomatognathic system at five years of age associated with premature birth.MethodsWe estimated the prevalence of developmental disorders of the stomatognathic system in the primary dentition of preschool children at five years of age. Changes in preterm infants (n = 32) compared with term born (n = 381) were evaluated . Clinical examinations and questionnaire with sociodemographic and health of mothers and children information. Gestational age, birth weight, head circumference, Apgar score and mechanical ventilation, were collected from the medical records to birth records. The explanatory variable was preterm (<37 weeks gestational age).ResultsResults: Prevalence of 7.7% of preterm infants was found. Of these, 40.6% had atresic palate, 56.2% malocclusion and 21.8% enamel hypoplasia. Forty (9.6%) children were not breastfed at the breast, and 26 (65.0%) had some type of malocclusion, showing association between not breastfeeding with an abnormal development of the stomatognathic system. The group of preterm infants showed five times more changes in head circumference and three times more mechanical ventilation use at birth. Change in head circumference at birth and mechanical ventilation has a significant association between groups of preterm and term infants.ConclusionsMechanical ventilation at birth directly contributed to an increased risk of developmental disorders of the stomatognathic system in preterm infants, especially dental hypoplasia. Non-breastfed children had a higher risk of developing malocclusion. Alterations in head circumference were related effective on dental malocclusion. The results suggest that changes in the stomatognathic system are influenced by premature birth and points to the imperative need of using methods of preventive.

Gravidez na adolescência é fator de risco para o baixo peso ao nascer

OBJETIVO: Evaluar el embarazo en la adolescencia como factor de riesgo para bajo peso al nacer. METODOS: Estudio transversal incluido en una cohorte de puerperas y sus respectivos recien nacidos, en las cuatro maternidades de Aracaju, SE (Brasil), de marzo a julio de 2005. Se estudiaron 4.646 pares de madres/recien nacidos. Los datos se colectaron consecutivamente durante cuatro meses. Variables sociales, biologicas y asistenciales se obtuvieron por medio de cuestionario estandarizado. Se realizo regresion logistica multiple, con control de factores de confusion y de modificacion. RESULTADOS: Del total analizadas, 20,6% eran adolescentes (<20 anos). Las madres adolescentes presentaron peores condiciones socioeconomicas, reproductivas y resultados perinatales mas adversos, al compararse con otros grupos etarios. Se identificaron como factores de riesgo asociados al bajo peso al nacer, la ausencia de asistencia en el prenatal y tabaquismo en la gestacion. Se identifico interaccion de la edad materna con la situacion conyugal: madres adolescentes sin companero tuvieron mayores proporciones de bajo peso al nacer. CONCLUSIONES: La adolescencia se mostro como factor de riesgo para bajo peso al nacer entre las madres sin companero. Tabaquismo durante la gestacion y ausencia de asistencia prenatal se asocian al bajo peso al nacer.

Aspectos funcionais respiratórios na leptospirose humana

INTRODUCTION Respiratory impairment may be the main clinical manifestation of human leptospirosis. METHODS With the aim of describing the respiratory functional characteristics of this disease, 21 patients were evaluated using pulse oximetry and spirometry at two times: an initial evaluation and after around 28 days. RESULTS Two (9.5%) patients presented peripheral oxygen saturation of less than 95%. Normal spirometric patterns were observed in eight (38.1%); cases restrictive ventilatory disorders were inferred in seven (33.3%), obstructive disorders with reduced forced vital capacity in four (19%), and nonspecific disorders in two (9.5%). Abnormal spirometry findings were associated with worse APACHE II scores (p = 0.02) and abnormalities on chest x-ray (p = 0.05). After clinical resolution, significant functional gain was observed (p < 0.05) in the group of patients with abnormal spirometry findings. CONCLUSIONS It was concluded that respiratory functional abnormalities were detected during the course of the disease and were associated with greater clinical severity and higher frequency of chest radiographic abnormalities.

Cirurgia valvar na infância: um novo aspecto de açäo

From January 1978 to December 1991, 148 children (age < 15 years) were operated upon on our Service for the first time, to correct defects (rheumatic fever) on the cardiac valves. The material was divided in two times, according to the point of view of the group in an attempt to preserve a great number of valves, in especial in children. Last year 24 children were operated upon in whom mitral valve disease treatment was necessary twenty times, and in aortic valve eight times. In that group, 95% (28% before) surgery on the mitral valve and 62% (20% before) on the aortic valve were conservative procedures. There were neither deaths nor complications and all children have good evolution. We conclude that on rheumatic fever, cardiac valve disease treatment in children must be conservative and the best time for the surgery must be earlier, to avoid valvar disfunction due to disease. We also think that follow up must be effective in order to analyze if different available plastic techniques are better than valve substitution in children with rheumatic fever.