Prenatal detection and postnatal management of an intranasal glioma

Nasal gliomas are rare benign congenital midline tumors composed of heterotopic neuroglial tissue. They have potential for intracranial extension through a bony defect in the skull base. Neuroimaging is essential for identifying nasal lesions and for determining their exact location and any possible intracranial extension. Computed tomography is often the initial imaging study obtained because it provides good visualization of the bony landmarks of the skull base; it is not, however, well suited for soft tissue imaging. Magnetic resonance imaging has better soft tissue resolution and may be the best initial study in patients seen early in life because the anterior skull base consists of an unossified cartilage and may falsely appear as if there is a bony dehiscence on computed tomography. A frontal craniotomy approach is recommended if intracranial extension is identified, followed by a transnasal endoscopic approach for intranasal glioma. A case is presented of a huge fetal facial mass that was shown by ultrasound that protruded through the left nostril at 33 weeks of gestation. Computed tomography of the neonate suggested a transethmoidal encephalocele. Magnetic resonance imaging showed a huge mass occupying the nasopharynx and the nasal cavity and protruding externally to the face but ruled out bony discontinuity in the skull base and, therefore, any intracranial connection. The infant underwent an endoscopic resection of the mass via oral and nasal routes and pathologic examination revealed intranasal glioma. (C) 2012 Elsevier Inc. All rights reserved.

Criança dependente de tecnologia: a experiência do cuidado materno

Este estudo tem como objetivo compreender a experiência materna no cuidado ao filho dependente de tecnologia. Utilizamos a abordagem do estudo de caso etnográfico tendo como instrumentos de coleta de dados os genograma e ecomapa, entrevista aberta e observação. Os dados foram organizados em três unidades de significados: a busca pelas causas e por culpados; a alta hospitalar e as demandas para o cuidado e as redes de apoio. O estudo permitiu conhecer a experiência materna em busca por explicações, bem como os sentimentos de desconfiança, insegurança e insatisfação relacionados ao serviço de saúde. Ainda a apropriação da mãe em relação aos cuidados à criança e no que se refere à organização do ambiente domiciliar para recebê-la, a utilização das redes de apoio, destacando a carência de vínculos com familiares e vizinhos e a busca formal e informal para garantir a subsistência da criança doente e dos demais filhos.

Hypoactivity of the central dopaminergic system and autistic-like behavior induced by a single early prenatal exposure to lipopolysaccharide

The aim of the present study was to evaluate the behavioral patterns associated with autism and the prevalence of these behaviors in males and females, to verify whether our model of lipopolysaccharide (LPS) administration represents an experimental model of autism. For this, we prenatally exposed Wistar rats to LPS (100 mu g/kg, intraperitoneally, on gestational day 9.5), which mimics infection by gram-negative bacteria. Furthermore, because the exact mechanisms by which autism develops are still unknown, we investigated the neurological mechanisms that might underlie the behavioral alterations that were observed. Because we previously had demonstrated that prenatal LPS decreases striatal dopamine (DA) and metabolite levels, the striatal dopaminergic system (tyrosine hydroxylase [TH] and DA receptors D1a and D2) and glial cells (astrocytes and microglia) were analyzed by using immunohistochemistry, immunoblotting, and real-time PCR. Our results show that prenatal LPS exposure impaired communication (ultrasonic vocalizations) in male pups and learning and memory (T-maze spontaneous alternation) in male adults, as well as inducing repetitive/restricted behavior, but did not change social interactions in either infancy (play behavior) or adulthood in females. Moreover, although the expression of DA receptors was unchanged, the experimental animals exhibited reduced striatal TH levels, indicating that reduced DA synthesis impaired the striatal dopaminergic system. The expression of glial cell markers was not increased, which suggests that prenatal LPS did not induce permanent neuroinflammation in the striatum. Together with our previous finding of social impairments in males, the present findings demonstrate that prenatal LPS induced autism-like effects and also a hypoactivation of the dopaminergic system. (c) 2012 Wiley Periodicals, Inc.

Variations in Management of Mild Prenatal Hydronephrosis Among Maternal-Fetal Medicine Obstetricians, and Pediatric Urologists and Radiologists

Purpose: There are no current guidelines for diagnosing and managing mild prenatal hydronephrosis. Variations in physician approach make it difficult to analyze outcomes and establish optimal management. We determined the variability of diagnostic approach and management regarding prenatal hydronephrosis among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. Materials and Methods: Online surveys were sent to mailing lists for national societies for each specialty. Participants were surveyed regarding criteria for diagnosing mild prenatal hydronephrosis and recommendations for postnatal management, including use of antibiotic prophylaxis, followup scheduling and type of followup imaging. Results: A total of 308 maternal-fetal medicine obstetricians, 126 pediatric urologists and 112 pediatric radiologists responded. Pediatric urologists and radiologists were divided between Society for Fetal Urology criteria and use of anteroposterior pelvic diameter for diagnosis, while maternal-fetal medicine obstetricians preferred using the latter. For postnatal evaluation radiologists preferred using personal criteria, while urologists preferred using anteroposterior pelvic diameter or Society for Fetal Urology grading system. There was wide variation in the use of antibiotic prophylaxis among pediatric urologists. Regarding the use of voiding cystourethrography/radionuclide cystography in patients with prenatal hydronephrosis, neither urologists nor radiologists were consistent in their recommendations. Finally, there was no agreement on length of followup for mild prenatal hydronephrosis. Conclusions: We observed a lack of uniformity regarding grading criteria in diagnosing hydronephrosis prenatally and postnatally among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. There was also a lack of agreement on the management of mild intermittent prenatal hydronephrosis, resulting in these cases being managed inconsistently. A unified set of guidelines for diagnosis, evaluation and management of mild intermittent prenatal hydronephrosis would allow more effective evaluation of outcomes.

Postnatal longitudinal evaluation of children diagnosed with prenatal hydronephrosis: insights in natural history and referral pattern

Objectives Clinical significance and management of prenatal hydronephrosis (PNH) are sources of debate. Existing studies are flawed with biased cohorts or inconsistent follow-up. We aimed to evaluate the incidence of pathology in a large cohort of PNH and assess the biases and outcomes of this population. Methods We reviewed 1034 charts of fetuses with PNH. Records of delivered offspring were reviewed at a pediatric center and analyzed with respect to prenatal and postnatal pathology and management. Results Prenatal resolution of hydronephrosis occurred in 24.7% of pregnancies. On first postnatal ultrasound, some degree of dilatation was present in 80%, 88% and 95% of mild, moderate and severe PNH cases, respectively. At the end of follow-up, hydronephrosis persisted in 10%, 25% and 72% of children, respectively. Incidence of vesicoureteral reflux did not correlate with severity of PNH. Children with postnatal workup had more severe PNH than those without. Conclusions Despite prenatal resolution totalizing 25%, pelvic dilatation persisted on first postnatal imaging in most cases, thus justifying postnatal ultrasound evaluation. Whereas most mild cases resolved spontaneously, a quarter of moderate and more than half of severe cases required surgery. Patients with postnatal imaging and referral had more severe PNH, which could result in overestimation of pathology. (c) 2012 John Wiley & Sons, Ltd.

Estado nutricional e ganho de peso de gestantes

Caracterizou-se estado nutricional de 228 gestantes e sua influência no peso ao nascer. Trata-se de estudo retrospectivo desenvolvido num centro de saúde do município de São Paulo, com dados obtidos de prontuários. Realizou-se análise de regressão linear. Verificou-se associação entre estado nutricional inicial e final (p<0,001). A média de ganho total de peso diminuiu das gestantes que iniciaram a gravidez com baixo peso para aquelas que iniciaram com sobrepeso/obesidade (p=0,005), sendo insuficiente para 43,4 e 36,4% das gestantes com peso inicial adequado e para o total das gestantes estudadas, respectivamente. Entretanto, 37,1% daquelas que iniciaram a gravidez com sobrepeso/obesidade finalizaram com ganho excessivo, condição que, no final, afetou quase um quarto das gestantes. Anemia e baixo peso ao nascer foram pouco frequentes, porém, na análise de regressão linear, peso ao nascer associou-se com ganho de peso (p<0,05). Evidencia-se a importância do cuidado nutricional antes e durante a gravidez, para promoção da saúde materno-infantil.

Prenatal retinoic acid improves lung vascularization and VEGF expression in CDH rat

OBJECTIVE: We sought to investigate the effects of antenatal retinoic acid on the pulmonary vasculature and vascular endothelial growth factor (VEGF) and VEGF receptors (VEGFR) expression in a nitrofen-induced congenital diaphragmatic hernia (CDH) model. STUDY DESIGN: Rat fetuses were exposed to nitrofen at gestational day 9.5 and/or all-trans retinoic acid (ATRA) at gestational days 18.5-20.5. We assessed lung growth, airway, and vascular morphometry. VEGF, VEGFR1, and VEGFR2 expression was analyzed by Western blotting and immunohistochemistry. Continuous data were analyzed by analysis of variance and Kruskal-Wallis test. RESULTS: CDH decreased lung to body weight ratio, increased mean linear intercept and mean transection length/airspace, and decreased mean airspace cord length. ATRA did not affect lung growth or morphometry. CDH increased proportional medial wall thickness of arterioles while ATRA reduced it. ATRA recovered expression of VEGF and receptors, which were reduced in CDH. CONCLUSION: Retinoic acid and VEGF may provide pathways for preventing pulmonary hypertension in CDH.

Organização dos serviços de saúde e a gestão do cuidado à tuberculose

Este estudo teve como objetivo analisar a discursividade de gestores sobre a relação entre a organização dos serviços de saúde e a gestão do cuidado à tuberculose (TB) em um município da região metropolitana de João Pessoa/PB. Conduzido pela pesquisa qualitativa no campo analítico da Análise de Discurso de linha francesa, participaram 16 trabalhadores de saúde que atuavam como integrantes de equipes gestoras. Os depoimentos transcritos foram organizados com uso do software Atlas.ti versão 6.0. Após leitura minuciosa do material empírico procurou-se observar nos discursos os processos parafrásicos, polissêmicos e metafóricos, os quais possibilitaram a identificação da seguinte formação discursiva: organização dos serviços de saúde e a relação com a gestão do cuidado à TB; o plano e a prática. Nos discursos dos gestores evidencia-se a fragmentação das ações de controle da tuberculose, a falta de articulação entre os serviços e os setores, o cumprimento de atividades específicas à TB, bem como a falta de planejamento estratégico para gestão do cuidado da doença. Nesse sentido, para que a organização dos serviços de saúde seja efetiva, se faz necessário que a tuberculose seja prioridade na agenda da gestão e reconhecida como um problema social.

Prenatal and Neonatal Adaptations with a Focus on the Respiratory System

Contents Among the modifications that occur during the neonatal period, pulmonary development is the most critical. The neonate's lungs must be able to perform adequate gas exchange, which was previously accomplished by the placenta. Neonatal respiratory distress syndrome is defined as insufficient surfactant production or pulmonary structural immaturity and is specifically relevant to preterm newborns. Prenatal maternal betamethasone treatment of bitches at 55days of gestation leads to structural changes in the neonatal lung parenchyma and consequently an improvement in the preterm neonatal respiratory condition, but not to an increase in pulmonary surfactant production. Parturition represents an important challenge to neonatal adaptation, as the uterine and abdominal contractions during labour provoke intermittent hypoxia. Immediately after birth, puppies present venous mixed acidosis (low blood pH and high dioxide carbon saturation) and low but satisfactory Apgar scores. Thus, the combination of physiological hypoxia during birth and the initial effort of filling the pulmonary alveoli with oxygen results in anaerobiosis. As a neonatal adaptation follow-up, the Apgar analysis indicates a tachypnoea response after 1h of life, which leads to a shift in the blood acidbase status to metabolic acidosis. One hour is sufficient for canine neonates to achieve an ideal Apgar score; however, a haemogasometric imbalance persists. Dystocia promotes a long-lasting bradycardia effect, slows down Apgar score progression and aggravates metabolic acidosis and stress. The latest data reinforce the need to accurately intervene during canine parturition and offer adequate medical treatment to puppies that underwent a pathological labour.

Adaptation and validation of the Patient Expectations and Satisfaction with Prenatal Care instrument among Brazilian pregnant women

Objective: to adapt and validate the Patient Expectations and Satisfaction with Prenatal Care instrument for use in Brazil. It contains 41 items divided into two dimensions: expectations and satisfaction. The adapted version was submitted to analysis for stability, convergent construct validity, and internal consistency (Cronbach’s alpha) for distinct groups and dimensions. Method: 119 pregnant women receiving prenatal care were interviewed and 26 of these women answered the instrument twice (retest). Internal consistency was appropriate (Cronbach’s alpha ≥ 0.70); test-retest presented strong correlation (r=0.82; p<0.001) for the domain expectations and moderate correlation (r=0.66; p<0.001) for the satisfaction domain. The analysis confirmed that the instrument’s adapted version is valid in the studied group. Results: there is strong evidence for the validity and reliability of the instrument’s adaptation. Conclusion: the instrument needs to be tested in groups of pregnant women with different social characteristics.

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

Abstract Background The 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. Methods A 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. Conclusion Prenatal 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.

Recém-nascido prematuro: suporte materno domiciliar para o cuidado

Este estudo descritivo, com abordagem qualitativa, teve como objetivo identificar o suporte materno, no domicílio, para o cuidado do recém-nascido prematuro egresso de Unidade Neonatal. O estudo, realizado em 2008, entrevistou doze mães residentes no município de Sumaré-SP. Os relatos, gravados, foram tratados pela técnica do Discurso do Sujeito Coletivo (DSC). Os resultados acrescem o conhecimento de enfermagem pela diversidade de recursos que emergiram, e que revelaram a importância da inserção materna na Unidade Neonatal; valorizaram a Cartilha de orientação oferecida pelo serviço; e destacaram a relevância do apoio social para o cuidado do bebê, no domicílio. Recomenda-se a inserção do familiar no plano de enfermagem para a alta do prematuro na Unidade Neonatal.

Seguimento da saúde da criança e a longitudinalidade do cuidado

Estudo reflexivo com o objetivo de apresentar, na perspectiva da hermenêutica filosófica, elementos relevantes para o seguimento da saúde da criança em atenção primária à saúde. A assistência à saúde da criança tem como eixo norteador o processo de crescimento e desenvolvimento na infância, sendo fundamental conhecer as escolhas e tomadas de decisão das famílias, estimular a produção de narrativas, fortalecer virtudes e experiências cotidianas, contribuindo para enriquecer o cuidado e apreendê-lo numa perspectiva integradora, contingencial, longitudinal e suficientemente boa. O seguimento da criança pode ser tomado como uma tecnologia de cuidado em saúde que não pressupõe um saber a priori, mas remete a uma reconstrução de saberes e práticas com novas dimensões para a produção de cuidados.

Intervenções de enfermagem para o cuidado de pacientes com artrite: revisão integrativa da literatura

Esta revisão integrativa buscou analisar a produção científica relacionada aos cuidados de enfermagem para pacientes com artrite. Foram incluídos 12 estudos experimentais, randomizados e controlados, publicados nas bases de dados CINAHL, MEDLINE, SciELO e LILACS, utilizando os descritores controlados "arthritis" e "nursing". Os resultados apontaram a efetividade de musicoterapia, estimulação elétrica neuromuscular, toque terapêutico e imagem guiada associada a relaxamento, para o tratamento da dor. Ser atendido por enfermeira especialista aumentou a satisfação com o atendimento, melhorou o impacto da doença e aumento a procura por serviços de saúde. Programas educativos específicos para portadores de artrite estimularam a prática de exercícios físicos e aqueles direcionados a pessoas com problemas crônicos em geral mostraram-se efetivos para controlar a dor e a incapacidade funcional. Concluímos que existe um conjunto de intervenções que podem subsidiar a prática de enfermagem baseada em evidências junto aos idosos com artrite.

A humanização do cuidado na formação dos profissionais de saúde nos cursos de graduação

A proposta desta pesquisa bibliográfica é conhecer e analisar a produção científica do campo da saúde, em periódicos nacionais, sobre o ensino da humanização do cuidado nos cursos de graduação. Realizou-se um levantamento bibliográfico na base de dados LILACS, utilizando o termo humanização, com textos publicados a partir do ano de 2000 até 2010, sendo analisados 42 artigos. Da análise dos artigos emergiram temáticas centrais: Humanização: algumas considerações sobre seus conceitos; Universidade e as Diretrizes Curriculares Nacionais para os Cursos de Graduação na Área da Saúde: relações com o ensino da humanização; Mudanças curriculares, conteúdos e estratégias de ensino-aprendizagem no cuidado humanizado e Sujeitos do processo ensino-aprendizagem: alunos e professores na aprendizagem da humanização do cuidado. Alguns elementos teórico-práticos vêm sendo construídos sobre o ensino da humanização no contexto de saúde, sendo imprescindível, todavia, maiores investimentos na construção efetiva de novos modos de cuidar.