Prognostic value of thumb pain sensation in birth brachial plexopathy

Objective: To evaluate the prognostic value of absent thumb pain sensation in newborns and young infants with birth brachial plexopathy. Methods: We evaluated 131 patients with birth brachial plexopathy with less than two months of age. Pain sensation was evoked by thumb nail bed compression to evaluate sensory fibers of the upper trunk (C6). The patients were followed-up monthly. Patients with less than antigravity elbow flexion at six months of age were considered to have a poor outcome. Results: Thirty patients had absent thumb pain sensation, from which 26 showed a poor outcome. Sensitivity of the test was 65% and specificity was 96%. Conclusion: Evaluation of thumb pain sensation should be included in the clinical assessment of infants with birth brachial plexopathy.

Invasive candidiasis and oral manifestations in premature newborns

Objective: To investigate prevalence of invasive candidiasis in a Neonatal Intensive Care Unit and to evaluate oral diseases and Candida spp. colonization in low birth weight preterm newborns. Methods: A descriptive epidemiological study performed in two stages. First, prevalence of candidiasis was analyzed in a database of 295 preterm patients admitted to hospital for over 10 days and birth weight less than 2,000g. In the second stage, oral changes and Candida spp. colonization were assessed in 65 patients weighing less than 2,000g, up to 4 week-old, hospitalized for over 10 days and presenting oral abnormalities compatible with fungal lesions. Swab samples were collected in the mouth to identify fungi. Results: Prevalence of candidiasis was 5.4% in the database analyzed. It correlated with prolonged hospital length of stay (p<0.001), in average, 31 days, and 85% risk of developing infection in the first 25 days. It correlated with low birth weight (p<0.001), with mean of 1,140g. The most frequent alterations were white soft plaques, detachable, in oral mucosa and tongue. Intense oral colonization by Candida spp was observed (80%). Conclusions: The frequency of invasive candidiasis was low and correlated with low birth weight and prolonged hospital stay. The most common oral changes were white plaques compatible with pseudomembranous candidiasis and colonization by Candida spp. was above average.

Revis��o sistem��tica das escalas utilizadas para avalia����o funcional na doen��a de Pompe

OBJETIVO: Identificar as escalas utilizadas para avalia����o funcional na doen��a de Pompe (DP) e descrever seu n��vel de evid��ncia e recomenda����o. FONTES DE DADOS: Revis��o sistem��tica sobre as escalas de avalia����o funcional na DP. Pesquisa realizada nos bancos de dados Medline, Lilacs, Registro Cochrane de Ensaios Controlados Central (CCTR) e SciELO com artigos (exceto artigos de revis��o) publicados entre 2000 e 2010. As palavras-chave utilizadas nos idiomas portugu��s e ingl��s foram: doen��a de dep��sito de glicog��nio tipo II, atividades cotidianas, avalia����o. Os artigos foram classificados em n��vel de evid��ncia e recomenda����o. S��NTESE DOS DADOS: Foram inclu��dos 14 estudos que avaliaram desde recém-nascidos a adultos (amostra total=449). Foram encontradas as seguintes escalas na literatura: Pediatric Evaluation of Disability Inventory (PEDI) e sua forma adaptada para DP (Pompe-PEDI), Alberta Infant Motor Scale (AIMS), Rotterdam Handiscap Scale (RHS), Functional Independence Measure (FIM), Gross Motor Function Measure (GMFM) e Peabody Developmental Motor Scales (PDMS-II). A maioria dos estudos apresentou n��vel de evid��ncia III, por serem n��o randomizados. Grau de recomenda����o das escalas: C para AIMS e Pompe-PEDI; D para GMFM e PDMS-II; E para RHS e FIM. CONCLUS��ES: A maioria das escalas utilizadas para avalia����o funcional na DP apresenta baixo n��vel de evid��ncia e recomenda����o. As que apresentam melhor grau de recomenda����o (C) s��o as escalas AIMS e Pompe-PEDI aplicadas em Pediatria.

Preval��ncia e motivos de remo����o n��o eletiva do cateter central de inser����o perif��rica em neonatos

Estudo transversal, realizado com 67 recém-nascidos internados em uma Unidade de Terapia Intensiva Neonatal de um hospital privado de S��o Paulo, entre julho e dezembro de 2010, submetidos a 84 inser����es de Cateteres Centrais de Inser����o Perif��rica (CCIP). Os objetivos foram descrever a preval��ncia de remo����o n��o eletiva do cateter e seus motivos. Os dados foram coletados de prontu��rios m��dicos e do formul��rio de registro de informa����es sobre o cateter. A m��dia de idade gestacional corrigida dos neonatos foi 32,8 semanas, peso 1.671,6 g e idade p��s-natal 9,4 dias. A remo����o n��o eletiva ocorreu em 33 (39,3%) cateteres, 13,1% por obstru����o, 9,5% ruptura, 7,1% edema do membro, 6% suspeita de infec����o, 1,2% tra����o acidental, 1,2% m�� perfus��o e 1,2% extravasamento. A preval��ncia e os motivos de remo����o n��o eletiva indicaram a necessidade de estrat��gias para a preven����o de complica����es evit��veis relacionadas ao CCIP.

Electrophysiological study of hearing in full-term small-for-gestational-age newborns

PURPOSE: To describe the Brainstem Auditory Evoked Potential (BAEP) results of full-term small-for-gestational-age newborns, comparing them to the results of full-term appropriate-for-gestational-age newborns, in order to verify whether the small-for-gestational-age condition is a risk indicator for retrocochlear hearing impairment. METHODS: This multicentric prospective cross-sectional study assessed 86 full-term newborns - 47 small- (Study Group) and 39 appropriate-for-gestational-age (Control Group - of both genders, with ages between 2 and 12 days. Newborns with presence of transient evoked otoacoustic emissions and type A tympanometry were included in the study. Quantitative analysis was based on the mean and standard deviation of the absolute latencies of waves I, III and V and interpeak intervals I-III, III-V and I-V, for each group. For qualitative analysis, the BAEP results were classified as normal or altered by analyzing these data considering the age range of the newborn at the time of testing. RESULTS: In the Study Group, nine of the 18 (38%) subjects with altered BAEP results had the condition of small-for-gestational-age as the only risk factor for hearing impairments. In the Control Group, seven (18%) had altered results. Female subjects from the Study Group tended to present more central alterations. In the Control Group, the male group tended to have more alterations. CONCLUSION: Full-term children born small or appropriate for gestational age might present transitory or permanent central hearing impairments, regardless of the presence of risk indicators.

Parotidite supurativa neonatal : caso cl��nico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Atitude expectante na pr��-ecl��mpsia moderada tardia

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Anomalias cong��nitas associadas a t��cnicas de reprodu����o medicamente assistida

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Infe����es associadas aos cuidados de sa��de e surtos infeciosos em unidades de cuidados intensivos neonatais e protocolos de seguimento

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Cuidar no parto : pr��tica de episiotomia

Enquadramento ��� A episiotomia �� uma incis��o feita no per��neo para aumentar o canal vaginal com o objetivo de evitar outros traumas perineais durante o parto. No entanto, esta pr��tica, por si s��, j�� se considera um trauma perineal pelo corte em estruturas que podem desencadear problemas futuros. A Organiza����o Mundial de Sa��de (1996) recomenda a utiliza����o limitada da episiotomia uma vez que n��o existem evid��ncias cred��veis de que a utiliza����o generalizada ou de rotina desta pr��tica tenha um efeito ben��fico. Objetivos: Demonstrar evid��ncia cient��fica dos determinantes da pr��tica de episiotomia seletiva em mulheres com parto normal/eut��cico; identificar a preval��ncia de episiotomia; analisar os fatores (vari��veis sociodemogr��ficas, vari��veis relativas ao rec��m-nascido, vari��veis contextuais da gravidez e contextuais do parto) que influenciam na ocorr��ncia de episiotomia. M��todos: O estudo emp��rico I seguiu a metodologia de revis��o sistem��tica da literatura. Efetuou-se uma pesquisa na EBSCO, PubMed, SciELO, RCAAP de estudos publicados entre janeiro de 2008 e 23 de dezembro de 2014. Os estudos encontrados foram avaliados tendo em considera����o os crit��rios de inclus��o previamente estabelecidos. Dois revisores avaliaram a qualidade dos estudos a incluir utilizando a grelha para avalia����o cr��tica de um estudo descrevendo um ensaio cl��nico prospetivo, aleatorizado e controlado de Carneiro (2008). Ap��s avalia����o cr��tica da qualidade, foram inclu��dos no corpus do estudo 4 artigos nos quais se obteve um score entre 87,5% e 95%. O estudo emp��rico II enquadra-se num estudo quantitativo, transversal, descritivo e retrospetivo, desenvolvido no servi��o de Obstetr��cia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem n��o probabil��stica por conveni��ncia (n = 382). A recolha de dados efetuou-se atrav��s da consulta dos processos cl��nicos das mulheres com idade ��� 18 anos que tiveram um parto vaginal com feto vivo ap��s as 37 semanas de gesta����o. Resultados: Evid��ncia de que a episiotomia n��o deve ser realizada de forma rotineira, cujo uso deve restringir-se a situa����es cl��nicas espec��ficas. A episiotomia seletiva, comparada com a episiotomia de rotina, est�� relacionada com um menor risco de trauma do per��neo posterior, a uma menor necessidade de sutura e a menos complica����es na cicatriza����o. Amostra constitu��da por 382 mulheres, na faixa et��ria dos 18-46 anos. Apenas, n��o se procedeu �� episiotomia em 41,7% da amostra, apontando para a presen��a da episiotomia seletiva. N��mero significativo de mulheres com parto eut��cico (80,5%), com sutura (95,0%), lacera����o de grau I (64,9%), dor perineal (89,1%) sujeitas a episiotomia (58,3%). A maioria dos recém-nascidos nasceram com peso normal (92,3%), com um valor expressivo de mulheres sujeitas a episiotomia (91,4%). Ainda se constatou a exist��ncia de casos, apesar de reduzidos, em que o rec��m-nascido nasceu macross��mico (5,4%), tendo-se recorrido igualmente a esta pr��tica. N��o h�� uma associa����o direta entre a realiza����o de episiotomia e os scores do APGAR. Conclus��o: Face a estes resultados e com base na evid��ncia cient��fica dispon��vel que recomenda, desde h�� v��rios anos, que se fa��a um uso seletivo da episiotomia, sugere-se que os profissionais de sa��de estejam mais despertos para esta realidade, de modo a que se possam anular as resist��ncias e as barreiras de mudan��as por parte dos mesmos face ao uso seletivo da episiotomia. Para promover essa mudan��a de comportamentos �� importante n��o s�� mostrar as evid��ncias cient��ficas, bem como transp��-las para a pr��tica, capacitando os profissionais de sa��de, sobretudo os enfermeiros, na sua atua����o. Palavras-chave: Parto Normal/eut��cico; Episiotomia; Episiotomia seletiva; Episiotomia de rotina.

Benef��cios da cafe��na na terap��utica

Disserta����o para obten����o do grau de Mestre no Instituto Superior de Ci��ncias da Sa��de Egas Moniz

Acidente vascular cerebral perinatal: 11 casos cl��nicos

Introdu����o: Os acidentes vasculares cerebrais (AVC) s��o causa de epilepsia e perturba����es do neurodesenvolvimento. T��m tido uma incidencia crescente atribu��vel em parte �� melhoria das tecnicas de imagens cerebrais. Alguns diagn��sticos s��o efectuados retrospectivamente ap��s o periodo neonatal. O objectivo da presente serie de casos cl��nicos foi identificar factores comuns que possam facilitar o diagn��stico no per��odo neonatal. Material e m��todos: Estudo retrospectivo efectuado com base na consulta dos processos clinicos dos recém-nascidos, com diagn��stico de AVC entre um de Janeiro de 2003 e 31 de Dezembro de 2013. Resultados: Foram identificados onze casos de AVC perinatal, num total 28382 nados-vivos. Dois casos foram diagnosticados no periodo fetal e nove no periodo neonatal. As convuls��es foram a manifesta����o clinica mais frequente (8 em 11 casos). A mediana da idade de diagn��stico foi um dia e variou entre um e nove dias. A ecografia transfontanelar mostrou altera����es em sete casos. A ressonancia magnetica nuclear cranio-encefalica mostrou altera����es em todos os casos. Cinco AVC foram arteriais isquemicos, quatro hemorragicos e dois tromboses dos seios venosos. Em seis casos foram identificadas possiveis causas. Foram observadas complica����es e sequelas em quatro dos casos. Discuss��o: As convuls��es foram a manifesta����o clinica mais frequentemente encontrada.Em recém-nascidos de termo com convuls��es sem historia de asfixia intraparto o AVC perinatal dever�� ser diagn��stico de exclus��o, mesmo na ausencia de altera����es na ecografia transfontanelar.

Ecologia e hist��ria natural de popula����o Hemidactylus agrius (Squamata: Gekkonidae) em ��rea de Caatinga, com avalia����o da distribui����o das esp��cies nativas do g��nero no nordeste do Brasil

The genus Hemidactylus Oken, 1817 has cosmopolite distribution, with three species occurring in Brazil, two of them native, H. brasilianus and H. agrius, and one exotic, H. mabouia. Considering the studies about ecology of lizards conducted in the Ecological Station of the Serid��, from 2001 to 2011, this study aimed (1) to re-evaluate the occurrence of the species of Hemidactylus in this ESEC; (2) to analyze ecological and biological aspects of the H. agrius population; and (3) to investigate the current and potential distribution of the native species of the genus in northeastern Brazil, analyzing the suitability of ESEC to this taxon. For the first two objectives, a sampling area consisting of five transects of 200 x 20 m, was inspected in alternating daily shifts for three consecutive days, from August 2012 to August 2013. For the latter objective, occurrence points of H. agrius and H. brasilianus from literature and from the database of Herpetological Collections of the UFRN and the UNICAMP were consulted to build predictive maps via the Maximum Entropy algorithm (MaxEnt). In ESEC Serid��, 62 H. agrius individuals were collected (25 females, 18 males and 19 juveniles), and two neonates were obtained from a communal nest incubated in the laboratory. No record was made for the other two species of the genus. Hemidactylus agrius demonstrated to be a nocturnal species specialized in habitats with rocky outcrops; but this species is generalist regarding microhabitat use. In the population studied, females had an average body length greater than males, and showed higher frequencies of caudal autotomy. Regarding diet, H. agrius is a moderately generalist species that consumes arthropods, especially insect larvae, Isoptera and Araneae; and vertebrates, with a case of cannibalism registered in the population. With respect to seasonal differences, only the number of food items ingested differed between seasons. The diet was similar between sexes, but ontogenetic differences were recorded for the total volume and maximum length of the food items. Significant relationships were found between lizard body/head size measurements and the maximum length of prey consumed. Cases of polydactyly and tail bifurcation were recorded in the population, with frequencies of 1.6% and 3.1%, respectively. In relation xv to the occurrence points of the native species, 27 were identified, 14 for H. agrius and 13 for H. brasilianus. The first species presented restricted distribution, while the second showed a wide distribution. In both models generated, the ESEC Serid�� area showed medium to high suitability. The results of this study confirm the absence of H. brasilianus and H. mabouia this ESEC, and reveal H. agrius as a dietary opportunist and cannibal species. Further, the results confirm the distribution patterns shown by native species of Hemidactylus, and point ESEC Serid�� as an area of probable occurrence for the species of the genus, the establishing of H. brasilianus and H. mabouia are probably limited by biotic factors, a fact yet little understood

Avalia����o do ganho de peso de beb��s prematuros em rela����o ao leite materno cru e leite pasteurizado

This study aims to evaluate the weight gain of premature newborns fed with breast milk from their mothers' from those that are fed with breast milk from the milk bank. The research is the quantitative, descriptive and observational kind. It was conducted in the Neonatal Intensive Care Unit and Housing from the Maternity Hospital Escola Janu��rio Cicco (MEJC), that is a reference for high risk pregnancy and birth in Rio Grande do Norte. The premature newborns included were following these parameters: gestational age from 26 to 37 weeks, initially hospitalized at UTIN, with oral diet, by means by gavage, cup and/or suction. Studies with premature newborns with a zero diet longer than seven days or complications that interfered in the evaluation of weight gain were excluded from this study. The sample was selected for convenience and had data of all newborns hospitalized at UTIN from the May to June of 2014 time period, followed to their discharge, ended by August of 2014 and had the inclusion parameters of the study. From the period of the data collection, 60 premature newborns entered the maternity and 39 of those were the sample of research. The project was approved by the Research Ethics Committee from UFRN, under CAAE n�� 0699.0.000.294-11. The data was analyzed by means of descriptive and deduced statistics. The results indicated that the involved in the study, were born from mother with average age of 25,36 years, with less than nine years education 21 (53,8%), had the family income less than a minimum wage 24 (61,5%). Among the newborn, the female gender predominated 20 (51,3%), had cesarean delivery 25 (64,1%), had moderate prematurity 29 (74,5%), more of 1.500g 22 (556,4%). The birth weight average was 1.608,49g. The total of diets were 9.994, and an average of 256 for each newborn, in a 32,12 days of hospitalization time period. Most of the diet supplies were from the breast milk bank (50,34%), however 56,4% of the newborns had most of the diet from their mothers' milked breast milk. It was detected that 38,5% of the newborns had, in some given moment, artificial milk. The daily weight gain average of all newborns was 2,59g, but 35% of them had an average above 10g per day. From the newborn's group (n=25) that had medium weight gain, only 9 of them (36,0%) received mainly their own mothers' milked breast milk. It's been conclusive that most of the premature newborns gained weight predominantly from diets from the breast milk of the Milk Bank, showing the need of a bigger incentive to exclusive breast feeding.

Avalia����o da suplementa����o de vitamina E sobre a concentra����o de alfa-tocoferol no leite materno em mulheres com partos prematuros

The term vitamin E refers to a group of eight molecular compounds which differ in structure and bioavailability, and the RRR-alpha-tocopherol more biologically active form. The composition of vitamin E in breast milk undergoes variations during lactation, colostrum and milk richer in this micronutrient compared to transitional and mature milk. Newborns, especially premature infants are more susceptible to vitamin E deficiency and to prevent the damage caused by this deficiency has been proposed supplementation of neonates with this micronutrient, however, there is no consensus to carry out this intervention. Thus, maternal supplementation with RRRalpha-tocopherol in the postpartum period can be a good alternative to try to raise the alpha-tocopherol levels in breast milk and therefore provide the premature newborn adequate amounts of vitamin E. This study to evaluate the effect of supplementation with 400 UI acetate RRR-alpha-tocopherol in women with premature births, on the concentration of alpha-tocopherol in breast milk colostrum, transitional and mature. The study included 89 healthy adult women were enrolled in the control group (n = 51) and supplemented group (n = 38). Blood samples were collected and milk colostrum soon after birth (0h milk) twenty-four hours, new rate of colostrum milk was collected (24h milk). The transitional and mature milk were collected in seven days (7d milk) and thirty days (30d milk) after delivery, respectively. Supplementation in the supplemented group was held after the collection of blood and 0h milk. The alpha-tocopherol analyzes were performed by high-performance liquid chromatography. Serum levels of alpha-tocopherol less than 516 ��g/dL were considered indicative of nutritional deficiency. The average concentration of alphatocopherol in the serum of the control group mothers was 1159.8 �� 292.4 ��g/dL and the supplemented group was 1128.3 �� 407.2 ��g/dL (p = 0.281). All women had nutritional status in vitamin E suitable. In both groups, it was observed that the concentration of vitamin E in colostrum milk was higher compared to transitional and mature milk. In the supplemented group, the concentration of alpha-tocopherol in the milk increased 60 % after supplementation, from 1339.3 �� 414.2 ��g/dL (0h milk) to 2234.7 �� 997.3 ��g/dL (24h milk). While the control group values in colostrum 0h and colostrum 24h were similar (p = 0.681). In the control group the follow-on milk alphatocopherol value was 875.3 �� 292.4 ��g/dL and in the group supplemented 1352.8 �� 542.3 ��g/dL, an increase of 35% in the supplemented group compared to control (p <0.001). In mature milk alpha-tocopherol concentrations between the control group (426.6 �� 187.5 ��g/dL) and supplemented (416.4 �� 214.2 ��g/dL) were similar (p = 0.853). Only 24h milk supplemented group answered the nutritional requirement of alpha-tocopherol (4 mg/day) of the newborn. These results show that the transport of this micronutrient for milk occurs in a controlled and limited way. Thus, the native vitamin E supplementation increases the concentration of alpha-tocopherol in colostrum and milk and transition does not influence the concentration in mature milk. Only the increase in colostrum milk was sufficient to meet the nutritional requirement of premature newborns.