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Abstract Objective Describe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients' medical records of those not submitted to CPR. Methods Observational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children's medical records in no-CPR group were researched by hand. Results 241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p= 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94-13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group. Conclusion Most deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.
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This study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP.
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COVID-19 , Doenças Transmissíveis , Adolescente , COVID-19/diagnóstico , Criança , Humanos , Rhinovirus , SARS-CoV-2RESUMO
OBJECTIVE: Describe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients' medical records of those not submitted to CPR. METHODS: Observational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children's medical records in no-CPR group were researched by hand. RESULTS: 241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p = 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94-13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group. CONCLUSION: Most deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.
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Reanimação Cardiopulmonar , Parada Cardíaca , Bradicardia , Criança , Estudos Transversais , Parada Cardíaca/epidemiologia , Hospitais Pediátricos , HumanosRESUMO
ABSTRACT This study aims to assess COVID-19 and other respiratory viruses in pediatric patients. Between April 17 and September 30, 2020, we collected 1,566 respiratory samples from 1,044 symptomatic patients who were younger than 18 years old to assess SARS-CoV-2 infection. Of these, 919 were analyzed for other respiratory pathogens (ORP). Patients with laboratory-confirmed COVID-19 or ORP were included. We evaluated 76 pediatric COVID-19 infections and 157 other respiratory virus infections. Rhinovirus occurred in 132/157 (84%). COVID-19 patients who were significantly older, had more fevers, headaches and pneumonia than those with ORP. The median white blood cell count was lower in patients with SARS-CoV-2 than in those with ORP (6,470 versus 8,170; p=0.02). COVID-19 patients had significantly worse symptoms than those with ORP.
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Introdução: o processo de senescência do indivíduo ocorre de forma lenta e contínua e pode gerar inúmeras alterações, dentre elas o envelhecimento cutâneo, derivado do declínio das atividades celulares. Inúmeros recursos têm sido criados ao longo dos anos com a finalidade de frear e ou reverter os aspectos inestéticos da pele, ocasionados por esse processo. Um novo recurso terapêutico vem sendo usado com o objetivo de promover o rejuvenescimento através da diminuição de rugas e linhas de expressão, trata-se do Jato de plasma. Objetivo: avaliar o padrão de variação térmica do tecido tratado com jato de plasma, através da termografia infravermelha. Metodologia: trata-se de uma série de casos clínicos que envolveu 5 pacientes mulheres, com idade acima de 40 anos que apresentavam rugas faciais. As pacientes foram avaliadas e anestesiadas previamente. Em seguida, foi realizada a terapia com o jato de plasma, na região supraorbital. As pacientes foram avaliadas termograficamente antes e depois da anestesia e pósterapia. Resultado: constatou-se através da análise termográfica, uma significativa variação no coeficiente de temperatura da pele onde foi aplicado o anestésico e em seguida o jato de plasma (ΔT > 0,4 °C), em todas as pacientes. Conclusão: o presente estudo comprovou através da utilização da termografia, que o jato de plasma foi capaz de gerar um aumento da temperatura local. Os autores sugerem que tal variação térmica pode ser resultante de um processo de vasodilatação na região tratada.
Introduction: individual's senescence process takes place slowly and continuously beyond generates several changes including skin aging, since the decline in cellular activities. Countless resources have been created over the years, with the goal of stopping and / or reversing the unsightly aspects of the skin caused by this process. Thus, plasma jet, a new therapeutic resource has been used in order to promote rejuvenation through the reduction of wrinkles and expression lines. Objective: To evaluate the pattern of thermal variation of the tissue treated with a plasma jet, using infrared thermography. Methodology: this was a series of clinical cases involving 5 female patients over the age of 40 who had facial wrinkles. Patients were previously evaluated and anesthetized. Then, plasma jet therapy was performed in the supra-orbital region. Patients were evaluated for thermal imaging before and after anesthesia and post-therapy. Result: it was found through thermographic analysis, a significant variation in the temperature coefficient of the skin of all patients where the anesthetic and plasma jet were applied (ΔT > 0.4 °C). Conclusion: the present study proved through the use of thermography that the plasma jet was able to generate an increase in local temperature. The authors suggest that such thermal variation may be the result of a process of vasodilation in the treated region.
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Humanos , Feminino , Adulto , Rejuvenescimento , Termografia , Relatos de Casos , Epidemiologia DescritivaRESUMO
BACKGROUND: Diagnosing pneumonia and other lung conditions can be challenging in patients with severe intellectual or physical disabilities or severe chest deformities. Physical examination is sometimes difficult to perform and the frequently requested chest x-ray (CXR) study is often of little value in the diagnostic approach to this population. Point-of-care lung ultrasound (US) is an emerging diagnostic tool with particularly high level of accuracy in detecting pneumonia, pleural effusion, and pneumothorax. CASE REPORT: This case series describes four cases demonstrating the usefulness of point-of-care US in a pediatric emergency department for lung assessment in patients for differentiation and diagnosis of acute causes of acute respiratory symptoms, in whom clinical features or CXR failed to confirm or exclude pulmonary complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with chest deformities, pulmonary complications can be disproportionately frequent. Lung US should be recognized as an important adjunctive tool in this subset of patients to detect pneumonia, pleural effusions, and pneumothorax. When used proactively, it can reduce unnecessary radiation exposure, provide more certainty in determining the diagnosis, and, most importantly, inform correct and timely management.
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Pulmão , Sistemas Automatizados de Assistência Junto ao Leito , Escoliose , Criança , Serviço Hospitalar de Emergência , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , UltrassonografiaRESUMO
INTRODUCTION: Although the exact cryolipolysis mechanisms on adipose tissue remain unknown, the current literature indicates that it may occur a crystallization followed by an ischemic reaction which generates an inflammatory process. OBJECTIVE: To evaluate thermographically, the tissue's circulatory pattern of a patient submitted to the cryolipolysis technique and the beginning of the inflammatory process, through variations of temperature gradients and the evaluation of the pains degree of the patient in these same moments. METHODS: A descriptive study, of an interventional case report, performed in an 18-year-old patient who had clearly visible fat in the lower abdomen area, with a skin fold greater than 2 centimeters and body mass index ≤ 30 kg/m2 . RESULTS: Comparing the maximum temperatures showed on the last thermography with the pre-application image, an increase of 0.4°C was observed, which is suggestive of abnormality. Regarding the minimum temperatures verified, there was a significative decrease in the temperature with the procedure, which was observed on the last 5 minutes (ΔT = 9.8°C). However, in 48 hour, the minimum temperature began to recover (ΔT = 0.3°C). CONCLUSION: The observed data indicate that there was a significant decrease in the temperature during the cooling phase, whereas in the recovery phase, the inverse was found.
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Criocirurgia , Gordura Subcutânea Abdominal/cirurgia , Termografia , Feminino , Humanos , Inflamação/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Temperatura Cutânea , Gordura Subcutânea Abdominal/fisiopatologia , Adulto JovemRESUMO
Concerns about plastic pollution and global public policies have encouraged consumers to acquire environmentally friendly products. Thus, products made of biodegradable plastics have been preferred by the public, despite their costs. However, greenwashing practices, promising more environmental benefits than the products actually offer, has become frequent. Nevertheless, no studies assessing the occurrence of greenwashing in commercial plastic products sold in large world economies have been performed. The present study aimed to experimentally evaluate alterations in structure and chemical composition of selected plastic products marketed in Canada, USA and Brazil. The aging experiments carried out by seawater immersion for 180 days showed no evidence of degradation in 4 out of the 6 studied samples, despite product claims of biodegradability or 100% degradability status. This finding denotes unequivocal greenwashing practices, even including bags made of polyethylene, an ordinary non-biodegradable polymer. Thus, the inadequate adoption of green marketing is deceiving to consumers and may lead to improper disposal of these materials. These practices are highly counterproductive in view of the global public policies recently adopted to control plastic pollution. Therefore, considering the technologies currently available for identification of polymers, a strict control should be exercised over products that claim biodegradable status.
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Plásticos Biodegradáveis , Água do Mar/química , Poluentes Químicos da Água/metabolismo , Brasil , Canadá , Estados UnidosRESUMO
Introduction: Blood donation should be voluntary, anonymous and altruistic, and the donor should not, directly or indirectly, receive any remuneration or benefit by virtue of donating blood. Like any other therapeutic method, transfusion procedures are not risk free and can expose the patient to a several complications. Serological screening is of great importance to ensure transfusion safety. The present study aimed to estimate the prevalence of serological ineligibility among blood donors from a Hemotherapy Center in Caxias do Sul (RS). Method: An exploratory, descriptive and quantitative study was conducted on data from July 2010 to December 2015 collected at a Hemotherapy Center in Caxias do Sul (RS). Results: During the study period, 14,267 blood donors attended the Hemotherapy Center, of which 9,332 (65.40%) were males and 4,935 (34.60%) were female. Considering only the suitable donors, 12,702 blood donations were performed, 144 (1.13%) presented positive serological tests. The most prevalent positive serology was for hepatitis B (anti-HBc) with 98 cases (0.77%), followed by syphilis with 19 cases (0.15%); Chagas disease, with 10 (0.08%); hepatitis C, with nine (0.07%); and HIV and HTLV, with four (0.03%) reactive samples each. Conclusion: The results presented are important for health surveillance and make it possible to take measures to ensure safe blood stocks (AU)
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Humanos , Doadores de Sangue/estatística & dados numéricos , Controle de Doenças Transmissíveis , Doenças Transmissíveis/sangue , Doença de Chagas/sangue , Anticorpos Antideltaretrovirus/sangue , Anticorpos Anti-Hepatite , Soropositividade para HIV/sangue , Prevalência , Estudos Retrospectivos , Sorodiagnóstico da SífilisRESUMO
BACKGROUND: Several studies have correlated protein restriction associated with other nutritional deficiencies with the development of cardiovascular and renal diseases. The driving hypothesis for this study was that Ang II signaling pathways in the heart and kidney are affected by chronic protein, mineral and vitamin restriction. METHODOLOGY/PRINCIPAL FINDINGS: Wistar rats aged 90 days were fed from weaning with either a control or a deficient diet that mimics those used in impoverished regions worldwide. Such restriction simultaneously increased ouabain-insensitive Na+-ATPase and decreased (Na++K+)ATPase activity in the same proportion in cardiomyocytes and proximal tubule cells. Type 1 angiotensin II receptor (AT1R) was downregulated by that restriction in both organs, whereas AT2R decreased only in the kidney. The PKC/PKA ratio increased in both tissues and returned to normal values in rats receiving Losartan daily from weaning. Inhibition of the MAPK pathway restored Na+-ATPase activity in both organs. The undernourished rats presented expanded plasma volume, increased heart rate, cardiac hypertrophy, and elevated systolic pressure, which also returned to control levels with Losartan. Such restriction led to electrical cardiac remodeling represented by prolonged ventricular repolarization parameters, induced triggered activity, early after-depolarization and delayed after-depolarization, which were also prevented by Losartan. CONCLUSION/SIGNIFICANCE: The mechanisms responsible for these alterations are underpinned by an imbalance in the PKC- and PKA-mediated pathways, with participation of angiotensin receptors and by activation of the MAPK/ERK1/2 pathway. These cellular and molecular alterations culminate in cardiac electric remodeling and in the onset of hypertension in adulthood.
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Sistema de Sinalização das MAP Quinases , Desnutrição/metabolismo , Receptor Tipo 2 de Angiotensina/metabolismo , Adenosina Trifosfatases/metabolismo , Angiotensina II , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Animais , Pressão Sanguínea , Cardiomegalia/patologia , Proteínas de Transporte de Cátions/metabolismo , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Coração/fisiopatologia , Frequência Cardíaca , Túbulos Renais Proximais/metabolismo , Losartan/farmacologia , Masculino , Miócitos Cardíacos/metabolismo , Volume Plasmático , Proteína Quinase C/metabolismo , Ratos , Ratos Wistar , ATPase Trocadora de Sódio-Potássio/metabolismoRESUMO
Estudo de natureza histórico social cujo objetivo é analisar as memórias e lembranças das enfermeiras do Hospital dos Servidores do Estado desde sua inauguração em 1947 até 2009. É um estudo em que as lembranças das Enfermeiras adquirem força à medida que se refletem no seu convívio na instituição. Desdobramos o conceito entre lembranças e memória na construção de uma realidade social. A historia oral foi utilizada como método e fonte primária, uma vez que nos proporcionou abordar o contexto estudado e, como fontes secundárias, elegemos livros sobre o contexto histórico em que foi criado o Hospital dos Servidores do Estado. Concluímos que o caminho percorrido pelas Enfermeiras implicou em conhecermos ora o passado (das mais antigas), ora o presente (das mais jovens), o que nos permite conhecer as experiências mediante seus próprios depoimentos, contribuindo assim para a história viva e verdadeira da enfermagem
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História do Século XX , História da Enfermagem , Enfermeiras e Enfermeiros , HospitaisRESUMO
INTRODUCTION: In this in-vitro study, we aimed to compare the residual monomers in composites beneath brackets bonded to enamel, using a light-emitting diode (LED) or a halogen unit, and to compare the residual monomers in the central to the peripheral areas of the composite. METHODS: Twenty bovine teeth preserved in 0.1% thymol were used in this study. Ten teeth were used to standardize the thickness of the composite film, since different thicknesses would cause different absorbance of light. Brackets were bonded to 10 bovine incisors, with the halogen light (n = 5) and the LED (n = 5). The brackets were debonded, and the remaining composite on the enamel surface was sectioned in 2 regions: peripheral (0.8 mm) and central, resulting in 2 subgroups per group: central halogen (n = 5), peripheral halogen (n = 5), central LED (n = 5), and peripheral LED (n = 5). The spectrometric analysis in the infrared region was used to measure the free monomers with the attenuated total reflectance method. RESULTS: Normal distribution was tested by using the Kolmogorov-Smirnov test. Data were compared by 2-way analysis of variance (ANOVA) at P <0.05. The LED group showed fewer residual monomers than did the halogen group (P = 0.014). No differences were found among the regions (P = 0.354), and there were no interactions between light type and region (P = 0.368). CONCLUSIONS: LED leaves less residual monomer than does the halogen light, even with half of the irradiation time; there were no differences between the central and peripheral regions, and no interaction between light type and region.
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Resinas Compostas/efeitos da radiação , Lâmpadas de Polimerização Dentária/classificação , Cimentos de Resina/efeitos da radiação , Condicionamento Ácido do Dente , Animais , Bis-Fenol A-Glicidil Metacrilato/química , Bis-Fenol A-Glicidil Metacrilato/efeitos da radiação , Bovinos , Resinas Compostas/química , Descolagem Dentária/instrumentação , Esmalte Dentário/ultraestrutura , Teste de Materiais , Braquetes Ortodônticos , Ácidos Fosfóricos/química , Polietilenoglicóis/química , Polietilenoglicóis/efeitos da radiação , Ácidos Polimetacrílicos/química , Ácidos Polimetacrílicos/efeitos da radiação , Cimentos de Resina/química , Espectrofotometria Infravermelho , Propriedades de Superfície , Temperatura , Fatores de TempoRESUMO
The article analyzes public policies for promoting equal employment opportunities in terms of race and gender in Brazil, with a double focus. First, seeking to reclaim the historical perspective in the policies' implementation, considering the difficulties they have encountered; second, through reflections on the policies' limits and potentialities. Since such policies have only been implemented recently in Brazil, the article focuses especially on how Federal government planning for 2004-2007 and 2008-2011 has dealt with gender and race inequalities.
Dans cet article, on examine les politiques publiques promouvant l'égalité des chances de genre et de race au Brésil, concernant le domaine de l'emploi, à partir d'une double optique. D'un côté, en cherchant à reconstituer la perspective historique de leur processus d'implantation, compte tenu des difficultés qu'elles ont rencontrées pour y être reconnues, de l' autre, au moyen d' une réflexion sur leurs potentiels et limites. Tout en considérant la courte période de mise en place de ces politiques au Brésil, une attention particulière est apportée à la la façon dont la question des inégalités de genre et de race est traitée par le Plan au gouvernement fédéral dans ces périodes de 2004-2007 et 2008-2011.
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Rio Grande do Sul (RS), in South Brazil, with about 10 million inhabitants, is known for its agricultural activities and consequent increased human exposure to toxic agents. Patients with de novo acute myeloid leukemia (AML) were included based on information retrieved from all referral hospitals in RS between 1996 and 2000. A total of 532 patients were registered. Median age at diagnosis was 42 years. The estimated annual incidence was 1.11 cases/100,000 inhabitants/year. There was an estimated incidence of 0.5-1 case per 100,000 inhabitants up to the age of 45 years, and of 3.5 cases per 100,000 inhabitants aged 70 years and older, with no geographical clusters. The mean 5-year survival rate was 17% for all cases. There was an increased number of M3 cases, as already described for individuals of Latin-American and the mortality rate was similar to that described in the literature.
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Leucemia Mieloide Aguda/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Leucemia Mieloide Aguda/mortalidade , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
O presente trabalho verificou a prevalência da queilite angular nos pacientes com fissura lábio-palatal do Hospital de Reabilitação de Anomalias Craniofaciais - USP - Bauru, de ambos os gêneros divididos em dois grupos: um constiruído por 100 adultos portadores de próteses dentárias; e o outro por 119 crianças na faixa etária de 7 a 12 anos. Foi realizado o exame clínico intrabucal e extrabucal seguindo-se uma ficha pardronizada, de forma sistemática e ordenada. A presente investigação foi baseada exclusivamente nas características clínicas das alterações. No grupo de adultos a queilite angular ocorreu em 12 indivíduos, sendo 4 lesões bilaterais e 8 lesões unilaterais, a qual apenas 1 era no gênero feminino. Concluiu-se que a prevalência de queilite angular em pacientes com fissura lábio-palatal foi de 12% em adultos portadores de prótese dentárias e de 4,2% em crianças de 7 a 12 anos...
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Humanos , Masculino , Feminino , Anormalidades da Boca/complicações , Fenda Labial , Fissura Palatina , Prótese Dentária , QueiliteRESUMO
Este estudo tem por objetivo analisar a prevalência de anomalias dentárias em pacientes portadores da síndrome de Apert e em pacientes portadores da síndrome de Crouzon. Foram analisadas radiografias ortopantomográficas de pacientes matriculados no Hospital de Reabilitação de Anomalias Cranofaciais, USP, Bauru/SP (HRAC-USP), vinte pacientes com a síndrome de Apert e nove pacientes com a síndrome de Crouzon. As radiografias analisadas foram obtidas do arquivo de radiologia odontológica deste Hospital. Utilizando-se os prontuários dos pacientes portadores das síndromes, foi possível verificar se os pacientes apresentavam algum tipo de fissura lábio-palatal. A anomalia dentária encontrada com maior freqüencia foi a alteração de erupção (dentes retidos/impactados), provavelmente resultante da grande hipoplasia maxilar que essas síndromes apresentam...
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Humanos , Acrocefalossindactilia/complicações , Acrocefalossindactilia , Anormalidades Dentárias , Disostose Craniofacial/complicações , Disostose Craniofacial , Erupção Ectópica de Dente/diagnóstico , Radiografia Panorâmica/métodosAssuntos
Humanos , Masculino , Feminino , Ensino , Educação , Materiais de Ensino , Tecnologia , Métodos , Acesso à InformaçãoRESUMO
Mostra como o trabalho de assistencialismo social, desenvolvido junto às chamadas necessitadas do Estado, grupos de mulheres associadas à iniciativa privada e à Igreja e, até mesmo de forma independente, passaram a ocupar espaços e posições importantes no meio em que viviam. Esta atividade possibilitou-lhes um contato mais aberto com os homens na comunidade, exigiu-lhes decisões fora do âmbito doméstico, funcionou como um novo tipo de sociabilidade, colocou-as frente a frente com uma realidade desconhecida, qual seja, a pobreza, a mendicância e o abandono das camadas populares da cidade de Salvador.(AU)
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Seguridade Social/história , Apoio Social , Mulheres , /história , Brasil , Saúde Pública/históriaRESUMO
Mostra como o trabalho de assistencialismo social, desenvolvido junto às chamadas necessitadas do Estado, grupos de mulheres associadas à iniciativa privada e à Igreja e, até mesmo de forma independente, passaram a ocupar espaços e posições importantes no meio em que viviam. Esta atividade possibilitou-lhes um contato mais aberto com os homens na comunidade, exigiu-lhes decisões fora do âmbito doméstico, funcionou como um novo tipo de sociabilidade, colocou-as frente a frente com uma realidade desconhecida, qual seja, a pobreza, a mendicância e o abandono das camadas populares da cidade de Salvador.
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Instituições de Caridade , Seguridade Social/história , Mulheres , Brasil , Saúde Pública/históriaRESUMO
Os autores relatam um caso de púrpura trombocitopênica idiopática em uma gestante de 18 semanas refratárias à corticoterapia ocorrido no Serviço de Obstetrícia do Hospital Geral da Universidade de Caxias do Sul. A paciente foi submetida à esplenectomia com remissäo completa da doença, tendo o concepto nascido a termo e por via vaginal. Foi realizada também uma revisäo bibliográfica da doença, abordando a sua fisiopatologia, diagnóstico, tratamento e riscos perinatais.