RESUMO
BACKGROUND: Oral Pathology (OP) and Oral Medicine (OM) are specialties in dentistry whose main objective is the diagnosis and treatment of oral and maxillofacial diseases, and aspects related to the academic training of professionals and fields of practice are distinct and heterogeneous around the world. This study aimed to evaluate professional training and areas of activity in OP and OM in Latin American countries. MATERIAL AND METHODS: A questionnaire was sent to 11 countries, with a professional in each country responsible for answering it. The questionnaire had 21 questions related to the process of professional training, areas of practice, the existence of scientific events in each country, and also collected demographic and population information. RESULTS: OP and OM are practiced in all the countries studied, but the specialty is not recognized in all of them. Brazil was the first to recognize both as a specialty. Postgraduate programs designed to train specialists are available in various countries. Two countries offer residency programs, 6 countries provide specialization courses, 6 offer master's programs, and 3 have doctoral programs. Brazil boasts the highest number of undergraduate courses (n=412), while Uruguay has the lowest (n=2). Professional societies representing the specialty exist in ten countries. Brazil has the highest number of OP and OM specialists (n=422 and 1,072), while Paraguay has the smallest number (n=1 and 3). CONCLUSIONS: Although both specialties are widely practiced around the globe, professional training, the number of dentists trained and the fields of professional practice are very different between the countries studied.
Assuntos
Medicina Bucal , Patologia Bucal , América Latina , Medicina Bucal/educação , Patologia Bucal/educação , Humanos , AutorrelatoRESUMO
The southern cattle tick Rhipicephalus microplus is a major problem for the cattle industry in tropical and subtropical areas worldwide. Chemical products are commonly applied to control it; however, their indiscriminate use has resulted in the appearance of resistant lineages. In the last decades, plants have been used as an alternative to conventional acaricidal drugs, as several plant compounds repel activity, decrease the reproductive potential and reduce the survival rate of ticks. For this reason, the in vitro efficacy of hexanic and hydroalcoholic extracts of Randia aculeata, Moringa oleifera and Carica papaya were evaluated against the larvae and engorged females of R. microplus. Larval packet tests and adult immersion tests were performed with seven concentrations of each of the extracts. The extracts obtained with hydroethanolic solution (polar solvent) exhibited a higher acaricidal activity than extracts prepared with n-hexane (non-polar solvent). Hydroethanolic extracts of R. aculeata seed and shell showed the highest larvicidal activity against R. microplus (100 and 91% mortality, respectively) at a concentration of 100 mg/mL. Randia aculeata (seed and shell), M. oleifera and C. papaya treatments at the same concentration (100 mg/mL) also resulted in adult mortality of 85, 75, 66 and 55%, respectively. The adult immersion test showed that hydroethanolic extracts derived from R. aculeata seed significantly reduced the index of egg laying and increased the percentage inhibition of oviposition of female ticks at a concentration of 100 mg/mL. These results indicate that the tested extracts exhibit acaricidal activity and could be considered as potential agents for the development of alternative natural acaricides against R. microplus.
Assuntos
Acaricidas , Ixodidae , Plantas Medicinais , Rhipicephalus , Animais , Larva , Extratos Vegetais/farmacologiaRESUMO
Herbaspirillum seropedicae is an associative, endophytic non-nodulating diazotrophic bacterium that colonises several grasses. An ORF encoding a LysR-type transcriptional regulator, very similar to NodD proteins of rhizobia, was identified in its genome. This nodD-like gene, named fdeR, is divergently transcribed from an operon encoding enzymes involved in flavonoid degradation (fde operon). Apigenin, chrysin, luteolin and naringenin strongly induce transcription of the fde operon, but not that of the fdeR, in an FdeR-dependent manner. The intergenic region between fdeR and fdeA contains several generic LysR consensus sequences (T-N11 -A) and we propose a binding site for FdeR, which is conserved in other bacteria. DNase I foot-printing revealed that the interaction with the FdeR binding site is modified by the four flavonoids that stimulate transcription of the fde operon. Moreover, FdeR binds naringenin and chrysin as shown by isothermal titration calorimetry. Interestingly, FdeR also binds in vitro to the nod-box from the nodABC operon of Rhizobium sp. NGR234 and is able to activate its transcription in vivo. These results show that FdeR exhibits two features of rhizobial NodD proteins: nod-box recognition and flavonoid-dependent transcription activation, but its role in H. seropedicae and related organisms seems to have evolved to control flavonoid metabolism.
Assuntos
Proteínas de Bactérias/metabolismo , Flavanonas/metabolismo , Regulação Bacteriana da Expressão Gênica , Herbaspirillum/genética , Sequência de Bases , Biodegradação Ambiental , Flavonoides/metabolismo , Herbaspirillum/metabolismo , Óperon , Regiões Promotoras Genéticas , Rhizobium/genética , Ativação TranscricionalRESUMO
Objetivou-se caracterizar para a espécie canina o desenvolvimento histológico uterino do nascimento aos seis meses de idade. Foram analisados úteros (n=32) de animais com idades entre um e 180 dias pós-nascimento (DPN), distribuídos em oito grupos: G1-1 DPN (1 Yorkshire Terrier, 1 Poodle, 2 Sem Raça Definida (SRD)/peso médio (Pm)=190g), G2-15 DPN (2 Yorkshire Terrier e 2 SRD/Pm=354g), G3-30 DPN (1 Rottweiler, 1 Poodle, 2 SRD/Pm=985g), G4-45 DPN (1 Poodle, 3 SRD/Pm=1,1kg), G5-60 DPN (1 Yorkshire Terrier, 1 Poodle e 2 SRD/Pm=1,4kg), G6-90 DPN (4 SRD/Pm=2,8kg), G7-120 DPN (1 Poodle e 3 SRD/Pm=6,6kg) e G8-180 DPN (1 Rottweiler, 1 Poodle e 2 SRD/Pm=11kg). A análise histológica constituiu de mensurações das espessuras (µm) da parede uterina, miométrio, endométrio, assim como diâmetro (µm) e número de glândulas endometriais. A análise estatística demonstrou estabilidade e homogeneidade nas estruturas avaliadas com coeficientes de variação baixos (<10%). Observou-se: útero com um DPN: epitélio com células cúbicas simples, miométrio rudimentar, presença de perimétrio e ausência de glândulas endometriais; aos 15 DPN: desenvolvimento de estrutura primordial de formação das glândulas endometriais; dos 30 aos 45 DPN: endométrio e glândulas endometriais simples; aos 60 DPN: glândulas endometriais em lâmina própria com ramificações e discreto pregueamento endometrial; de 90 a 180 DPN: todas as estruturas uterinas apresentaram histoarquitetura de um animal maduro. Todas as variáveis analisadas apresentaram correlação positiva com a idade pós-nascimento (R2≥72,2%). Conclui-se que o útero da cadela desenvolve-se continuamente do nascimento à 180 dias de vida e que apresenta-se desprovido de glândulas endometriais ao nascimento. As primeiras glândulas endometriais são observadas aos 15 dias de vida e apresenta conformação histológica de um animal adulto após 60 dias do nascimento.
This study aimed to characterize canine species' uterine histological development from birth to six months of age. Uteri (n = 32) of animals aged between one and 180 days postnatal (PND), distributed into eight groups were analyzed: G1-1 PND (1 Yorkshire Terrier, Poodle 1, 2 Mixed Breed (MB)/Medium weight (Mw) = 190g), G2-15 PND (2 Yorkshire Terrier and 2 MB/Mw = 354g), G3-30 PND (1 Rottweiler, 1 Poodle, 2 MB/Mw = 985g), G4-45 PND (1 Poodle, 3 MB/Mw = 1.1kg), G5-60 PND (1 Yorkshire Terrier, Poodle 1 and 2 MB/Mw = 1.4kg), G6-90 PND (4 MB/Mw = 2.8kg), G7-120 PND (1 Poodle and 3 MB/Mw = 6.6kg) and G8-180 PND (1 Rottweiler, Poodle 1 and 2 MB/Mw = 11kg). Histological examination consisted of thickness measurement (µm) of the uterine wall, myometrium, endometrium, as well as diameter (µm) and number of endometrial glands. Statistical analysis showed stability and uniformity in the evaluated structures with low coefficients of variation (<10%). We observed: uterus with one PND: simple cubic epithelium cells, rudimentary myometrium, perimetrium presence and absence of endometrial glands; at 15 PND: development of primordial structure formation of endometrial glands; from 30 to 45 PND: simple endometrium and endometrial glands; PND 60: endometrial glands in the lamina propria with branches and discreet endometrial pleating; 90-180 PND: uterine all structures presented histoarchitecture of a mature animal. All variables were positively correlated with postnatal age (R2 ≥ 72.2%). It is concluded that the uterus of the bitch continuously evolves from birth to 180 days old and is presented devoid of endometrial glands at birth. The first endometrial glands are observed at 15 days of life and present histological conformation to an adult 60 days after birth.
Assuntos
Animais , Feminino , Recém-Nascido , Cães , Útero/anatomia & histologia , Útero/crescimento & desenvolvimentoRESUMO
Objetivou-se caracterizar para a espécie canina o desenvolvimento histológico uterino do nascimento aos seis meses de idade. Foram analisados úteros (n=32) de animais com idades entre um e 180 dias pós-nascimento (DPN), distribuídos em oito grupos: G1-1 DPN (1 Yorkshire Terrier, 1 Poodle, 2 Sem Raça Definida (SRD)/peso médio (Pm)=190g), G2-15 DPN (2 Yorkshire Terrier e 2 SRD/Pm=354g), G3-30 DPN (1 Rottweiler, 1 Poodle, 2 SRD/Pm=985g), G4-45 DPN (1 Poodle, 3 SRD/Pm=1,1kg), G5-60 DPN (1 Yorkshire Terrier, 1 Poodle e 2 SRD/Pm=1,4kg), G6-90 DPN (4 SRD/Pm=2,8kg), G7-120 DPN (1 Poodle e 3 SRD/Pm=6,6kg) e G8-180 DPN (1 Rottweiler, 1 Poodle e 2 SRD/Pm=11kg). A análise histológica constituiu de mensurações das espessuras (µm) da parede uterina, miométrio, endométrio, assim como diâmetro (µm) e número de glândulas endometriais. A análise estatística demonstrou estabilidade e homogeneidade nas estruturas avaliadas com coeficientes de variação baixos (<10%). Observou-se: útero com um DPN: epitélio com células cúbicas simples, miométrio rudimentar, presença de perimétrio e ausência de glândulas endometriais, aos 15 DPN: desenvolvimento de estrutura primordial de formação das glândulas endometriais, dos 30 aos 45 DPN: endométrio e glândulas endometriais simples, aos 60 DPN: glândulas endometriais em lâmina própria com ramificações e discreto pregueamento endometrial, de 90 a 180 DPN: todas as estruturas uterinas apresentaram histoarquitetura de um animal maduro. Todas as variáveis analisadas apresentaram correlação positiva com a idade pós-nascimento (R272,2%). Conclui-se que o útero da cadela desenvolve-se continuamente do nascimento à 180 dias de vida e que apresenta-se desprovido de glândulas endometriais ao nascimento. As primeiras glândulas endometriais são observadas aos 15 dias de vida e apresenta conformação histológica de um animal adulto após 60 dias do nascimento.(AU)
This study aimed to characterize canine species' uterine histological development from birth to six months of age. Uteri (n = 32) of animals aged between one and 180 days postnatal (PND), distributed into eight groups were analyzed: G1-1 PND (1 Yorkshire Terrier, Poodle 1, 2 Mixed Breed (MB)/Medium weight (Mw) = 190g), G2-15 PND (2 Yorkshire Terrier and 2 MB/Mw = 354g), G3-30 PND (1 Rottweiler, 1 Poodle, 2 MB/Mw = 985g), G4-45 PND (1 Poodle, 3 MB/Mw = 1.1kg), G5-60 PND (1 Yorkshire Terrier, Poodle 1 and 2 MB/Mw = 1.4kg), G6-90 PND (4 MB/Mw = 2.8kg), G7-120 PND (1 Poodle and 3 MB/Mw = 6.6kg) and G8-180 PND (1 Rottweiler, Poodle 1 and 2 MB/Mw = 11kg). Histological examination consisted of thickness measurement (µm) of the uterine wall, myometrium, endometrium, as well as diameter (µm) and number of endometrial glands. Statistical analysis showed stability and uniformity in the evaluated structures with low coefficients of variation (<10%). We observed: uterus with one PND: simple cubic epithelium cells, rudimentary myometrium, perimetrium presence and absence of endometrial glands, at 15 PND: development of primordial structure formation of endometrial glands, from 30 to 45 PND: simple endometrium and endometrial glands, PND 60: endometrial glands in the lamina propria with branches and discreet endometrial pleating, 90-180 PND: uterine all structures presented histoarchitecture of a mature animal. All variables were positively correlated with postnatal age (R2 72.2%). It is concluded that the uterus of the bitch continuously evolves from birth to 180 days old and is presented devoid of endometrial glands at birth. The first endometrial glands are observed at 15 days of life and present histological conformation to an adult 60 days after birth.(AU)
Assuntos
Animais , Feminino , Recém-Nascido , Cães , Útero/anatomia & histologia , Útero/crescimento & desenvolvimentoRESUMO
Electroejaculation is a technique that can be used to collect semen from canines, but its use with this group of animals is restricted by low success rate and low semen quality. Here, we evaluated whether pharmacological and sexual sensory stimuli, which may affect ejaculation, can increase electroejaculation efficiency and improve ejaculate quality. We worked with 20 dogs of mixed breed weighing between 5.3 and 22.2 kg, divided into two groups. Both groups were exposed to a spayed female for 10 min, but in the second group, the same spayed female had her vagina impregnated with methyl 4-hydroxybenzoate synthetic pheromone for 10 min and after receiving dinoprost tromethamine IM, 0.1 mg/kg. After stimulation, all dogs were chemically restrained with ketamine, 8 mg/kg, IM; and xylazine, 1 mg/kg, IM, and subjected to electroejaculation protocol. We obtained 100% of antegrade ejaculate in treatments when the spayed female had her vagina impregnated with pheromone and 80% when she did not. Sperm motility was significantly different (p < 0.05) between controls and the test group (10.1 ± 4.5 and 43.0 ± 8.3, respectively). We concluded that the adopted electroejaculation protocol was efficient and that the PGF2α associated with sexual sensory stimulation can improve semen quality in dogs undergoing the procedure.
Assuntos
Dinoprosta/análogos & derivados , Cães/fisiologia , Ejaculação/fisiologia , Estimulação Elétrica/métodos , Parabenos/farmacologia , Espermatozoides/fisiologia , Animais , Dinoprosta/administração & dosagem , Dinoprosta/farmacologia , Quimioterapia Combinada , Masculino , Parabenos/administração & dosagem , Comportamento Sexual Animal , Motilidade dos Espermatozoides/fisiologiaRESUMO
The authors report a prospective study of correlation between histopathological alterations of the placenta, risk factors and early-onset bacterial infections in 224 premature newborns. They used a mathematical model for evaluation and prediction of neonatal bacterial infection according to the localization in chorioamniotic tissues (chorioamniotic plate, amniotic membranes and umbilical cord) invaded by leukocytes. Septicemia, pneumonia or omphalitis were documented in 45 (20%) infected premature newborns and inflammatory lesions in the placenta were observed in all of them. In order of statistical significance, the most important variables for early-onset bacterial neonatal infection were invasion of the chorioamniotic plate, amniotic membranes and umbilical cord tissues by PMNL (P < 0.0000), premature rupture of membranes (P < 0.0000), birthweight lower than 1500 g (P < 0.0000), gestational age under 34 weeks (P < 0.0001), foul smell (P < 0.0038), no antibiotics before delivery (P < 0.0066) and intrapartum fever (P < 0.0087). By logistic stepwise multiple regression analysis, invasion of fetal chorioamniotic plate and of amniotic membranes by leukocytes were the only statistically significant variables. The probability of neonatal infection in premature newborns, when polymorphonuclear neutrophils were present in chorioamniotic plate and in amniotic membranes, was 62.5%, while the probability was 0.5% when these tissues were normal. These data suggest that histological chorioamnionitis has to be considered as an important risk factor for early-onset infection in premature newborns.
Assuntos
Infecções Bacterianas/patologia , Corioamnionite/patologia , Doenças do Prematuro/patologia , Recém-Nascido Prematuro , Neutrófilos/patologia , Idade de Início , Âmnio/microbiologia , Âmnio/patologia , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/patologia , Bactérias/isolamento & purificação , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Corioamnionite/epidemiologia , Corioamnionite/microbiologia , Córion/microbiologia , Córion/patologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/microbiologia , Masculino , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/patologia , Gravidez , Estudos Prospectivos , Fatores de Risco , Umbigo/microbiologia , Umbigo/patologiaRESUMO
Many conditions are associated with hyperglycemia in preterm neonates because they are very susceptible to changes in carbohydrate homeostasis. The purpose of this study was to evaluate the occurrence of hyperglycemia in preterm infants undergoing glucose infusion during the first week of life, and to enumerate the main variables predictive of hyperglycemia. This prospective study (during 1994) included 40 preterm neonates (gestational age < 37 weeks); 511 determinations of glycemic status were made in these infants (average 12.8/infant), classified by gestational age, birth weight, glucose infusion rate and clinical status at the time of determination (based on clinical and laboratory parameters). The clinical status was classified as stable or unstable, as an indication of the stability or instability of the mechanisms governing glucose homeostasis at the time of determination of blood glucose; 59 episodes of hyperglycemia (11.5%) were identified. A case-control study was used (case = hyperglycemia; control = normoglycemia) to derive a model for predicting glycemia. The risk factors considered were gestational age (< or = 31 vs. > 31 weeks), birth weight (< or = 1500 vs. > 1500 g), glucose infusion rate (< or = 6 vs. > 6 mg/kg/min) and clinical status (stable vs. unstable). Multivariate analysis by logistic regression gave the following mathematical model for predicting the probability of hyperglycemia: 1/exp{-3.1437 + 0.5819(GA) + 0.9234(GIR) + 1.0978 (Clinical status)}The main predictive variables in our study, in increasing order of importance, were gestational age, glucose infusion rate and, the clinical status (stable or unstable) of the preterm newborn infant. The probability of hyperglycemia ranged from 4.1% to 36.9%.
Assuntos
Hiperglicemia/sangue , Recém-Nascido Prematuro/sangue , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Fatores de TempoRESUMO
CONTEXT: Adequacy of glucose infusion may be monitored via the glycosuria levels, as there is a relationship between glycemia and glycosuria regulated by the renal glucose threshold. In the neonatal period, however, this relationship is not so clear. OBJECTIVE: To evaluate the occurrence of glycosuria in preferm infants submitted to glucose infusion and to verify the relationship between glycosuria and blood glucose level. DESIGN: Accuracy study. SETTING: Neonatal intensive care unit of General Maternity Hospital. PATIENTS: 40 Preterm newborns receiving glucose infusion. PROCEDURES: 511 concomitant determinations of glycemia and glycosuria were performed. These 511 pairs were divided into stable and unstable, according to the clinical status of the newborn at the time of data collection, and they were studied in relation to the gestational age, birth weight and glucose infusion rate. RESULTS: The results revealed a greater frequency of glycosuria in gestational age < or = 30 weeks, birth weight < 1500 g and glucose infusion rate > 6 mg/kg/min. Eight (25.8%) episodes of positive glycosuria occurred in the absence of hyperglycemia, indicating only a moderate concordance between them. CONCLUSION: Glycosuria alone is an unreliable marker of blood glucose concentration and adequacy of glucose infusion rate. It is therefore necessary to monitor blood glucose levels in infants submitted to continuous glucose infusion.
Assuntos
Glicemia/análise , Glucose/administração & dosagem , Glicosúria/diagnóstico , Recém-Nascido Prematuro/metabolismo , Biomarcadores , Feminino , Glucose/metabolismo , Glicosúria/epidemiologia , Humanos , Hiperglicemia/sangue , Recém-Nascido , Infusões Parenterais , Masculino , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
OBJECTIVE: To develop models for estimating the length of hospital stay (LOS) of very low birth weight infants (VLBW), based on perinatal risk factors present during the first week of life and during the entire hospitalization period. STUDY DESIGN: The files of 155 VLBW were analyzed, and the influence of individual risk factors were initially evaluated by univariate analysis, using multiple-regression. Two mathematical models were built to estimate the LOS. RESULTS: The first model, using risk factors present during the first 3 days of life, is as follows: LOS = -0.074A + 22.06B + 22.85C - 16.78D - 2.07E + 10.51F + 203.12 (R2 = 0.63). (The letters are added to show what each number represents: A: birth weight; B: occurrence of respiratory distress syndrome; C: endotracheal intubation during resuscitation; D: 1-minute Apgar score; E: gestational age; F: presence of complications during delivery.) The second model, using factors present during the entire hospitalization period, is: LOS = 0.61G + 29.19H + 24.68I + 14.21J + 23.56K + 9.54L + 7.41M + 20.43 (R2 = 0.82). (G: age receiving nutritional support of > or = 120 kcal/kg per day; H: occurrence of systemic candidiasis; I: birth weight < 1000 gm; J: presence of delivery complication; K: occurrence of bronchopulmonary dysplasia; L: birth weight > or = 1000 gm and < or = 1249 gm; M: occurrence of anemia). CONCLUSION: Both models are applicable for estimating the hospitalization period, and the addition of variables present during the entire hospitalization period improved the accuracy of the model.
Assuntos
Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Brasil , Humanos , Recém-Nascido , Modelos Estatísticos , Análise de Regressão , Fatores de RiscoRESUMO
Fluid management and dosage regimens of drugs in preterm infants should be based on the glomerular filtration rate. The current methods to determine glomerular filtration rate are invasive, time-consuming, and expensive. In contrast, creatinine clearance can be easy obtained and quickly determined. The purpose of this study was to compare plasma creatinine on the third and seventh day of life in preterm newborn infants, to evaluate the influence of maternal creatinine, and to demonstrate creatinine clearance can be used as a reliable indicator of glomerular filtration rate. We developed a prospective study (1994) including 40 preterm newborns (gestational age < 37 weeks), average = 34 weeks; birth weight (average) = 1840 g, in the first week of life. Inclusion criteria consisted of: absence of renal and urinary tract anomalies; O2 saturation >/= 92%; adequate urine output (>1ml/kg/hr); normal blood pressure; absence of infections and no sympathomimetic amines in use. A blood sample was collected to determine plasma creatinine (enzymatic method) on the third and seventh day of life and creatinine clearance (CrCl) was obtained using the following equation: [formula: see text], k = 0.33 in preterm infant All plasma creatinine determinations showed normal values [third day: 0.78 mg/dl +/- 0.24 (mean +/- SD)and seventh day: 0.67 mg/dl +/- 0.31 - (p>0.05)]. Also all creatinine clearance at third and seventh day of life were normal [third day: 19.5 ml/min +/- 5.2 (mean +/- SD) and seventh day: 23.8 ml/min +/- 7.3 - (p>0,05)]. All preterm infants developed adequate renal function for their respective gestational age. In summary, our results indicate that, for clinical practice, the creatinine clearance, using newborn length, can be used to estimate glomerular filtration rate in preterm newborn infants.
Assuntos
Creatinina/sangue , Taxa de Filtração Glomerular , Recém-Nascido Prematuro/fisiologia , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
Between november 1994 and september 1995, there were 4 cases of premature infants in our Neonatal Intensive Care Unit (NICU) who developed gastrointestinal perforation and bleeding due to peptic ulcer and 3 died of this complication. In the first case, the neonate developed pneumoperitonium when weaning from the ventilator and was submitted to the operation with clinical diagnosis of Necrotizing Enterocolitis. Surprisingly, during the procedure, a perforated gastric ulcer was disclosed. Ever since, this NICU is aware of this diagnosis and try to better identify the possible risks factors. Asphyxia, prematurity, stress and situations where low gastrointestinal flow (asphyxia, exchange transfusion, pneumothorax, hemodynamic shock, cardiac arrest) were observed in almost every case. Treatment with dexamethasone or aminophilline was used in 3 of 4 cases and this potential serious side effect should be considered in all babies treated with steroids. The association of ranitidine (2 mg/kg 12/12 h) could not prevent the perforation in cases 1 and 3. Better understanding of physiopathology of the ulcer in this period of life and a effective preventable drug is still lacking.
Assuntos
Úlcera Péptica Perfurada/etiologia , Úlcera Gástrica/complicações , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Úlcera Péptica Perfurada/diagnóstico , Fatores de Risco , Úlcera Gástrica/diagnóstico , Úlcera Gástrica/etiologiaRESUMO
Three patients, 11, 17 and 41 days old with various degrees of central nervous system (CNS) lesions developed central diabetes insipidus as a complication of hypothalamic damage. Two of the children had congenital CNS malformations including meningomyelocele, hydrocephalus, and prosencephaly, while the third child presented Streptococcus agalactiae meningitis, complicated with CNS hemorrhage and hypertensive dilatation of the lateral ventricles. All of them fulfilled the criteria for central diabetes insipidus, reaching high levels of serum sodium and osmolality, along with hypotonic urine. The responses to intranasal arginine-vasopressin were prompt, normalizing the serum levels of sodium and increasing urinary osmolality, allowing a better metabolic balance, avoiding continuing damage to the already compromised CNS. The neonatologist must be aware of the possibility of this kind of complication even in a normal child with CNS infection. Imaging studies showing hemorrhage in the region of the posterior hypothalamus must be a sign that this type of complication is able to occur.
Assuntos
Encéfalo/anormalidades , Diabetes Insípido/etiologia , Meningites Bacterianas/complicações , Infecções Estreptocócicas/complicações , Streptococcus agalactiae , Adolescente , Feminino , Humanos , Lactente , Recém-Nascido , Vasopressinas/uso terapêuticoRESUMO
OBJECTIVE: Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD: The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500 g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal) and three indexes of physiological status during first 12 hours after birth-maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS: In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 +/- 275.6 g, gestational age 30 weeks 4/7 +/- 2 weeks 3/7; male (57%); Apgar 1(0) min. score < or = 3 (36.2%) and Apgar 5 degrees min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION: The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.
Assuntos
Peso ao Nascer , Mortalidade Infantil , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
Propionic Acidemia is an inherited disorder of organic acid metabolism characterized by a wide spectrum of clinical and biochemical findings. Many times is present in the neonatal period, when mortality is high and neurologic residua in survivors is severe. The present case concerns to a healthy male newborn who started with a picture of refusing to feed, lethargy and hypothermia at 49 hours of life. He developed a severe neurotoxicity state with metabolic acidosis. The laboratory evaluation showed high levels of 3-hidroxi-propionic, 2-metil-hidroxibutiric and metil-citric in urine, confirming the diagnosis of proprionic acidemia.
Assuntos
Erros Inatos do Metabolismo/diagnóstico , Propionatos/sangue , Acidose/etiologia , Evolução Fatal , Humanos , Recém-Nascido , Masculino , Propionatos/urinaRESUMO
Immunological behavior (IgG, IgM, IgA) and total Complement (CH50) of newborns infants with risk factors for early onset sepsis. Comparative analysis between newborns with and without infection. Rev. Hosp. Clín. Fac. Med. S. Paulo, 53(6): 303-310, 1998. The objective of this study was to verify the immunological behavior of the newborn infant in front of an infection. We studied 60 newborn infants that had risk factors for early onset sepsis (premature rupture membranes, clinic amnionitis or tract urinary infection) from de immunological and infection point of view. They were classified into three gestational age groups: < 34 weeks, between 34 and 36 6/7 weeks and > or = 37 weeks. Sepsis diagnosis was done through clinical and laboratorial data and we also included the followings exams: Immunological types (IgG, IgM, IgA) and total complement (CH50) obtained from the newborn at birth and on the fifth day of life. We could verify that 15 newborns (25%) presented early sepsis. There was a statistical association between perinatal asfixia and infection in the group with gestational age < 34 weeks and this same group presented statistical association between infection and death. The serical levels of IgG and CH50 were directly related to the gestational age and there were significant statistical differences between levels of IgG, IgM and total Complement between infected and not infected newborns within the same group os gestional age. We observed that the infection was associated to low levels of IgG and CH50, at birth and on the fifth day, mainly in the group of infected newborns with gestional age < 34 weeks, being this group, therefore, the one that would mostly benefit from an immunological support in front of and infection.
Assuntos
Ensaio de Atividade Hemolítica de Complemento , Imunoglobulinas/imunologia , Sepse/diagnóstico , Feminino , Idade Gestacional , Humanos , Imunoglobulina A/sangue , Imunoglobulina A/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulinas/sangue , Recém-Nascido , Masculino , Fatores de Risco , Fatores de TempoRESUMO
The aim of this study is to evaluate the influence of intra-uterine growth retardation (IUGR), as well as it's types and severity on the development of respiratory distress among low-birth-weight infants. A total of 673 neonates were studied, the small-for-dates infants (SFD), 40% of total, were divided according to the type of IUGR, in proportionate and disproportionate, and according to the severity, in birth weight below 3rd and between 3rd and 10th percentile. Respiratory distress was more frequent among the appropriate for gestational age (57.3%) compared to the SFD infants (33.7%), (p < 0.0001), and among males (52.6%) compared to females (47.4%) (p = 0.01). There was an inverse relationship between gestational age, as well as birth weight and respiratory distress. It occurred in 90.6% of very-low-birth-weight infants and in 39% of the others, with a predominance among the appropriate for gestational age newborns. Respiratory distress occurred in 80% of neonates below 34 weeks of gestational age and in 26% of the neonates above it (p < 0.0001). Regarding to the small-for-dates infants, respiratory distress occurred more frequently among the disproportionate (42.5%), when compared to proportionate infants (28.1%) (p = 0.03). The severity of IUGR had no influence on these results. The authors concluded that among low birth weight infants, the groups with increased risk for respiratory distress are the appropriate for gestational age and, among small-for-dates and disproportionate infants, those weighing less than 1500 g.
Assuntos
Retardo do Crescimento Fetal/complicações , Recém-Nascido de Baixo Peso , Insuficiência Respiratória/etiologia , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Gravidez , Insuficiência Respiratória/epidemiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: Morbidity and mortality of premature infants have decreased considerably over the last decades, therefore, adequate nutrition of the premature is a major concern. Enteral feeding is the route of choice, but when it is not possible the parenteral route, which contains glucose as one of its main components, is used. Glucose infusions are not devoid of risk as they facilitate the development of hyperglycemia leading to intracranial hemorrhage, glucosuria and dehydration. The aim of this paper is to relate hyperglycemia and glucosuria to birth weight, gestational age and glucose infusion rate.METHODS: The study was developed at the Nursery of Santa Catarina Hospital (São Paulo). The authors developed a prospective study; 511 concurrent determinations of glycemia and qualitative glucosuria were performed in 40 preterm newborn infants receiving parenteral glucose (mean of 12.8 dosages per newborn).RESULTS: Fifty-nine (11.5%) episodes of hyperglycemia were detected, and their frequency was higher at lower gestational ages (/= 6 mg/kg/min). Thirty-one (6.1%) episodes of glucosuria were detected, and were more frequent in lower gestational ages (/= 6 mg/kg/min).CONCLUSIONS: The frequency of hyperglycemia and glucosuria in preterm newborn infants receiving glucose infusion was higher in lower gestational ages, lower birth weights and higher glucose infusion rates. In preterm newborn infants it is necessary to observe the glucose infusion rate and its respective glycemia, in order to avoid the complications of hyperglycemia.
RESUMO
OBJETIVO - Estudo ecocardiográfico em recém-nascido (RN) de grupos de risco para cardiopatia congênita, a fim de se determinar a prevalência que justifique esse exame no período neonatal. MÉTODOS - Estudaram-se, de novembro/91 a abril/93, 156 RN do berçário anexo à Maternidade do HC-FMUSP, sendo RN de mães com cardiopatia congênita ou diabetes mellitus, crianças de muito baixo peso, com malformaçöes extracardíacas ou presença de sinais cardíacos, caracterizados por sopro, cianose, ou arritmia, todos submetidos ao ecocardiograma. RESULTADOS - A prevalência encontrada foi de 21,8 'por cento', superior ao da população geral (0,8 a 1,2 'por cento'), sendo que a maior entre os grupos, de 40,7 'por cento', ocorreu no grupo de malformaçöes extracardíacas. CONCLUSÄO - Nossos dados justificam a realização de ecocardiograma em RN pertencentes a um destes grupos de risco para cardiopatia congênita.
Assuntos
Humanos , Recém-Nascido , Pré-Escolar , Asfixia Neonatal , Cardiopatias Congênitas , Ecocardiografia , Epidemiologia Descritiva , Evolução Fatal , Mortalidade , Cuidados Pós-Operatórios , Prevalência , Grupos de RiscoRESUMO
PURPOSE: An echocardiographic study was performed in newborns from risk groups, with the aim of to determining prevalence and to evaluate the indications for this test in the neonatal period. METHODS: One hundred fifty six newborns were studied. They were admitted to the Newborn ward of the Department of Obstetric of the HC-FMUSP, in the period of November 91 to April 93, from mothers with congenital heart disease or diabetes, low birth weight newborns, with extracardiac malformations, cardiac signs and/or congenital infections. RESULTS: The observed prevalence was 21.8%, greater than that of the general population (0.8-1.2%). The group composed by 27 children with extracardiac abnormalities presented the largest prevalence when compared with the other groups (40.7%). These data justify the use of echocardiography in high risk newborns for the detection of congenital heart disease.