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de Carvalho E.H.,Institute Medicina Integral Professor Fernando Figueira IMIP | Gelenske T.,Institute Medicina Integral Professor Fernando Figueira IMIP | Bandeira F.,University of Pernambuco
Arquivos Brasileiros de Endocrinologia e Metabologia | Year: 2010

There is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIVpositive men, studies have also demonstrated a high prevalence of osteoporosis in HIV-infected women. It would appear that antiretroviral therapy (ART) plays an important role in the pathogenesis of osteoporosis in HIV-infected patients, although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women. The aim of this systematic review was to evaluate the frequency of bone loss, bone mineral density (BMD) and fractures in HIVpositive women taking ART or protease inhibitors (PI). After screening 597 citations from the databases of PubMed, EMBASE and Lilacs, five studies were selected for the review. A difference was demonstrated of over 3% in the BMD at the femoral neck of HIV-positive women taking PI/ ART. No difference was registered in the BMD at the lumbar spine between users and non-users of PI/ART. The lack of studies has made it impossible to reach any conclusion regarding the occurrence of fractures. © ABE&M todos os direitos reservados.

Bezerra P.G.M.,Institute Medicina Integral Professor Fernando Figueira IMIP | Britto M.C.A.,Institute Medicina Integral Professor Fernando Figueira IMIP | Correia J.B.,Institute Medicina Integral Professor Fernando Figueira IMIP | Correia J.B.,University of Pernambuco | And 5 more authors.
PLoS ONE | Year: 2011

Background: Acute respiratory infection (ARI) is a leading cause of morbidity and mortality in children worldwide. This study aimed to determine the viral and atypical bacterial causes of different severities and clinical manifestations of ARI in preschool children from low-income families in North-East Brazil. Methods: Clinical/demographic data and nasopharyngeal aspirates (NPA) were prospectively collected from children <5 years presenting with ARI over one year to a paediatric A&E department. Disease severity was grouped according to presence of lower respiratory tract signs, need for hospital admission and need for oxygen. Clinical manifestation of ARI was based on discharge diagnosis from hospital with four conditions predominating: bronchiolitis, pneumonia, episodic viral wheeze/asthma and upper respiratory tract infection. Multiplex PCR was used to detect 17 common respiratory viral and atypical bacterial pathogens in NPA. Findings: 407 children with a median age of eight months were recruited. Pathogens were detected in 85·5% samples with co-infection being particularly common (39·5%). Respiratory Syncytial Virus (RSV; 37%), Adenoviruses (AdV; 25%), Rhinoviruses (hRV; 19%), Bocavirus (hBoV; 19%), human Meta-pneumovirus (hMPV; 10%) and Mycoplasma pneumoniae (Mpp; 10%) were most prevalent. Detection and co-infection rates were similar in all severities and clinical manifestations of ARI apart from RSV, which was associated with more severe disease and specifically more severe cases of bronchiolitis, and Mpp, which was associated with more severe cases of pneumonia. Mpp was detected in 17% of children admitted to hospital with pneumonia. Interpretation: This study underlines the importance of viral and atypical bacterial pathogens in ARI in pre-school children and highlights the complex epidemiology of these pathogens in this age group. Generally, viruses and atypical bacteria were detected in all severities and clinical manifestations of ARI but RSV and Mpp were associated with more severe cases of bronchiolitis and pneumonia respectively. © 2011 Bezerra et al.

de Oliveira M.G.O.A.,Federal University of Pernambuco | Lira P.I.C.,Federal University of Pernambuco | Batista Filho M.,Institute Medicina Integral Professor Fernando Figueira IMIP | Lima M.C.,Federal University of Pernambuco
Revista Brasileira de Epidemiologia | Year: 2013

Objective: To determine the duration of breastfeeding and to identify factors associated with exclusive / predominant breastfeeding in children under two years old. Methods: This is a cross-sectional study conducted from March to June 2005 in the municipalities of Gameleira and São João do Tigre, located in the interior of Pernambuco and Paraiba States. The sample comprised 504 children under two years (280 residents in Gameleira and 224 in São João do Tigre). Survival analysis was used to estimate the median duration of survival time of breastfeeding and the associations with socioeconomic conditions, factors related to mothers and children and health care. Results: The duration of exclusive and exclusive/predominant breastfeeding and breastfeeding were of 19, 79 and 179 days in Gameleira and 23, 91 and 169 days in São João do Tigre, respectively. Mothers with better socioeconomic conditions, as represented by education, sanitation, and possession of consumer goods, had a higher median duration of exclusive/ predominant breastfeeding in both towns. Prenatal care represented by higher number of attendance, earlier onset and feeding and breastfeeding advice had a positive influence on breastfeeding duration. Conclusions: Breastfeeding duration was lower than the recommendation. Despite the families precarious living conditions, a better socioeconomic status and prenatal care were protective factors for exclusive/ predominant breastfeeding duration in these areas.

da Silva Nunes F.L.,Institute Medicina Integral Professor Fernando Figueira IMIP | Gadelha P.C.F.P.,Federal University of Pernambuco | de Souza Costa M.D.,University of Pernambuco | de Amorim A.C.R.,Institute Medicina Integral Professor Fernando Figueira IMIP | da Silva M.G.B.,Maternal and Child health and Nutritionist IMIP
Nutricion Hospitalaria | Year: 2014

Introduction: The nutritional state is the independent factor that most influences the post-operational results in elective surgeries.Objective: to evaluate the influence of the nutritional state on the hospitalization period and on the post-operative complications of patients submitted to abdominal surgery.Methods: prospective study with 99 surgical patients over 18 years of age, submitted to abdominal surgeries in the period from April to October of 2013, in the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). All patients were submitted to anthropometric nutritional evaluations through the body mass Index (BMI), arm circumference (AC) and triceps skinfold thickness (TEST). The biochemical evaluation was carried out from the leukogram and serum albumin results. The identification of candidate patients to nutritional therapy (NT) was carried out through the nutritional risk (NR) evaluation by using the BMI, loss of weight and hypoalbuminemia. The information about post-operational complications, hospitalization period and clinical diagnosis was collected from the medical records. Program SPSS version 13.0 and significance level of 5% were used for the statistical analysis.Results: The malnutrition diagnosed by the AC showed significant positive association with the presence of post-operative complications (p=0.02) and with hospitalization period (p=0.02). The presence of NR was greater when evaluated by hypoalbuminemia (28.9%), however, only 4% of the sample carried out the NT in the pre-operational period. The hospitalization period was greater for patients with malignant neoplasia (p<0.01).Conclusion: The malnutrition diagnosis of patients submitted to abdominal surgeries is associated to greater risk of post-operational complications and longer hospitalization permanence. © 2014, Grupo Aula Medica S.A. All rights reserved.

PubMed | Institute Medicina Integral Professor Fernando Figueira IMIP and University of Sao Paulo
Type: Journal Article | Journal: Acta cirurgica brasileira | Year: 2016

To describe the anatomical course of the intralaryngeal portion of the inferior laryngeal nerve (ILN) and to standardize the surgical access to its thyroarytenoid branch (TAb) through the thyroid cartilage.Under surgical microscopy, 33 adult human excised larynges were dissected, to expose the intralaryngeal portion of ILN. The point of entry of TAb, ILNs terminal branch, in the thyroarytenoid (TA) muscle was determined and correlated with thyroid cartilage dimensions.After entering the larynx, the ILN consistently traveled between the thyroid cartilage and the lateral cricoarytenoid muscle in an anterior and slightly cranial course. The distance from the point of entry of the TAb in the TA muscle to the midline (TAb-H) and to the inferior border (TAb-V) of the thyroid cartilage differed according to gender. In females, mean distances of TAb-H and TAb-V were 20.5mm and 5.2mm and in males, 22.3mm and 5.9mm, respectively.The intralaryngeal course of the inferior laryngeal nerve presents low variability and measures from landmarks in the thyroid cartilage help to estimate the point of entry of thyroarytenoid branch in thyroarytenoid muscle.

Avila Moura A.,Federal University of Alagoas | de Mello M.J.G.,Institute Medicina Integral Professor Fernando Figueira IMIP | Correia J.B.,Institute Medicina Integral Professor Fernando Figueira IMIP | Correia J.B.,University of Pernambuco
Vaccine | Year: 2016

Background: Vaccinating populations against rubella aims to mitigate viral circulation and to ensure that women of childbearing age are immunized to reduce the incidence of congenital rubella syndrome. This study determined the serological statuses of pregnant women in an urban Brazilian population before and after the national rubella immunization campaign that was undertaken in 2008, and it assessed the socio-demographic factors associated with seronegativity. Methods: Pregnant women living in Maceió, Alagoas, Brazil, who participated in a municipal prenatal screening program that involved blood tests for rubella, were assessed between June 2007 and May 2012. Socio-demographic factors associated with seronegativity were assessed, including the year of the blood test, categorized as before or after the 2008 immunization campaign, and the women's birth cohorts, the women's ethnicities, the gestational ages at the first prenatal visit, and the women's districts of residence. Results: A total of 54,717 capillary blood samples were tested for rubella. The prevalence of pregnant women who were seronegative for rubella declined from 9.4% before the national immunization campaign to 2.8% after the national immunization campaign. Women were more likely to be seronegative for rubella before and after the immunization campaign if they were born between 1990 and 2000 or delayed starting prenatal care. Conclusions: The decline in the prevalence of pregnant women who were seronegative for rubella to <5% indicates that the 2008 Brazilian rubella immunization campaign was successful in Maceió. © 2015 Elsevier Ltd.

Levy S.S.S.,Institute Medicina Integral Professor Fernando Figueira IMIP | Mello M.J.G.,Institute Medicina Integral Professor Fernando Figueira IMIP | Gusmao-filho F.A.R.,Institute Medicina Integral Professor Fernando Figueira IMIP | Gusmao-filho F.A.R.,University of Pernambuco | And 2 more authors.
Journal of Hospital Infection | Year: 2010

A prospective cohort study was performed in order to study the incidence and risk factors for bacterial colonisation with extended-spectrum producing β-lactamase (ESBL) Klebsiella spp. in children. The study took place in a paediatric intensive care unit (PICU) in Recife, Brazil over a five-month period in 2008. Rectal swabs were collected during the first 24 h of admission and on the 2nd, 5th, 7th and 14th days of PICU stay. ESBL-producing strains of Klebsiella spp. were detected by Kirby-Bauer disc diffusion and confirmed by double disc synergy testing. A total of 186 children were enrolled with a median age of three years. The overall colonisation rate with ESBL-producing Klebsiella spp. was 14%, but 13 (7%) children were already colonised upon admission. The incidence density of colonisation during PICU admission was 14.2 per 1000 patient-days. On multivariable analysis, the use of third generation cephalosporins (P=0.008) was a risk factor for colonisation. Survival analysis revealed an increase in the accumulated risk of colonisation with an increase in length of stay in the PICU. The present study provides baseline information to guide improved practices in similar settings and direct future studies in relation to the magnitude of cross-infection and effectiveness of infection control interventions. © 2010 The Hospital Infection Society.

de Carvalho C.C.M.,Institute Medicina Integral Professor Fernando Figueira IMIP | Souza A.S.R.,Residencia Medica em Medicina Fetal | Filho O.B.M.,University of Pernambuco
Revista da Associacao Medica Brasileira | Year: 2010

Objective. To determine the prevalence and factors associated with episiotomy in a reference center of Pernambuco. Methods. A retrospective cross-sectional study was carried out from January to December 2006 with 495 women who had a normal delivery at the Maternity Center Monteiro de Moraes Integrated Health Amaury de Medeiros (CISAM) University of Pernambuco. Assciated factors were issues preceeding birth, characteristics of labor and perinatal outcome. To verify the association between predictors and performance of episio-tomy the Chi square, Fisher's exact and Student's t tests were used as appropriate, with a a significance level of 5%. The prevalence ratio and confidence intervals were calculated at 95%, in addition to logistic regression analysis. Results. Prevalence of performing episiotomy was 29.1% (n = 144). After bivariate analysis, we found a significant association of episiotomy with adolescence (PR 1.74. 95% CI I. 33-2.28), age over 35 years (PR 0.35. 95% CI 0.14-0.90), primiparity (PR 4.73, 95% CI 3.33-6.71), absence of previous vaginal delivery (PR 5.44, 95% CI 3.67-8.06) and related diseases at the time of delivery (RP 1.71, 95% CI 1.30-2.25). There was no significant relation with gestational age at delivery, duration of labor over 6h and expulsion period of more than 30 minutes, use of misoprostol or oxytocin, abnormal fetal heart rate, presence of meconium, shift of completion of delivery (night or day), rate of Apgar score in 1 and 5 minutes and weight of the newborn. Presence of perineal lacerations was higher in the group not subject to episiotomy, however only 1 st and 2 nd degree lacerations were described. After logistic regression, the analyzed remaining factors associated with episiotomies were maternal diseases (RA 1.99, 95% CI 1.20-3.28) and absence of previous vaginal delivery (9.85 RA, 95% CI 6.04-16.06). Conclusion. Prevalence of episiotomies in the institution was 29%. Variables that remained related to episiotomy were maternal diseases and absence of previous vaginal delivery.

Porto A.M.F.,Institute Medicina Integral Professor Fernando Figueira IMIP | Coutinho I.C.,Institute Medicina Integral Professor Fernando Figueira IMIP | Correia J.B.,Institute Medicina Integral Professor Fernando Figueira IMIP | Amorim M.M.R.,Institute Medicina Integral Professor Fernando Figueira IMIP
BMJ | Year: 2011

Objectives To determine the effectiveness of corticosteroids in reducing respiratory disorders in infants born at 34-36 weeks' gestation. Design Randomised triple blind clinical trial. Setting A large tertiary teaching hospital in northeast of Brazil. Participants Women at 34-36 weeks of pregnancy at risk of imminent premature delivery. Interventions Betamethasone 12 mg or placebo intramuscularly for two consecutive days. Main outcomes measures Primary outcome was the incidence of respiratory disorders (respiratory distress syndrome and transient tachypnoea of the newborn). Secondary outcomes included the need for ventilatory support, neonatal morbidity, and duration of stay in hospital. Results 320 women were randomised, 163 of whom were assigned to the treatment group and 157 to the controls. Final analysis included 143 and 130 infants, respectively. The rate of respiratory distress syndrome was low (two (1.4%) in the corticosteroid group; one (0.8%) in the placebo group; P=0.54), while the rate of transient tachypnoea was high in both groups (34 (24%) v 29 (22%); P=0.77). There was no reduction in the risk of respiratory morbidity with corticosteroid use even after adjustment for subgroups of gestational age (34-34 +6 weeks, 35-35 +6 weeks, and ≥36 weeks). The adjusted risk of respiratory morbidity was 1.12 (95% confidence interval 0.74 to 1.70). The need for ventilatory support was around 20% in both groups. There was no difference in neonatal morbidity (88 (62%) v 93 (72%); P=0.08) or in the duration of stay in hospital between the two groups (5.12 v 5.22 days; P=0.87). Phototherapy for jaundice was required less often in babies whose mothers received corticosteroids (risk ratio 0.63, 0.44 to 0.91). Conclusions Antenatal treatment with corticosteroids at 34-36 weeks of pregnancy does not reduce the incidence of respiratory disorders in newborn infants.

McNamara P.S.,University of Liverpool | Fonceca A.M.,University of Liverpool | Howarth D.,University of Liverpool | Correia J.B.,Institute Medicina Integral Professor Fernando Figueira IMIP | And 5 more authors.
Thorax | Year: 2013

Background: The mechanisms regulating antibody expression within the human lung during airway infection are largely unknown. In this study, our objectives were to determine if infection with respiratory syncytial virus (RSV) upregulates expression of the B cell differentiation factors A proliferation inducing ligand (APRIL) and B cell activating factor of the TNF family (BAFF), if this is a common feature of viral airway infection, and how this is regulated in human airway epithelial cells. Methods: We measured BAFF and APRIL protein expression in bronchoalveolar lavage (BAL) fluid from infants with severe RSV disease, and healthy control children, and in nasopharyngeal aspirates from preschool children with other single respiratory viral infections. We also measured mRNA expression in bronchial brushings from RSV-infected infants, and in RSV-infected paediatric primary airway epithelial cell cultures ( pAEC). Beas-2B cell cultures were used to examine mechanisms regulating BAFF expression. Results: BAFF protein and mRNA were elevated (in marked contrast with APRIL) in BAL and bronchial brushings, respectively, from RSV-infected infants. BAFF protein was also found in upper airway secretions from children with human metapneumovirus, H1N1, bocavirus, rhinovirus, RSV and Mycoplasma pneumoniae infection. BAFF mRNA and protein were expressed following in vitro RSV infection of both pAEC and Beas- 2B cultures, with mRNA expression peaking 12-h postinfection. BAFF induction was blocked by addition of a neutralising anti-interferon-β antibody or palivizumab. Conclusions: BAFF, produced through an interferon-β- dependant process, is a consistent feature of airway infection, and suggests a role for the airway epithelia in supporting protective antibody and B cell responses in the lung.

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