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Bomfim LN, de Barros CRA, Veloso FCS, Micheleto JPC, Melo KA, Gonçalves IS, Kassar SB, Oliveira MJC. Chest computed tomography findings of patients infected with Covid-19 and their association with disease evolution stages. Radiography (Lond) 2023; 29:1093-1099. [PMID: 37757676 DOI: 10.1016/j.radi.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION To describe CT findings in patients with confirmed Covid-19 infection and correlate them with the disease evolution stages. METHODS This is a historical cohort observational analytical study carried out with outpatients, inpatients, and emergency patients from a private hospital in Maceió/AL, Brazil. The final sample consisted of 390 patients with positive RT-PCR for Covid-19 with available laboratory tests and chest CT results. RESULTS The most frequent initial symptoms were cough, fever, dyspnea and headache. The most commonly found comorbidities were hypertension, diabetes mellitus and obesity. A total of 22% of the CT scans showed no alterations; ground-glass opacity was the most frequently found one. There was a significant association between age, comorbidities, pulmonary involvement, ground-glass opacity, mosaic attenuation and percentage of pulmonary involvement with death. The analysis of the disease stages showed a significant association with laboratory data (CRP and platelet levels), ground-glass opacity and mosaic attenuation with the disease evolution stages in relation to the days since symptom onset. CONCLUSION The disease evolution of Covid-19 occurs in stages, and this study describes tomographic findings in patients with confirmed Covid-19 infection and shows they vary depending on the disease evolution stages. IMPLICATIONS FOR PRACTICE This paper provides important addition to the various records that have been accumulated through the Covid-19 pandemic.
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Affiliation(s)
- L N Bomfim
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - C R A de Barros
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - F C S Veloso
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - J P C Micheleto
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - K A Melo
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - I S Gonçalves
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
| | - S B Kassar
- Av. Comendador Gustavo Paiva, 5017, Cruz das Almas, Maceió, AL, Cep 57038-000, Brazil.
| | - M J C Oliveira
- Universidade Federal de Alagoas, Endereço: Av. Lourival Melo Mota, S/N, Tabuleiro do Martins, Maceió, AL, Cep: 57072-970, Brazil.
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Lima Chagas GC, Rangel AR, Noronha LM, Veloso FCS, Kassar SB, Oliveira MJC, Meneses GC, da Silva Junior GB, Daher EDF. Risk Factors for Mortality in Patients with Dengue: A Systematic Review and Meta-Analysis. Trop Med Int Health 2022; 27:656-668. [PMID: 35761748 DOI: 10.1111/tmi.13797] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate risk factors for mortality in dengue. METHODS Systematic review and meta-analysis searching MEDLINE, Embase, SciELO, LILACS Bireme, and OpenGrey to identify eligible observational studies of patients with dengue, of both genders, aged 14 years or older, that analyzed risk factors associated with mortality and reported adjusted risk measures with their respective confidence intervals (CIs). We estimated the pooled weighted mean difference and 95% CIs with a DerSimonian and Laird random-effects model. Methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS Of 1,170 citations reviewed, 18 papers, with a total of 25,851 patients, were included in the systematic review and 12 in the meta-analysis. Severe hepatitis (OR 29.222, 95% CI: 3.876-220.314), dengue shock syndrome (OR 23.575, 95% CI 3.664-151.702), altered mental status (OR 3.76, 95% CI 1.67-8.42), diabetes mellitus (OR 3.698, 95% CI 1.196-11.433), and higher pulse rate (OR 1.039, 95% CI 1.011-1.067) are associated with mortality in patients with dengue. All studies included were classified as having a high quality. CONCLUSIONS Proper identification and management of these risk factors should be considered to improve patient outcomes and reduce the hidden burden of this neglected tropical disease. Future well-designed studies are needed to investigate the association of other clinical, radiological, and laboratorial findings with mortality in dengue, as well as to develop prognostic models based on the risk factors found in our study.
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Affiliation(s)
- Gabriel Cavalcante Lima Chagas
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Amanda Ribeiro Rangel
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Luísa Macambira Noronha
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Felipe Camilo Santiago Veloso
- Federal University of Alagoas, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Maceió, Brazil
| | - Samir Buainain Kassar
- Federal University of Alagoas, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Maceió, Brazil
| | | | - Gdayllon Cavalcante Meneses
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
| | - Geraldo Bezerra da Silva Junior
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil.,University of Fortaleza, School of Medicine, Health Sciences, Public Health and Medical Sciences Graduate Programs, Fortaleza, Brazil
| | - Elizabeth De Francesco Daher
- Federal University of Ceará, Faculty of Medicine, Department of Internal Medicine, Post-Graduation Program in Medical Sciences, Fortaleza, Brazil
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Ferreira HDS, Santos LGMDL, Ferreira CMX, Kassar SB, dos Santos TR, Vasconcelos NBR, de Assunção ML, Cardoso MA. Factors associated with childhood anaemia in Afro-descendant communities in Alagoas, Brazil. Public Health Nutr 2021; 24:4888-4898. [PMID: 33210585 PMCID: PMC11094382 DOI: 10.1017/s1368980020004711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate factors associated with anaemia in preschool children. DESIGN A home survey was conducted in 2018. Anaemia in children (capillary blood Hb level < 110 g/l) was the outcome, and socio-economic, demographic and health factors of the mother and child were the independent variables. The measure of association was the prevalence ratio, and its 95 % CI was calculated using Poisson's regression with robust variance and hierarchical selection of independent variables. SETTING Afro-descendants communities living in the state of Alagoas, northeast Brazil. PARTICIPANTS Children aged 6-59 months and their mothers (n 428 pairs). RESULTS The prevalence of child anaemia was 38·1 % (95 % CI 33·5, 42·7). The associated factors with child anaemia were male sex, age < 24 months, larger number of residents at home (> 4), relatively taller mothers (highest tertile) and higher z-score of BMI for age, after further adjustment for wealth index, vitamin A supplementation in the past 6 months and clinical visit in the last 30 d. CONCLUSIONS The high prevalence of anaemia observed reveals a relevant public health problem amongst children under five from the quilombola communities of Alagoas. Considering the damage caused to health and multiplicity of risk factors associated with anaemia, the adoption of intersectoral strategies that act on modifiable risk factors and increase vigilance concerning those that are not modifiable becomes urgent.
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Affiliation(s)
- Haroldo da Silva Ferreira
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Rua Constant Pacheco, 550, Cruz das Almas 57038-020, Maceió, AL, Brasil
- Programa de Pós-Graduação em Nutrição (mestrado), FANUT/UFAL, Maceió, AL, Brasil
- Programa de Pós-Graduação em Ciências da Saúde (doutorado), Instituto de Ciências Biológicas e da Saúde/UFAL, Maceió, AL, Brasil
| | | | | | | | - Tamara Rodrigues dos Santos
- Programa de Pós-Graduação em Ciências da Saúde (doutorado), Instituto de Ciências Biológicas e da Saúde/UFAL, Maceió, AL, Brasil
| | | | - Monica Lopes de Assunção
- Faculdade de Nutrição (FANUT), Universidade Federal de Alagoas (UFAL), Rua Constant Pacheco, 550, Cruz das Almas 57038-020, Maceió, AL, Brasil
- Programa de Pós-Graduação em Nutrição (mestrado), FANUT/UFAL, Maceió, AL, Brasil
| | - Marly Augusto Cardoso
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil
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Santos LGMDL, Ferreira CMX, Azevedo AB, Santos SLS, Kassar SB, Cardoso MA, Ferreira HDS. [Trend in the prevalence of anemia in children from maroon communities according to two population-based surveys in Alagoas State, Brazil (2008-2018)]. CAD SAUDE PUBLICA 2021; 37:e00122520. [PMID: 34586163 DOI: 10.1590/0102-311x00122520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/04/2021] [Indexed: 11/22/2022] Open
Abstract
The study aimed to assess trends in the prevalence of anemia in children from quilombos (maroon communities) in Alagoas State, Brazil. This was a descriptive study comparing the results of two household surveys (2008; n = 950 and 2018; n = 426), involving a sample of children from 6 to 59 months of age. Anemia was diagnosed as hemoglobin < 110g/L (HemoCue). Prevalence rates between the two surveys were described by percentage and by prevalence ratio (PR) and 95% confidence interval (95%CI), calculated by Poisson regression. Prevalence rates for anemia in 2008 and 2018 were 53% (95%CI: 49.8-56.1) and 38% (95%CI: 33.4-42.6), respectively, or a decrease of 28.3% (RP = 0.72; 95%CI: 0.63-0.82). Children 6 to 24 months of age had higher anemia rates than those 25 to 59 months of age, both in 2008 (72% vs. 44%) and in 2018 (54.8% vs. 28.3%). There was a reduction in prevalence in both age brackets (23.9% and 35.7%, respectively). This sharper decline in older children meant that younger children had nearly double the prevalence rate compared to older children (PR = 1.94; 95%CI: 1.53-2.46). In conclusion, there was a major decline in prevalence of anemia during the period studied, but anemia persisted as a relevant public health problem, especially in children 6 to 24 months of age. The children in the sample are exposed to harsh social vulnerabilities, evidencing that health promotion for this population requires more than actions in the public health sphere itself. Healthcare workers and administrators should be alert to the data presented here, aimed at implementation of measures to confront the social and health iniquities that contribute to greater vulnerability in this ethnic-racial group.
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Teixeira RF, Costa CM, Maria de Abreu C, Lessa CA, Carvalho AC, Kassar SB, Barreto ID, Gurgel RQ, Medeiros AM. Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil. J Perinat Med 2021; 49:506-513. [PMID: 33470964 DOI: 10.1515/jpm-2020-0313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/06/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Identifying and understanding the main risk factors associated with extubation failure of very low birthweight (VLBW) infants in different populations can subsequently help in establishing better criteria while taking decision of extubation. The aim of the study was to identify factors associated with extubation failure in VLBW infants. METHODS A cohort study of VLBW infants who underwent their first extubation between April 2018 and December 2019 in a Neonatal Intensive Care Unit, Alagoas, Brazil, were included in this study. Extubation failure was defined as reintubation within seven days of extubation. Relative risks of predictive variables different between the extubation success group (ES) and extubation failure group (EF) were estimated with a robust Poisson regression model. RESULTS Out of the 112 infants included, 26 (23%) cases exhibited extubation failure. Extremely low birth weight (RR 2.55, 95% CI 1.07, 6.06), mechanical ventilation duration for first extubation greater than seven days (RR 2.66, 95% CI 1.10, 6.45), vaginal delivery (RR 2.07, 95% CI 1.03, 4.18) and maternal chorioamnionitis (RR 4.89, 95% CI 1.26-18.98) remained independently associated with extubation failure. EF had a significant greater need for respiratory support, longer oxygen therapy duration, more bronchopulmonary dysplasia (BPD) and longer length of hospital stay, even when adjusted for confounding variables. CONCLUSIONS Extremely low birth weight infants needing mechanical ventilation, wherein the duration for first extubation was longer than seven days, with vaginal delivery and maternal chorioamnionitis failed more frequently at the first attempt of extubation. And this failure increased the risk of BPD and the length of hospital stay.
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Affiliation(s)
- Raphaela Farias Teixeira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- CESMAC University Centre, Maceió, Alagoas, Brazil
- Santa Monica Maternity School Hospital, Maceió, Alagoas, Brazil
| | | | | | | | | | | | | | - Ricardo Queiroz Gurgel
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Teixeira RF, Carvalho ACA, de Araujo RD, Veloso FCS, Kassar SB, Medeiros AMC. Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis. Respir Care 2021; 66:129-137. [PMID: 32843509 PMCID: PMC9993830 DOI: 10.4187/respcare.07928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Few data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this meta-analysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants. METHODS Following the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model. RESULTS Six studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similar in 5 of the 6 studies and included bradycardia or desaturation during the test. The SBT showed a high pooled sensitivity (0.97, 95% CI 0.85-0.99), indicating proper identification of neonates "ready" for successful extubation. However, a low pooled specificity (0.40, 95% CI 0.24-0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. Heterogeneity of included studies was considerable for sensitivity and substantial for specificity. CONCLUSIONS The SBT in premature infants can accurately predict extubation success but not extubation failure. Therefore, even though it is an attractive, practical, and easy-to-perform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.
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Affiliation(s)
- Raphaela Farias Teixeira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
- CESMAC University Centre, Maceió, Alagoas, Brazil
| | - Aline Carla Araújo Carvalho
- CESMAC University Centre, Maceió, Alagoas, Brazil
- State University of Health Sciences of Alagoas, Maceió, Alagoas, Brazil
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Silva Neto OBD, Costa CFPDA, Veloso FS, Kassar SB, Sampaio DL. Effects of vasoconstrictor use on digital nerve block: systematic review with meta-analysis. Rev Col Bras Cir 2020; 46:e20192269. [PMID: 31967242 DOI: 10.1590/0100-6991e-20192269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/28/2019] [Indexed: 11/21/2022] Open
Abstract
Conventionally, the association of local anesthetics with vasoconstrictors is avoided at extremities due to the risk of ischemia. However, recent studies suggest that there is safety in the use of vasoconstrictors at extremities. Thus, we sought to evaluate the effectiveness and safety of vasoconstrictor use combined with local anesthetics in digital nerve block compared to the use of anesthetics without vasoconstrictors, through a systematic review with meta-analysis of randomized clinical trials. Until May 2019 we searched MEDLINE, LILACS, SciELO, ScienceDirect, Scopus, ClinicalTrials.gov, and gray literature databases, without date or language restrictions. The keywords were the following: digital block, vasoconstrictor, and ischemia. We included randomized clinical trials in which there was the use of local anesthetics with associated or not with vasoconstrictors in digital blocks. In the primary variables, the occurrence of ischemic complications and the duration of anesthesia were analysed; in the secondary variables, the need for anesthetic reapplication, bleeding control, and latency were observed. Ten studies were included in this review. The occurrence of ischemia was not observed, regardless of the use of vasoconstrictors or not. The use of vasoconstrictors at a concentration of 1:100,000 or less was associated with longer anesthesia duration (P<0.00001), lower need for anesthetic reapplication (P=0.02), lower need for bleeding control (P=0.00006), and lower latency (P<0.00001). We could conclude that the use of vasoconstrictors associated with local anesthetics in digital block proved to be a safe and effective technique.
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Affiliation(s)
| | | | - Felipe Santiago Veloso
- Universidade Estadual de Ciências da Saúde de Alagoas, Curso de Medicina, Maceió, AL, Brasil
| | - Samir Buainain Kassar
- Centro Universitário Tiradentes, Curso de Medicina, Maceió, AL, Brasil.,Universidade Estadual de Ciências da Saúde de Alagoas, Curso de Medicina, Maceió, AL, Brasil
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Veloso FCS, Kassar LDML, Oliveira MJC, Lima THBD, Bueno NB, Gurgel RQ, Kassar SB. Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta‐analysis of observational studies. Jornal de Pediatria (Versão em Português) 2019. [DOI: 10.1016/j.jpedp.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Veloso FCS, Kassar LDML, Oliveira MJC, Lima THBD, Bueno NB, Gurgel RQ, Kassar SB. Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies. J Pediatr (Rio J) 2019; 95:519-530. [PMID: 31028747 DOI: 10.1016/j.jped.2018.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To identify, using a systematic review and meta-analysis of observational studies, which risk factors are significantly associated with neonatal mortality in Brazil, and to build a comprehensive national analysis on neonatal mortality. SOURCES This review included observational studies on neonatal mortality, performed between 2000 and 2018 in Brazilian cities. The MEDLINE, Elsevier, Cochrane, LILACS, SciELO, and OpenGrey databases were used. For the qualitative analysis, the Newcastle-Ottawa Scale was used. For the quantitative analysis, the natural logarithms of the risk measures and their confidence intervals were used, as well as the DerSimonian and Laird method as a random effects model, and the Mantel-Haenszel model for heterogeneity estimation. A confidence level of 95% was considered. SUMMARY OF FINDINGS The qualitative analysis resulted in six studies of low and four studies of intermediate-low bias risk. The following exposure factors were significant: absence of partner, maternal age ≥35 years, male gender, multiple gestation, inadequate and absent prenatal care, presence of complications during pregnancy, congenital malformation in the assessed pregnancy, Apgar<7 at the fifth minute, low and very low birth weight, gestational age≤37 weeks, and caesarean delivery. CONCLUSION The most significant risk factors presented in this study are modifiable, allowing aiming at a real reduction in neonatal deaths, which remain high in the country.
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Affiliation(s)
| | | | - Michelle Jacintha Cavalcante Oliveira
- Universidade Federal de Alagoas (UFAL), Faculdade de Medicina, Maceió, AL, Brazil; Centro Universitário Tiradentes, Curso de Medicina, Maceió, AL, Brazil
| | - Telmo Henrique Barbosa de Lima
- Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Curso de Medicina, Maceió, AL, Brazil; Centro Universitário Tiradentes, Curso de Medicina, Maceió, AL, Brazil
| | - Nassib Bezerra Bueno
- Universidade Federal de Alagoas (UFAL), Faculdade de Nutrição, Maceió, AL, Brazil
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de Lima THB, Amorim MM, Buainain Kassar S, Katz L. Maternal near miss determinants at a maternity hospital for high-risk pregnancy in northeastern Brazil: a prospective study. BMC Pregnancy Childbirth 2019; 19:271. [PMID: 31370813 PMCID: PMC6670122 DOI: 10.1186/s12884-019-2381-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022] Open
Abstract
Background To investigate the association between sociodemographic and obstetric variables and delays in care with maternal near misses (MNMs) and their health indicators. Methods A prospective cohort study was conducted at a high-risk maternity hospital in northeastern Brazil from June 2015 to May 2016 that included all pregnant women seen at the maternity hospital during the data collection period and excluded those who had not been discharged at the end of the study or whom we were unable to contact after the 42nd postpartum day for MNM control. We used the MNM criteria recommended by the WHO. Risk ratios (RRs) and their 95% confidence intervals (CIs) were calculated. Hierarchical multiple logistic regression analysis was performed. The p values of all tests were two-tailed, and the significance level was set to 5%. Results A total of 1094 pregnant women were studied. We identified 682 (62.4%) women without adverse maternal outcomes (WOAMOs) and 412 (37.6%) with adverse maternal outcomes (WAMOs), of whom 352 had potentially life-threatening conditions (PLTCs) (85.4%), including 55 MNM cases (13.3%) and five maternal deaths (1.2%). During the study period, 1002 live births (LBs) were recorded at the maternity hospital, resulting in an MNM ratio of 54.8/1000 LB. The MNM distribution by clinical condition identified hypertension in pregnancy (67.2%), hemorrhage (42.2%) and sepsis (12.7%). In the multivariate analysis, the factors significantly associated with an increased risk of MNM were fewer than six prenatal visits (OR: 3.13; 95% CI: 1.74–5.64) and cesarean section in the current pregnancy (OR: 2.91; 95% CI: 1.45–5.82). Conclusions The factors significantly associated with the occurrence of MNM were fewer than six prenatal visits and cesarean section in the current pregnancy. These findings highlight the need for improved quality, an increased number of prenatal visits and the identification of innovative and viable models of labor and delivery care that value normal delivery and decrease the percentage of unnecessary cesarean sections.
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Affiliation(s)
- Telmo Henrique Barbosa de Lima
- Health Sciences University of Alagoas (UNCISAL), Rua Dr. Mario Nunes Vieira, 149 - Apto. 201, Jatiuca, Maceió, AL, Brazil.
| | - Melania Maria Amorim
- Prof. Fernando Figueira Institute of Integral Medicine (IMIP), Department of Obstetrics and Gynecology, Recife, Brazil
| | | | - Leila Katz
- Prof. Fernando Figueira Institute of Integral Medicine (IMIP), Obstetric Intensive Care Unit, IMIP, Recife, Brazil
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Bezerra FD, Menezes MADS, Mendes RB, Santos JMDJ, Leite DCF, Kassar SB, Gurgel RQ. PERINATAL CARE IN A NORTHEASTERN BRAZILIAN STATE: STRUCTURE, WORK PROCESSES, AND EVALUATION OF THE COMPONENTS OF ESSENTIAL NEWBORN CARE. Rev Paul Pediatr 2019; 37:140-148. [PMID: 30810691 PMCID: PMC6651313 DOI: 10.1590/1984-0462/;2019;37;2;00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. METHODS A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants' records, were also analyzed. RESULTS Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. CONCLUSIONS The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.
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de Lima THB, Katz L, Kassar SB, Amorim MM. Neonatal near miss determinants at a maternity hospital for high-risk pregnancy in Northeastern Brazil: a prospective study. BMC Pregnancy Childbirth 2018; 18:401. [PMID: 30314456 PMCID: PMC6186100 DOI: 10.1186/s12884-018-2020-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 09/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the associations of maternal variables - sociodemographic, obstetrical and maternal near miss (MNM) variables - with neonatal near miss (NNM) using the new concept of NNM formulated by the Centro Latino-Americano de Perinatologia (CLAP) and the corresponding health indicators for NNM. METHODS An analytical prospective cohort study was performed at maternity hospital for high-risk pregnancy in Northeastern Brazil. Puerperal women whose newborn infants met the selection criteria were subjected to interviews involving pretested questionnaires. Statistical analysis was performed with the Epi Info 3.5.1 program using the Chi square test and Fisher's exact test when appropriate, with a level of significance of 5%. A bivariate analysis was performed to evaluate differences between the groups. All the variables evaluated in the bivariate analysis were subsequently included in the multivariate analysis. For stepwise logistic regression analysis, a hierarchical model was plotted to assess variable responses and adverse outcomes associated with MNM and NNM variables. RESULTS There were 1002 live births (LB) from June 2015 through May 2016, corresponding to 723 newborn infants (72.2%) without any neonatal adverse outcomes, 221 (22%) NNM cases, 44 (4.4%) early neonatal deaths and 14 (1.4%) late neonatal deaths. The incidence of NNM was 220/1000 LB. Following multivariate analysis, the factors that remained significantly associated with increased risk of NNM were fewer than 6 prenatal care visits (odds ratio (OR): 3.57; 95% confidence interval (CI): 2.57-4.94) and fetal malformations (OR: 8.78; 95% CI: 3.69-20.90). Maternal age older than 35 years (OR: 0.43; 95% CI: 0.23-0.83) and previous cesarean section (OR: 0.45; 95% CI: 0.29-0.68) protected against NNM. CONCLUSION Based on the large differences between the NNM and neonatal mortality rates found in the present study and the fact that NNM seems to be a preventable precursor of neonatal death, we suggest that all cases of NNM should be audited. Inadequate prenatal care and fetal malformations increased the risk of NNM, while older maternal age and a history of a previous cesarean section were protective factors.
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Affiliation(s)
- Telmo Henrique Barbosa de Lima
- Health Sciences University of Alagoas (UNCISAL), Maceió, Brazil
- Health Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Maternidade Santa Mônica, Maceió, Brazil
| | - Leila Katz
- Postgraduate Program, Fernando Figueira Institute of Integral Medicine (IMIP), Obstetric Intensive Care Unit, IMIP, Recife, Brazil
| | | | - Melania Maria Amorim
- Postgraduate Program, Fernando Figueira Institute of Integral Medicine (IMIP), Obstetric Intensive Care Unit, IMIP, Recife, Brazil
- Federal University of Campina Grande (UFCG), Campina Grande, Brazil
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