Qual Deve Ser o Tratamento de Primeira Linha para o Fechamento de Persistência de Canal Arterial Hemodinamicamente Significativo em Bebês Prematuros? / What Should be the First-line Treatment for the Closure of Hemodynamically Significant Patent Ductus Arteriosus in Premature Infants?

Resumo Fundamento É importante saber qual medicamento usar como tratamento de primeira linha para fechar o duto. Objetivos O objetivo deste estudo é comparar a eficácia e os efeitos colaterais das formas intravenosas (IV) de ibuprofeno e paracetamol e contribuir para a literatura investigando o primeiro medicamento selecionado no tratamento clínico da persistência do canal arterial (PCA). Métodos Nosso estudo foi realizado entre janeiro de 2017 e dezembro de 2019. Foram incluídos no estudo bebês prematuros com peso ao nascer (PN) ≤1500 g e idade gestacional (IG) ≤32 semanas. No período do estudo, todos os bebês com persistência do canal arterial hemodinamicamente significativa (hsPCA) receberam ibuprofeno intravenoso (IV) como resgate como tratamento clínico primário ou tratamento com paracetamol IV se houvesse contraindicações para o ibuprofeno. Os pacientes foram divididos em dois grupos: pacientes que receberam ibuprofeno IV e pacientes que receberam paracetamol IV. Resultados Desses pacientes, 101 receberam paracetamol IV e 169 receberam ibuprofeno IV. A taxa de sucesso do fechamento da PCA com o primeiro curso do tratamento foi de 74,3% no grupo de paracetamol IV e 72,8% no grupo de ibuprofeno IV (p=0,212). Conclusões Nossos resultados mostram que o paracetamol IV é tão eficaz quanto o ibuprofeno IV no tratamento de primeira linha de hsPCA, podendo se tornar o tratamento preferencial para o controle de hsPCA.

Abstract Background It is important which medicine to use as a first-line treatment to close the duct. Objectives The aim of this study is to compare the effectiveness and side effects of intravenous (IV) forms of ibuprofen and paracetamol and to contribute to the literature investigating the first drug selected in the medical treatment of patent ductus arteriosus (PDA). Methods Our study was conducted between January 2017 and December 2019. Premature infants with birth weight (BW) ≤1500 g and gestational age (GA) ≤32 weeks were included in the study. In the study period, all infants with hemodynamically significant patent ductus arteriosus (hsPDA) were given rescue intravenous (IV) ibuprofen as a primary medical treatment or IV paracetamol treatment if there were contraindications for ibuprofen. The patients were divided into two groups: patients receiving IV ibuprofen and patients receiving IV paracetamol. Results Of these patients, 101 were given IV paracetamol and 169 were given IV ibuprofen. The success rate of PDA closure with first-course treatment was 74.3% in the IV paracetamol group and 72.8% in the IV ibuprofen group (p=0.212). Conclusions Our results show that IV paracetamol is as effective as IV ibuprofen in the first-line treatment of hsPDA, and can become the preferred treatment for the management of hsPDA.

Manifestaciones clínicas post vacunación con AstraZeneca en docentes de la Unidad Educativa Emilio LorenzoStehle / Clinical manifestations post vaccination with AstraZeneca in teachers of Emilio Lorenzo Stehle School

RESUMEN Introducción: La vacuna AstraZeneca contra la COVID-19 es un tema coyuntural, por ser una de las vacunas de mayor acceso a nivel mundial para hacer frente a esta enfermedad. Sin embargo, presenta manifestaciones clínicas como cualquier otra vacuna, que van de leves a severas, se presenta de distinta manera en cada persona inoculada y en ciertas ocasiones generan desconfianza por sus efectos adversos a corto plazo. Objetivo: Determinar las manifestaciones clínicas post inoculación con la vacuna AstraZeneca contra la COVID-19. Métodos: Se efectuó un estudio descriptivo, con diseño de corte transversal, con enfoque cuantitativo en la Unidad Educativa Emilio Lorenzo Stehle de Santo Domingo de los Tsáchilas Ecuador, con una población de 23 docentes que participaron con su debido consentimiento informado. Se empleó el instrumento de cuestionario que constó de siete preguntas formuladas de acuerdo a las variables de investigación. Resultados: Las manifestaciones clínicas tras la vacunación con AstraZeneca con mayor incidencia fueron el dolor muscular, dolor de cabeza y fiebre; cabe mencionar que existen personas que no tuvieron ningún signo o síntoma. Además, un punto preocupante en un mínimo porcentaje la severidad de las manifestaciones clínicas que se trataron en su mayoría con paracetamol. Conclusiones: Las manifestaciones fueron de intensidad leve de manera esencial en las docentes de género femenino, los síntomas duraron hasta tres días, se usó el paracetamol para aliviar el malestar.

ABSTRACT Introduction: The AstraZeneca vaccine against COVID-19 is a current issue as it is one of the most widely available vaccines in the world to deal with this disease. However, it presents clinical manifestations, likewise other vaccine, that range from mild to severe, presenting differently in each inoculated person and that, on certain occasions, generate mistrust due to its short-term adverse effects. Objective: To determine the clinical manifestations after inoculation with the AstraZeneca vaccine against COVID-19. Methods: A descriptive study with a cross-sectional design with a quantitative approach was carried out in the Emilio Lorenzo Stehle School in Santo Domingo de los Tsáchilas-Ecuador, with a population of 23 teachers who participated with their informed consent. The data collection instrument was a questionnaire which consisted of seven questions formulated according to the research variables. Results: The clinical manifestations after vaccination with AstraZeneca with the highest incidence were muscle pain, headache and fever. It is worth mentioning that there are people who did not have any symptom. In addition, a point of concern in a minimum percentage is the severity of the clinical manifestations that were mostly treated with paracetamol. Conclusions: The manifestations were of mild intensity, mainly in female teachers, with symptoms lasting up to three days, especially using paracetamol to alleviate discomfort.