Controles de salud durante la pandemia e impacto clínico del COVID-19 en niños con enfermedad neuromuscular / Health checkups during the pandemic and clinical impact of COVID-19 in children with neuromuscular disease

Introducción. Los niños con enfermedad neuromuscular (ENM) requieren cuidados crónicos de salud (CCS) y podrían presentar COVID-19 grave. Objetivos. Describir CCS para niños con ENM durante la pandemia y evolución del COVID-19 en este grupo. Población y métodos. Cohorte prospectiva unicéntrica. Se incluyeron pacientes de 2-18 años, con ≥ 1 año de seguimiento previo a la pandemia. Se recolectaron variables demográficas, relativas a los CCS y al COVID-19 mediante historias clínicas y encuestas telefónicas. Resultados. Se incluyeron 226 pacientes; el 71 % varones, mediana de edad 11,3 años. Presentaban distrofias musculares (55,7 %) y atrofia muscular espinal (23 %). Comparando el primer año de pandemia con el previo, el 30 % no realizó controles médicos y el 25 % no realizó kinesioterapia. Otros disminuyeron la frecuencia. Hubo 52 casos de COVID-19. Fueron sintomáticos el 82 %: el 88,4 % leves/moderados y el 11,6 % graves. No hubo fallecidos. Conclusiones. La pandemia impactó negativamente en los CCS y los casos de COVID-19 fueron mayormente leves.

Introduction. Children with neuromuscular disease (NMD) require chronic health care (CHC) and may develop severe COVID-19. Objectives. To describe CHC for children with NMD during the pandemic and the course of COVID-19 in this group. Population and methods. Prospective, single-center cohort. Patients aged 2 to 18 years with ≥ 1 year of follow-up prior to the pandemic were included. Demographic variables in relation to CHC and COVID-19 were collected from medical records and via telephone surveys. Results. A total of 226 patients with a median age of 11.3 years were included; 71% were males. They had muscular dystrophy (55.7%) and spinal muscular atrophy (23%). When comparing the first year of the pandemic with the previous year, 30% did not have a health checkup and 25% did not receive kinesiotherapy. Others did, but with a lower frequency. A total of 52 COVID-19 cases were reported; 82% were symptomatic: 88.4% were mild/moderate and 11.6%, severe. No patient died. Conclusions. The pandemic had a negative impact on CHC, and COVID-19 cases were mostly mild.

Seguimiento de niños con diagnóstico de asma grave antes y durante la pandemia por COVID-19 / Follow-up of children diagnosed with severe asthma before and during the COVID-19 pandemic

En la pandemia por COVID-19 se exploraron estrategias de atención para garantizar el seguimiento de niños con asma grave. Estudio prospectivo, observacional, comparativo. Se incluyeron pacientes del programa de asma grave de un hospital pediátrico de tercer nivel (n 74). Se evaluó el grado de control, exacerbaciones y hospitalizaciones durante un período presencial (PP), marzo 2019-2020, y uno virtual (PV), abril 2020-2021. En el PP, se incluyeron 74 pacientes vs. 68 (92 %) del PV. En el PP, el 68 % (46) de los pacientes presentaron exacerbaciones vs. el 46 % (31) de los pacientes en el PV (p 0,003). En el PP, se registraron 135 exacerbaciones totales vs. 79 en el PV (p 0,001); hubo una reducción del 41 %. En el PP, el 47 % (32) de los pacientes tuvieron exacerbaciones graves vs. el 32 % (22) de los pacientes en el PV (p 0,048). Hubo 91 exacerbaciones graves en el PP vs. 49 en el PV (p 0,029), reducción del 46 %. No hubo diferencias en las hospitalizaciones (PP 10, PV 6; p 0,9). La telemedicina fue efectiva para el seguimiento de pacientes con asma grave

During the COVID-19 pandemic, health care strategies were explored to ensure the follow-up of children with severe asthma. This was a prospective, observational, and comparative study. Patients in the severe asthma program of a tertiary care children's hospital were included (n: 74). The extent of control, exacerbations, and hospitalizations during an in-person period (IPP) (March 2019­2020) and an online period (OP) (April 2020­2021) was assessed. A total of 74 patients were enrolled in the IPP compared to 68 (92%) in the OP. During the IPP, 68% (46) of patients had exacerbations versus 46% (31) during the OP (p = 0.003). During the IPP, 135 total exacerbations were recorded compared to 79 during the OP (p = 0.001); this accounted for a 41% reduction. During the IPP, 47% (32) of patients had severe exacerbations versus 32% (22) during the OP (p = 0.048). A total of 91 severe exacerbations were recorded during the IPP compared to 49 during the OP (p = 0.029); the reduction was 46%. No differences were observed in terms of hospitalization (IPP: 10, OP: 6; p = 0,9). Telemedicine was effective for the follow-up of patients with severe asthma.

Orientaciones para el manejo ambulatorio de adultos que viven con VIH en Chile / Guidelines for the primary care of adult people living with HIV in Chile

El enfrentamiento de las personas que viven con VIH es amplio y requiere dedicación en múltiples dimensiones, más allá de la terapia antirretroviral. Estas recomendaciones abordan el manejo desde el diagnóstico, primera visita, seguimiento, manejo de comorbilidades infecciosas y no infecciosas, tamizaje de neoplasias, profilaxis antimicrobiana y vacunas, entre otras.

Management of people living with HIV is broad and multiple dimensions must be considered, beyond antiretroviral therapy. These recommendations include management from diagnosis, first visit, patient follow-up, infectious and non-infectious comorbidities, malignancies screening, antimicrobial and immunizations prophylaxis, among others.

Persistencia de signos y síntomas a los 6 meses posinfección por chikungunya en pacientes de un hospital público en Paraguay

Introducción: El virus chikungunya (CHIKV) causa una enfermedad con manifestaciones agudas bien documentadas, pero existen pocos datos sobre la persistencia de síntomas y secuelas a largo plazo. Objetivos: Evaluar la persistencia de signos, síntomas y factores asociados en pacientes con infección por CHIKV en un seguimiento de 6 meses posinfección. Materiales y métodos: Estudio de cohorte ambispectivo que incluyó casos confirmados de CHIKV notificados en abril de 2023 en Coronel Oviedo, Paraguay. Se realizaron entrevistas al mes, a los tres meses y a los 6 meses posinfección. Se analizaron características demográficas, comorbilidades, manifestaciones reumáticas y sintomáticas. Resultados: Ingresaron 333 participantes, completando seguimiento a 6 meses 170 pacientes. A los 6 meses persistieron: dolor de espalda (61.2%), artritis (57.1%), cefalea (54.1%), fatiga (51.2%), mialgia (49.4%), debilidad (47.6%), depresión (45.9%) y artralgia (45.9%). La persistencia de artritis (OR 7.54; p=0.008) y mialgia (OR 3.24; p=0.031) a 6 meses fue mayor en el grupo de 36-45 años. Conclusiones: Alta persistencia de síntomas musculoesqueléticos y fatiga hasta 6 meses posinfección, con tendencia decreciente, pero exacerbación de depresión. Edad entre 36-45 años asociada a mayor persistencia. Se requieren protocolos de seguimiento integral, investigar mecanismos fisiopatológicos y fortalecer prevención, dado el impacto individual y socioeconómico de la enfermedad.

Introduction: Chikungunya virus (CHIKV) causes a disease with well-documented acute manifestations, but there is limited data on the persistence of symptoms and long-term sequelae. Objectives: To evaluate the persistence of signs, symptoms, and associated factors in patients with CHIKV infection during a 6-month post-infection follow-up. Material and Methods: An ambispective cohort study that included confirmed cases of CHIKV reported in April 2023 in Coronel Oviedo, Paraguay. Interviews were conducted at 1, 3 and 6 months post-infection. Demographic characteristics, comorbidities, rheumatic, and symptomatic manifestations were analyzed. Results: 333 participants were enrolled, with 170 patients completing the 6-month follow-up. At 6 months, the following symptoms persisted: back pain (61.2%), arthritis (57.1%), headache (54.1%), fatigue (51.2%), myalgia (49.4%), weakness (47.6%), depression (45.9%), and arthralgia (45.9%). The persistence of arthritis (OR 7.54, p=0.008) and myalgia (OR 3.24, p=0.031) at 6 months was higher in the 36-45 age group. Conclusions: High persistence of musculoskeletal symptoms and fatigue up to 6 months post-infection, with a decreasing trend but exacerbation of depression. Age between 36-45 years was associated with greater persistence. Comprehensive follow-up protocols, investigation of pathophysiological mechanisms, and strengthening prevention are required, given the individual and socioeconomic impact of the disease.

Guía de práctica clínica para el tratamiento y seguimiento de personas con cáncer diferenciado de tiroides. Parte I: Vigilancia activa

Introducción: El cáncer de tiroides es una enfermedad frecuente en el mundo, con mayor prevalencia del tipo diferenciado. El diagnóstico temprano y manejo pertinente, individualizado y adaptable puede mejorar su pronóstico. Objetivo: Generar recomendaciones basadas en evidencia sobre el tratamiento y seguimiento de personas adultas con cáncer diferenciado de tiroides (CDT). Metodología: Guía de práctica clínica (GPC) a partir de revisión sistemática de literatura (RSL) y consenso de expertos clínicos. El grupo desarrollador definió el alcance y cuatro preguntas que se resolvieron a través de revisión de evidencia de GPC existentes, RSL, estudios primarios publicadas en español o inglés en diferentes fuentes de información desde 2013. Las preguntas de investigación fueron: 1. ¿Cuáles son las indicaciones de la vigilancia activa?, ¿cómo realizarla?, ¿cuándo y con que periodicidad realizarla? 2. ¿Cuál es el tratamiento y su indicación en pacientes con nódulos tiroideos sospechosos de cáncer? 3. ¿Cómo y cuándo realizar seguimiento de pacientes con CDT de acuerdo con el riesgo dinámico? 4. ¿Cuál es el manejo actual de los pacientes iodo refractarios? Se propusieron recomendaciones basadas en la evidencia, y analizadas y discutidas por el colectivo experto en sesiones asincrónicas. Se evalúo la calidad de la evidencia y las recomendaciones fueron gradadas en fuerte o condicional y a favor o en contra a partir del análisis de la calidad de la evidencia, contexto de implementación (disponibilidad e implementación) y la experticia clínica. En el presente documento se desarrollada la primera pregunta, referente a vigilancia activa. Resultados: 86 recomendaciones fueron propuestas y acordadas por el grupo desarrollador, categorizadas en tratamiento y seguimiento para resolver las preguntas planteadas. 10 de las recomendaciones corresponden a vigilancia activa y se incluyen en el presente documento. Recomendaciones claves incluyen, brindar información completa y oportuna a pacientes, conformación de equipos multidisciplinarios, análisis individualizado del paciente para la decisión de tratamiento, estadificación rutinaria de riesgo dinámico para evaluar la respuesta al tratamiento y ajustarlo, minimización de procedimientos fútiles o que aportan poco a la supervivencia y calidad de vida de los pacientes. Conclusión: Se presentan recomendaciones que esperan incidir en la estandarización de la práctica clínica cotidiana de pacientes con CDT y mejores resultados en salud.

Introduction: Thyroid cancer is a common disease in the world, with a higher prevalence of the differentiated type. Early diagnosis individualized and adaptive management can improve prognosis. Objective: Generate evidence-based recommendations on the treatment and follow-up of adults with differentiated thyroid carcinoma (DTC). Methodology: Clinical practice guideline (CPG) based on systematic literature review (RSL) and consensus of clinical experts. The development group defined the range and four questions that were resolved through a review of evidence from existing CPGs, RSLs, primary studies published in Spanish or English in various sources of information since 2013. The research questions were: 1. What are the indications for active surveillance? How to carry it out? When and how often to carry it out? 2. What is the treatment and its indication in patients with thyroid nodules suspicious for cancer? 3. How and when to follow up patients with CDT according to dynamic risk? 4. What is the current management of iodine refractory patients? Evidence-based recommendations analyzed and discussed by the expert group in asynchronous sessions were proposed. The quality of the evidence was evaluated, and the recommendations were graded as strong or conditional and in favor or against based on the analysis of the quality of the evidence, implementation context (availability and implementation) and clinical expertise. In this document, is developed the first question, referring to active surveillance. Results: 86 recommendations were proposed and agreed upon by the development group, categorized into treatment and follow-up to solve the questions raised. 10 of the recommendations correspond to active surveillance and are included in this document. Key recommendations include providing complete and timely information to patients, develop of multidisciplinary teams, individualized patient analysis for treatment decisions, routine dynamic risk staging to evaluate response to treatment and adjust it, minimization of futile procedures or that contribute little to the survival and quality of life of patients. Conclusion: Recommendations are presented that longs to influence the standardization of the daily clinical practice of patients with DTC and better health outcomes.

Congenital hyperinsulinism and surgical outcome in a single tertiary center in Brazil

Abstract Objective: Congenital hyperinsulinism (CHI) is a heterogeneous genetic disease characterized by increased insulin secretion and causes persistent hypoglycemia in neonates and infants due to dysregulation of insulin secretion by pancreatic β cells. Babies with severe hypoglycemia and for whom medical treatment has been ineffective usually require surgical treatment with near-total pancreatectomy. To evaluate the clinical and surgical aspects affecting survival outcomes in babies diagnosed with CHI in a single tertiary care center. Methods: Retrospective Cohort study involving a single university tertiary center for the treatment of CHI. The authors study the demographics, clinical, laboratory, and surgical outcomes of this casuistic. Results: 61 % were female, 39 % male, Birth weight: 3576 g (±313); Age of onset of symptoms: from the 2nd hour of life to 28 days; Time between diagnosis and surgery ranged between 10 and 60 days; Medical clinical treatment, all patients received glucose solution with a continuous glucose infusion and diazoxide. 81 % of the patients used corticosteroids, 77 %. thiazide, 72 % octreotide, 27 % nifedipine; Neurological sequelae during development and growth: 54 % had some degree of delay in neuropsychomotor development, 27 % obesity. Surgery was performed open in 6 and 12 minimally invasive surgery (MIS). Histopathology: 2 focal and 16 diffuse, Length of stay (days) was lower in MIS (p < 0.05). Survival was 100 %. Conclusions: CHI is a rare and difficult-to-manage tumor that must be performed in a multidisciplinary and tertiary center. Most surgical results are good and the laparoscopic approach to disease has been the best choice for patients.

Calidad asistencial y seguimiento de los pacientes operados por cáncer colorrectal en un Hospital de Paysandú, Uruguay / Quality of care and follow-up of patients operated on forcolorectal cancer at the Paysandú Hospital, Uruguay

Introducción: el cáncer colorrectal (CCR) es la segunda causa de muerte dentro de las enfermedades neoplásicas. El pronóstico individual está signado por el estadio de la enfermedad al momento del diagnóstico y la posibilidad de realizar un tratamiento curativo. Este también depende de la estratificación post quirúrgica y de la aparición de complicaciones ulteriores. El objetivo del seguimiento es diagnosticar la recidiva en un estadio potencialmente curable y detectar otros cánceres primarios. Objetivo: realizar una valoración de la calidad de la cirugía colorrectal y el seguimiento de los pacientes operados de CCR en nuestro hospital. Diseño: estudio descriptivo, observacional, retrospectivo. Material y métodos: se analizaron todos los pacientes con CCR operados en el servicio de cirugía del Hospital de Paysandú entre enero de 2017 y diciembre de 2020. Se describen diversas variables que influyen en la calidad quirúrgica y se analizan las relacionadas al seguimiento post operatorio dividiendo a los pacientes en 3 grupos, seguimiento completo, perdidos y sin datos de seguimiento. Resultados: se incluyeron 39 pacientes, con una edad media de 68 años. El 28% se diagnosticaron en estadio IV, con porcentajes bajos en estadios tempranos. Hubo 57% de cirugías de urgencia y 43% electivas. La causa más frecuente de urgencia fue la oclusión intestinal (36,6%). La tasa de dehiscencia anastomótica fue 16,6% y la de mortalidad 15,3%. Solo el 33% de los pacientes tuvieron seguimiento completo. Conclusión: existe un déficit en la atención y el seguimiento de los pacientes operados por CCR en nuestro hospital. Se impone la creación de un equipo específico en el área de coloproctología, así como un protocolo de seguimiento unificado para mejorar estos resultados. (AU)

Introduction: colorectal cancer (CRC) is the second cause of death among neoplastic diseases. The individual prognosis is determined by the stage of the disease at the time of diagnosis and the possibility of curative treatment. This also depends on the postsurgical stratification and the appearance of subsequent complications. The goal of follow-up is to diagnose recurrence at a potentially curable stage and detect other primary cancers. Objective: to carry out an evaluation of the quality of colorectal surgery and the follow-up of patients operated on for CRC in our hospital. Design: descriptive, retrospective observational study. Material and methods: all patients with CRC operated on in the surgery service of the Paysandú Hospital between January 2017 and December 2020 were analyzed. Variables that influence surgical quality are described and those related to postoperative follow-up are analyzed by dividing patients in 3 groups, complete follow-up, lost to follow-up and without follow-up data. Results: Thirty-nine patients were included, with a mean age of 68 years. Twenty-eight percent were diagnosed in stage IV, with low percentages in early stages. There were 57% emergency procedures and 43% elective proceduress. The most common cause of emergency was intestinal obstruction (36.6%). The anastomotic dehiscence rate was 16.6% and the mortality rate was 15.3%. Only 33% of patients had complete follow-up. Conclusion: there is a deficit in the care and follow-up of patients undergoing CRC surgery in our hospital. The creation of a specific team in the area of coloproctology is required, as well as a unified monitoring protocol to improve these results. (AU)

Seguimiento Funcional hasta Seis Meses después de Sobrevivir a Cuidados Intensivos: Lecciones aprendidas de un Estudio Chileno Multicéntrico / Functional follow-up six months after surviving intensive care: lessons learned from a Chilean multicenter study

Introducción. Las tasas de retención en los estudios de seguimiento oscilan entre el 32 y 100%, demostrando el desafío que implica realizar estudios longitudinales de sobrevivientes de la unidad de cuidados intensivos (UCI). Objetivo. Identificar las estrategias implementadas y lecciones aprendidas en un estudio prospectivo multicéntrico de seguimiento de sobrevivientes de la UCI durante la pandemia. Métodos. Estudio post-hoc de las lecciones aprendidas mediante encuestas y entrevistas dirigidas a explorar la experiencia de los investigadores y coordinadores del estudio IMPACCT COVID-19, realizado en siete centros chilenos entre octubre 2020 y abril 2021 evaluando el síndrome post-cuidados intensivos de sobrevivientes hasta seis meses después. Resultados. Identificamos ocho lecciones: 1) selección de instrumentos de medición, 2) identificación de centros participantes, 3) aprobación del estudio, 4) financiamiento, 5) capacitación de evaluadores, 6) coordinación/aseguramiento de calidad, 7) reclutamiento y 8) seguimiento de pacientes. Incluso durante el primer año de pandemia, reclutamos 252 pacientes a una tasa de 1,4 pacientes/día con una retención del 48% a los 6 meses de seguimiento. El uso de redes académicas existentes y las estrategias de comunicación entre investigadores, coordinadores y evaluadores fueron aspectos positivos; mientras que la fidelización con evaluadores al egreso de la UCI y con pacientes durante el seguimiento son aspectos que deberían considerarse en futuros estudios. Conclusiones. Se evaluaron más de 250 pacientes en seis meses durante la pandemia, con tasas de retención post UCI acorde a la literatura. Futuros estudios debiesen optimizar los procesos de medición y de seguimiento para minimizar la pérdida de pacientes.

Background. Retention rates of follow-up studies range from 32 to 100%, demonstrating the challenge to conduct longitudinal studies of intensive care unit (ICU) survivors. Objective. To identify the strategies implemented and lessons learned in a multicenter prospective follow-up study of ICU survivors during pandemic times. Methods. Post-hoc study of lessons learned through surveys and interviews aimed at exploring the experience of the researchers and coordinators of the IMPACCT COVID-19 study. The original study was performed in seven Chilean sites between October 2020 and April 2021 evaluating the post-intensive care syndrome of survivors up to six-month follow-up. Results. We identified eight lessons: 1) selection of measurement instruments, 2) identification of participating sites, 3) Study approval, 4) funding, 5) evaluators training, 6) coordination/quality assurance, 7) recruitment, and 8) patient follow-up. Even during the first year of the pandemic, we recruited 252 patients at a rate of 1.4 patients/day with a retention rate of 48% at 6 months of follow-up. The use of existing academic networks and communication strategies between researchers, coordinators and evaluators were positive aspects; while evaluators fidelity at ICU discharge and patient engagement during follow-up are aspects should be considered. Conclusions. More than 250 patients were evaluated in six months during the pandemic, with post-ICU retention rates consistent with the literature. Future studies should optimize measurement and monitoring processes to minimize patient atrition.

Desfechos das inserções de dispositivos intrauterinos por enfermeiros em instituições de saúde: revisão integrativa / Outcomes of intrauterine device insertions by nurses in healthcare institutions: an integrative review

RESUMO Objetivo identificar quais os desfechos das inserções de dispositivos intrauterinos por enfermeiros em instituições de saúde. Métodos revisão integrativa realizada em oito bases de dados, com auxílio de um gerenciador de referências bibliográficas, utilizando o modelo de JBI para a análise do nível de evidência. Os dados foram organizados, categorizados e discutidos por meio de síntese descritiva. Resultados 10 estudos compuseram a amostra final, sendo dois apenas com enfermeiros e os demais com enfermeiros e médicos. Os principais desfechos avaliados foram perfuração e expulsão, sem diferenças significativas entre os profissionais que realizaram o procedimento. As taxas de sucesso, continuidade e satisfação foram semelhantes entre médicos e enfermeiros. Conclusão os desfechos das inserções de dispositivos intrauterinos por enfermeiros em instituições de saúde são similares aos realizados por médicos, com ampliação do acesso, sem aumentar as complicações relacionadas a esse método contraceptivo, contribuindo para a integralidade da assistência no campo do planejamento reprodutivo. Contribuições para a prática: os achados podem contribuir para o enfrentamento de barreiras pelos enfermeiros, servindo como subsídio para diretrizes e políticas de saúde que incentivem a inserção do dispositivo intrauterino por estes profissionais, principalmente, em contextos onde esta prática ainda não ocorre.

ABSTRACT Objective to identify the outcomes of intrauterine device insertions by nurses in healthcare institutions. Methods integrative review carried out in eight databases, with the help of a bibliographic reference manager, using the JBI model for analyzing the evidence level. The data was organized, categorized and discussed using descriptive summaries. Results 10 studies made up the final sample, two with nurses only and the others with nurses and physicians. The main outcomes assessed were perforation and expulsion, with no significant differences between the professionals who performed the procedure. Success rates, continuity and satisfaction were similar between physicians and nurses. Conclusion the outcomes of intrauterine device insertions by nurses in health institutions are similar to those carried out by physicians, with increased access, without increasing the complications related to this contraceptive method, contributing to comprehensive care in the field of reproductive planning. Contributions to practice: the findings could help nurses to tackle barriers and serve as a basis for guidelines and health policies that encourage the insertion of the intrauterine device by these professionals, especially in contexts where this practice does not yet take place.

Instability of tear film and loss of meibomian glands in patients with acne vulgaris / Instabilidade do filme lacrimal e perda de glândulas meibomianas em pacientes com acne vulgaris

ABSTRACT Purpose: In this prospective study, we compared ocular clinical variables in patients with acne vulgaris with those of healthy controls. These variables included tear film break-up time, meibomian gland dropout rate, and anterior chamber parameters. Methods: Our sample comprised 73 eyes from 73 patients with acne vulgaris and 67 eyes from 67 healthy controls. All participants underwent a non-invasive first tear film break-up time test and the average tear film break-up time was evaluated. Meibography was used to identify any meibomian gland dropout. The parameters of the cornea and anterior chamber were measured using Scheimpflug topography imaging. Finally, the ocular surface disease index questionnaire was administered to score each participant on their subjective experience of ocular complaints. Results: The noninvasive first tear film break-up time values of the acne vulgaris Group and the control Group were 4.7 ± 2.8 and 6.4 ± 3.5 sec, respectively. There was a significant difference between the groups (p=0.016). The number of eyes with tear break-up at any time during the measurement period was also significantly higher in the acne Group (p=0.018). In the acne vulgaris Group, the mean meibomian gland dropout rates were 33.21 ± 15.5% in the upper lids and 45.4 ± 14.5% in the lower lids. In the control group, these rates were 15.7 ± 6.9% and 21 ± 9.7% respectively. Dropout was significantly higher in the acne group for both the upper and lower lids (p=0.000). Conclusion: We found impaired tear stability in patients with acne vulgaris and a high rate of meibomian gland dropout. These glands play a key role in tear stability and their dropout is likely to result in evaporative dry eye. Measurement of the variables in this study allows objective diagnosis of this condition using a non-invasive, dye-free methodology, with minimum contact.

RESUMO Objetivo: Neste estudo prospectivo, pacientes com acne vulgaris e indivíduos saudáveis do grupo controle foram comparados em relação ao tempo de ruptura do filme lacrimal, taxa de abandono de glândulas meibomianas e parâmetros da câmara anterior, usando o tempo de ruptura do filme lacrimal topográfico não invasivo, meibografia não invasiva e fotografia de Scheimpflug, respectivamente. Métodos: Setenta e três olhos de 73 pacientes com acne vulgaris e 67 olhos de 67 indivíduos saudáveis foram incluídos. Todos os participantes submetidos ao primeiro tempo de ruptura do filme lacrimal não-invasivo e ao tempo médio de ruptura do filme lacrimal não-invasivo foram avaliados pelo uso do tempo de ruptura do filme lacrimal; perda de glândulas meibomianas foram avaliadas por meibografia; os parâmetros da córnea e da câmara anterior foram medidos por fotografia de Scheimpflug; e, finalmente, as queixas oculares subjetivas foram pontuadas com o uso do questionário do Indice de doenças de superfície ocular. Resultados: Os valores do tempo de ruptura do primeiro filme lacrimal não-invasivo do Grupo com acne vulgaris e do Grupo controle foram 4,7 ± 2,8 e 6,4 ± 3,5 segundos, respectivamente, refererindo-se a uma diferença significativa entre os valores dos grupos (p=0,016). Qualitativamente, o número de olhos com ruptura lacrimal a qualquer momento durante o período de medição foi significativamente maior no grupo de pacientes. (p=0,018). No Grupo com acne vulgaris, a perda de glândulas meibomianas nas pálpebras superiores foi de 33,21 ± 15,5% e nas pálpebras inferiores foi de 45,4 ± 14,5%; por outro lado, no Grupo controle foi de 15,7 ± 6,9% e 21 ± 9,7% respectivamente; ambos os casos referem-se a uma diferença significativa entre os grupos (p=0,000). Conclusão: Encontramos estabilidade comprometida do filme lacrimal em pacientes com acne vulgaris. No entanto, o comprometimento foi de grau muito menor, em comparação com a taxa de perda das glândulas meibomianas que desempenham um papel fundamental na estabilidade do filme lacrimal. Esta condição pode ser documentada de forma objetiva - uma metodologia parcialmente sem contato, totalmente não-invasiva e livre de corantes.

Prognostic Impact of Residual Moderate Mitral Regurgitation Following Valve-in-Valve Transcatheter Aortic Valve Implantation

ABSTRACT Introduction: The impact of mitral regurgitation (MR) on valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with failed bioprostheses remains unclear. The purpose of this study was to assess the prognostic impact of residual moderate MR following VIV-TAVI. Methods: We retrospectively analyzed 127 patients who underwent VIV-TAVI between March 2010 and November 2021. At least moderate MR was observed in 51.2% of patients before the procedure, and MR improved in 42.1% of all patients. Patients with postoperative severe MR, previous mitral valve intervention, and patients who died before postoperative echocardiography were excluded from further analyses. The remaining 114 subjects were divided into two groups according to the degree of postprocedural MR: none-mild MR (73.7%) or moderate MR (26.3%). Propensity score matching yielded 23 pairs for final comparison. Results: No significant differences were found between groups before and after matching in early results. In the matched cohort, survival probabilities at one, three, and five years were 95.7% vs. 87.0%, 85.0% vs. 64.5%, and 85.0% vs. 29.0% in the none-mild MR group vs. moderate MR-group, respectively (log-rank P=0.035). Among survivors, patients with moderate MR had worse functional status according to New York Heart Association (NYHA) class at follow-up (P=0.006). Conclusion: MR is common in patients with failed aortic bioprostheses, and improvement in MR-status was observed in over 40% of patients following VIV-TAVI. Residual moderate MR after VIV-TAVI is not associated with worse early outcomes, however, it was associated with increased mortality at five years of follow-up and worse NYHA class among survivors.

Gegen Qinliantang Ameliorates Glucose and Lipid Metabolism Disorders in Rat Model of Catch-up Growth by Regulating SIRT1/PGC1α/Nrf1 Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the effect of Gegen Qinliantang on glucose and lipid metabolism in the rat model of catch-up growth （CUG） induced by a high-fat diet and the underlying mechanism. MethodA total of 60 SD rats were randomized into a normal control group （n=18） and a modeling group （n=42）. The rat model of CUG was established with a restricted diet followed by a high-fat diet， and the changes of general status and body weight were observed. The levels of fasting blood glucose （FBG）， fasting insulin （FINS）， triglyceride （TG）， and total cholesterol （TC） were measured in 6 rats in each group at the end of the 4th and 8th week， respectively. The homeostasis model assessment of insulin resistance index （HOMA-IR） was calculated， and the insulin sensitivity and body composition changes of CUG rats were evaluated. The successfully modeled rats were assigned into 6 groups： normal control， model， high-， medium-， and low-dose Gegen Qinliantang （2.5， 5， 10 g·kg-1）， and pioglitazone （3.125 mg·kg-1）. The rats were administrated with corresponding drugs by gavage for 6 weeks， and the normal control group and model group were administrated with the same amount of normal saline. During the experiment period， the changes of body weight were recorded， and the FBG， FINS， HOMA-IR， TG， and TC were determined at the end of the experiment. Hematoxylin-eosin （HE） staining was employed to observe the pathological changes of skeletal muscle in rats. The levels of reactive oxygen species （ROS） and malondialdehyde （MDA） in the skeletal muscle were measured strictly according to the manuals of the reagent kits. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was performed to measure the mRNA levels of silencing information regulator 1 （SIRT1）， peroxisome proliferator-activated receptor-gamma coactivator1α （PGC1α）， and nuclear respiratory factor 1 （Nrf1） in the skeletal muscle. Western blot and immunohistochemistry were employed to assess the expression of SIRT1， PGC1α， and Nrf1 in the skeletal muscle. ResultCompared with the normal control group， the model group presented elevated levels of FBG， FINS， TG， and TC （P<0.05， P<0.01）， increased HOMA-IR （P<0.01）， increased diameter of muscle fibers and adipocytes between muscle cells in the skeletal muscle， rising levels of ROS and MDA in the skeletal muscle （P<0.01）， and down-regulated mRNA and protein levels of SIRT1， PGC1α， and Nrf1 （P<0.05， P<0.01）. Compared with the model group， Gegen Qinliantang （especially the medium and high doses） and pioglitazone decreased the body weight， FINS， HOMA-IR， and TG （P<0.05， P<0.01） and reduced interstitial components such as intermuscular fat in the skeletal muscles and the diameter of muscle fibers. Furthermore， the drugs lowerd the levels of ROS and MDA （P<0.05， P<0.01） and up-regulated the mRNA and protein levels of SIRT1， PGC1α， and Nrf1 （P<0.05， P<0.01） in the skeletal muscle. ConclusionGegen Qinliantang can ameliorate the glucose and lipid metabolism disorders and insulin resistance in CUG rats by regulating the SIRT1/PGC1α/Nrf1 signaling pathway.

Survival rate and quality of life in patients with liver cirrhosis complicated with bacterial infection / 公共卫生与预防医学

Objective To analyze the short-term survival and prognostic quality of life of patients with liver cirrhosis complicated by bacterial infection. Methods This study collected and analyzed 300 patients with liver cirrhosis complicated with infection who were hospitalized in the First Affiliated Hospital of Hebei North University, and followed up to discuss their survival and quality of life. Results In this study, the top two causes of infection were spontaneous bacterial peritonitis (60.67% of patients) and pneumonia (50.67% of patients). The second causes were urinary tract infections (15.33%), gastrointestinal infections (12.33%), and other causes. There was no statistically significant difference between male and female patients (P>0.05). In addition, the proportion of hospital infections was 71.00%, and there was no statistically significant difference between male and female patients (P>0.05). A total of 353 strains of pathogenic bacteria were isolated in this study (73.37% of patients with hospital infections). The distribution analysis of pathogenic bacteria showed that the highest proportion of ECO was 35.98%, followed by Klebsiella pneumoniae (18.98%). The distribution trend of 259 strains of pathogenic bacteria among hospital patients was consistent with that of all strains, and the difference was not statistically significant (P>0.05). Gram negative bacteria accounted for 79.60% (281/353) of all detected strains, of which Escherichia coli was mostly detected in patients with spontaneous bacterial peritonitis, Klebsiella Pneumoniae (KPN) and Pseudomonas aeruginosa (PAE) were mostly detected in patients with pneumonia, and Enterococcus (ENF) was mostly detected in patients with urinary tract infection; Among gram-negative bacteria, Staphylococcus epidermidis (SEP) and Staphylococcus aureus (SAU) are mostly found in patients with other infectious causes (blood flow infection, etc.) , and Streptococcus (STR) accounts for a high proportion in patients with Spontaneous bacterial peritonitis. In this study, 9 cases of death prognosis were detected during follow-up, and there was no statistically significant difference in the detection of death prognosis between different bacterial strains in both genders, as well as the difference in detection of death prognosis between hospital infections and out of hospital infections in both genders (P>0.05). There was no statistically significant difference in the detection of death prognosis between males and females due to different causes of infection, P>0.05. The quality of life scores of 291 surviving patients were compared between baseline and follow-up, indicating an increase in follow-up scores, especially in the dimensions of physiological function and physical pain. There was no statistically significant difference between different bacterial strains, infection causes, and hospital/non hospital infections (P>0.05) . Conclusion Spontaneous bacterial peritonitis and pneumonia are the main causes of infection that deserve special attention, and the main pathogens of infection are Gram negative bacteria. Targeted treatment and rehabilitation should be provided for patients with liver cirrhosis complicated by infection. At the same time, the proportion of hospital infections is relatively high, and attention should be paid to, prevention and control measures should be implemented as well.

Role of inhibiting lncRNA TUG1 to down⁃regulate nucleotide binding oligomerization domain like receptor protein 1 inflammasome in delaying the progression of Alzheimer’s disease / 解剖学报

Objective To investigate the relieving effects of knockdown of long non-coding RNA(lncRNA)taurine up-regulated gene 1 (TUG1) on inhibiting nucleotide binding oligomerization domain like receptor protein 1 (NLRP1) inflammasome and the progression of Alzheimer’ s disease. Methods Wild-type (WT group, 10 mice) or amyloid precursor protein (APP) / presenilin-1 (PS1) transgenic mice (30 mice) with a genetic background of C57 / BL6 aged 9-10 weeks were used in this study. APP / PS1 transgenic mice were randomly divided into model group, model+lncRNA TUG1 short hairpin RNA (shRNA) group and model + shRNA non target (NT) group (n = 10) . Blood samples, cerebral cortex tissues, primary microglial cells and primary astrocytes were collected from mice 12 weeks of age on day 1 (3-month-old) and 32 weeks of age on day 1 (8-month-old), with 5 mice per group at each time point. Real-time PCR analysis was used to detect the expression levels of lncRNA TUG1 and macrophage migration inhibitory factor (MIF) mRNA in cerebral cortex tissues and primary microglial cells, and C1r and C1s mRNA levels in primary astrocytes of 3-month-old and 8-month-old mice in the above 4 groups, respectively. ELISA was used to determine the MIF in plasma samples of the above 4 groups of mice. Primary microglia and astrocytes from the cerebral cortex of 3-month-old and 8-month-old mice were co-cultured. CCK-8 method was used to determine the proliferation ability of the above cells. Western blotting was used to determine the expression levels of MIF, pro interleukin-1β (pro-IL-1β), apoptosis associated speck-like protein containing a caspase recrult domain(ASC), Caspase-1 (p20), Caspase-1 (full), NLRP1 and NLRP3 in cerebral cortex tissues of 3-month-old and 8-month-old mice. Immunofluorescent staining was used to determine amyloid beta(Aβ) in cerebral cortex of 8-month-old mice. Results At the age of 3-month-old and 8-month-old, compared with the WT group, the relative expression level of lncRNA TUG1 and MIF in cerebral cortex tissues and primary microglia of model group mice was significantly up-regulated, with primary microglial cells and astrocytes proliferation ability enhanced (P0. 05) . There was no significant difference between the model group and the model+shRNA NT group mice of all the above factors (P>0. 05) . Conclusion In APP / PS1 transgenic mice, up-regulation of lncRNA TUG1 and MIF are positively associated with the activation of NLRP1 inflammasome in mice cerebral cortex tissues and primary microglia. Knock-down of lncRNA TUG1 can ameliorate the progression of Alzheimer’ s disease.

Establishment and application of a prospective follow-up research method for acute infectious diseases in Shanghai community residents / 上海预防医学

ObjectiveTo present the exploration and application of a prospective follow-up research method for acute infectious disease surveillance based on natural community populations， using COVID-19 infection as an example， and to provide a reference for improving the infectious disease surveillance and early warning system. MethodsA multi-stage probability proportional sampling method was employed to sample residents from all communities of 16 administrative districts in Shanghai， with households as the units. A cohort for acute infectious diseases based on natural community populations was established. The baseline survey was conducted for all cohort subjects， and COVID-19 antigen test kits were distributed. From December 21， 2022 to September 30， 2023， prospective follow-up monitoring of COVID-19 antigen and nucleic acid was carried out on the study subjects on a weekly basis. The baseline characteristics and follow-up information of the cohort subjects were described. ResultsThe cohort for acute infectious diseases included a total of 12 881 subjects， comprising 6 098 males （47.3%） and 6 783 females （52.7%）. The baseline survey revealed that 35.2% （4 540/12 881） of the subjects had a history of COVID-19 infection. During the follow-up period from December 21， 2022 to September 30， 2023， the average incidence density in the cohort was 0.61/person-year， with a higher incidence density in females （0.63/person-year） compared to males （0.59/person-year）. Individuals aged 60 and above （0.64/person-year） and those with underlying health conditions （0.67/person-year） had a higher incidence density. Healthcare workers showed a notably higher incidence density （0.84/person-year） than that in other occupational groups. As of September 30， 2023， a total of 340 subjects in the cohort experienced secondary infections， with a median interval of 170 days between the first and second infections. ConclusionThis study applies cohort study method to acute infectious disease surveillance， providing crucial data support for estimating infection rates and forecasting alerts for acute infectious diseases in the community. This method can be promoted and applied as a new approach for acute infectious disease surveillance.

Longitudinal study on anxiety and intolerance of uncertainty among Chinese college students / 中国学校卫生

Objective@#To explore the longitudinal changes and related predictive factors of anxiety and intolerance of uncertainty (IU) among Chinese college students, so as to provide theoretical reference for promoting students mental health.@*Methods@#Intolerance of Uncertainty Scale-short Form and the 7 item Generalized Anxiety Disorder Scale were administered among 5 683 students from 22 universities in Guangdong Province from September 10 to October 17, 2021 (T1, baseline survey), and from March 15 to April 22, 2023 (T2). Using paired sample t-test to analyze the changes in anxiety and IU among college students, a linear regression model was established to explore factors that can predict anxiety, IU and their changes during T1 and T2 periods.@*Results@#During the T1 period, the average scores of anxiety and IU among college students were (3.26±3.46, 34.88±7.96), while during the T2 period, they were (4.41±4.16, 36.40±8.07). During the T2 period, the levels of anxiety and IU among college students were higher than those during the T1 period ( t=19.59, 13.67, P <0.01). The linear regression results showed that age ( B = -0.02 ), moderate ( B =-0.18) and poor ( B =-0.88) mental health status, as well as online browsing of Corona Virus Disease 2019 (COVID-19) epidemic (later called as epidemic) related information for >1-<3 hours ( B =-0.30) and ≥3 hours ( B =-0.22), all of which could negatively predict changes in anxiety during T1 to T2 periods. Living in rural areas ( B =0.11) could positively predict changes in anxiety during T1 to T2 periods ( P <0.05). Moderate ( B =-0.19) and poor ( B =-0.47) mental health status, browsing epidemic related information online for >1-<3 hours ( B =-0.32) and ≥3 hours ( B =-0.33), academic performance being moderately affected by the epidemic ( B =-0.10), and personal planning being moderately affected by the epidemic ( B =-0.13) and severely affected ( B =-0.22), all of which could negatively predict changes in IU during T1 to T2 periods ( P <0.05).@*Conclusions@#Levels of anxiety and intolerance of uncertainty increases significantly after epidemic. Mental health status of college students should need long term monitoring, and students with poor mental health should need special attention.

Effect of a brief training program on the knowledge of Filipino primary care providers in a rural and a remote setting: A before and after study

Background and Objective@#Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.@*Methods@#A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.@*Results@#The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14). @*Conclusions@#Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.

Lived experiences of UAAP Season 84 and NCAA Season 97 student-athletes in their bubble set-up training during the COVID-19 pandemic: A research protocol

Background@#The COVID-19 pandemic has greatly affected the sports industry, postponing events worldwide. To adapt to the situation, athletes have been forced to train at home. Bubble training was introduced to provide a safe and conducive training environment while adhering to government health protocols. However, concerns have emerged regarding the set-up’s implementation.@*Objective@#The study aims to explore the lived experiences of UAAP Season 84 and NCAA Season 97 student-athletes who underwent bubble training.@*Methods@#The study will employ a qualitative phenomenological approach based on Seligman's Well-Being Theory. A purposive sampling technique will be used to recruit at least seven eligible student-athletes. Data will be collected through on-site or online interviews using a semi-structured interview guide to reveal a narrative of the student-athletes' bubble training experiences, common themes, and patterns. Deductive thematic analysis approach will be used with the help of the NVivo software program.@*Expected Results@#This study is expected to develop themes from the daily bubble training routines, habits, coping strategies, and perceived thoughts and feelings of Filipino collegiate student-athletes, regarding their emotions, engagement, relationships, meaning, and achievement in bubble training. This may provide insights to the government, educational institutions, and athletic associations on possible comprehensive guidelines if they plan to implement bubble training when the need arises.

Recurrence rate of oral melanotic macule treated with Q-switched alexandrite laser versus surgical excision: a retrospective cohort study / 口腔疾病防治

Objective@#To compare the recurrence rates between 755 nm Q-switched alexandrite laser (QSAL) treatment and surgical excision of oral melanotic macules (OMM).@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. A retrospective cohort study was designed to collect demographic and clinical characteristics and follow-up data from patients with OMM. Patients who received QSAL or surgical excision in the Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2019 to August 2021 were included. The one-year recurrence rate was investigated as the primary outcome. Long-term adverse reaction rates were investigated as safety indicators. Kaplan-Meier analyses were performed to analyze the recurrence-free rates between the groups.@*Results@#A total of 57 patients were enrolled in this study. 16 patients underwent surgical excision, and 41 underwent QSAL. The baseline demographic and clinical characteristics between the groups were not significantly different. No recurrence (0%) of OMM was observed in the surgical excision group, while in the QSAL group, the macule recurred in 12 patients (29.27%). The average duration of recurrence was 6.08 months after treatment. Recurrence was not found to be associated with smoking (P = 1.000), gastrointestinal polyps (P = 1.000), longitudinal melanonychia (P = 0.187), family history (P = 0.552), treatment sessions (P = 0.567) or multiple macule lesions (P = 0.497). Compared with treatment with surgical excision, the odds ratio of recurrence for treatment with QSAL was 4.41, with a 95% confidence interval of 1.27-15.24 (P = 0.020). In the surgical excision group, 3 patients (18.75%) reported depressions and scars on the lesion, while no long-term adverse reactions (0%) were reported in the QSAL group (P = 0.019).@*Conclusion@#Compared with surgical excision, the advantage of QSAL is the low long-term adverse reaction rate, while the disadvantage is the relatively high one-year recurrence rate. It is necessary to communicate the advantages and disadvantages of the two methods with OMM patients to assist in clinical decision-making.

Functional status of children and adolescents with COVID-19 in a reference hospital in southern Brazil / Estado funcional de crianças e adolescentes com COVID-19 em um hospital de referência no sul do Brasil

Abstract Introduction COVID-19 could leave important consequences, including functional decline. Objective Eval-uate functional status in pediatric patients hospitalized with COVID-19 and correlate with clinical variables. Methods Prospective and retrospective longitudinal study with patients with COVID-19. Hospitalization data were collected from medical record review and post discharge data were collected by telephone contact. Functional status was evaluated by Functional Status Scale (FSS-Brazil) in three moments (hospital admission, hospi-tal discharge and after hospital discharge). Spearman test was used to correlate continuous variables and the linear model with generalized estimation equations was used to verify differences in the proportion of functional impairment occurrence (FSS-Brazil ≥ 8) at different mo-ments of the study and previous disease presence. Results It was included 232 patients, 56% male, median age of five years old. Seventy (30.2%) patients had post discharge data. The mean global score of FSS-Brazil was 7.3 at hospital admission, 6.8 at discharge hospital and 6.8 after discharge hospital. Functional status was adequate in the three different moments evaluated in 75% of the sample. The ventilatory support needed was not correlated with functional status and the length of hos-pital stay and oxygen therapy showed weak correlations with functional status. Having no previous disease reduced the risk of functional impairment by 94%. Conclusion The majority of the patients maintained adequate functional status. Absence of previous disease was a protective factor for long term functional impairment.

Resumo Introdução A COVID-19 pode deixar sequelas impor-tantes, como declínio funcional. Objetivo Avaliar a funcionalidade dos pacientes pediátricos internados com COVID-19 e correlacionar com variáveis clínicas. Métodos Estudo longitudinal retrospectivo e prospectivo, com pacientes pediátricos com COVID-19. Os dados de internação hospitalar foram coletados a partir da revisão de prontuários e os dados pós-alta através de contato telefônico. A funcionalidade foi avaliada através da Escala de Estado Funcional Pediátrica (FSS-Brasil) em três momentos (admissão, alta e pós-alta hospitalar). A correlação entre as variáveis contínuas foi avaliada pelo teste de Spearman e utilizou-se o modelo linear com equações de estimação generalizada para verificar as diferenças nas proporções de ocorrência de prejuízo funcional (FSS-Brasil ≥ 8) nos diferentes momentos do estudo e na presença de doenças prévias. Resultados Foram incluídos 232 pacientes, 56% do sexo masculino, mediana de 5 anos de idade. Foram obtidos dados de seguimento pós-alta hospitalar de 70 (30,2%) crianças. O escore global médio da FSS-Brasil foi de 7,3 na admissão, 6,8 na alta e 6,8 após a alta. A funcionalidade apresentou-se adequada nos três momentos de avalia-ção em 75% da amostra. A necessidade de suporte ven-tilatório não foi correlacionado com a funcionalidade, e o tempo de internação e oxigenoterapia apresentaram correlações fracas com a funcionalidade. A inexistência de doenças prévias reduziu em 94% o risco de prejuízo funcional. Conclusão A maioria das crianças manteve funcionalidade adequada. Não ter doenças prévias foi um fator de proteção para o prejuízo funcional em longo prazo.