Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Sorologia positiva para sífilis no período neonatal: prevalência em maternidade de nível secundário; associaçäo com fatores de risco maternos e com sorologia positiva para HIV-1 / Positive serology for syphilis in neonatal period: prevalence in secondary level maternity; association with maternal risk factors and with positive serology for HIV-1

Este estudo teve como objetivos: observar a incidência de soropositividade para sífilis (RSS+) em recém-mascidos (RN) de maternidade de nível secundário; verificar associaçäo entre RSS+ no RN e fatores de risco maternos para aquisiçäo de sífilis; definir o impacto dos critérios diagnósticados de sífilis congênita propostos pelo CDC; observar uma possível associaçäo entre sorologia positiva para sífilis e para HIV-1. De dez/91-jul/92 estudou-se 3.664 nascidos-vivos através do VDRL e hemaglutinaçäo indireta (HAI) para sifilis (sangue de cordäo). Nos RN RSS+ avaliou-se: se a mäe apresentava fatores de risco para sífilis; se o RN se enquadrava nos critérios diagnósticos propostos pelo CDC e se a sorologia para HIV-1 (ELISA) era positiva. O grupo controle constituiu-se de 200 RN com VDRL E HAI para sífilis negativos nascidos em jan/92. Análise estatística foi realizada pelo qui-quadrado (significante p < 0,05). Dentre os 3.664 RN estudados, 5,6// eram soropositivos para sífilis. Verificou-se forte associaçäo entre RN RSS+ e idade materna maior que 20 anos, falta de parceiro sexual fixo, promiscuidade sexual, uso de drogas, ausência de pré-natal, multiparidade e natimortalidade pregressa. Todos os RN soropositivos para sífilis enquadraram-se no diagnóstico de sífilis congênita provável segundo critérios do CDC: tratamento inadequado na gestaçäo. Dos 205 RN RSS+, em 50 foi feito o estudo do HIV-1 e 12// deles eram HIV-1 positivos. Poucas doenças säo mais atuais que a sífilis congênita

Positive serology for Chagas' disease among women from nonendemic urban areas

Important transformations in the profile of health and disease of the Brazilian population have been broughtby migrations from the rural to the urban area. In relation to American trypanosomiasis this migration has increased the risk of the urbanization of the disease, meaning that in addition to the classical epidemiologic link "vector-to-man", the "man-to-man" transfusional or transplacental transmission becomes important. Three hundred women, in reproductive age (mean of 29 years), all migrants from Brazilian rural area and presently settled in the urban area of Sao Paulo, were studied. These people were from low socio-economical level, since in 70 per cent of the cases the per capita income was less than one minimum wage. Serodiagnosis for Chagas' disease was done by indirect hemagglutination and immunofluorescense tests. Sixteen women (5.3 per cent) were positive for one or both tests. Seropositive and seronegative groups were compared taking into account socio-economical data, gestational antecedents (parity, miscarriages, perinatal mortality and low birth weight) and familiarity with Chagas' disease and its vector. No significant differences were found between these two groups. The consequences of the seropositiveness found in this group of women in reproductive age, presently living in urban nonendemic areas are discussed, giving emphasis to the risk of spreading the disease by transmission "man-to-man".

Evacuacion gastrica en el geronte.Accion del clebopride. / Gastric emptying in the aged. Effect of clebopride

A 15 pacientes considerados "gerontes", (promedio 70 anos) a quienes se efectuo radiologia, endoscopia y biopsias gastricas, encontrandose distintos grados de gastritis cronica como unica patologia gastrica y a 8 "adultos sanos" (controles), se les evaluo el T1/2 de evacuacion gastrica,con una comida solida marcada con DTPA Tc 99 y medicion de la actividad isotopica en Camara Gamma, antes y despues de la administracion de una dosis terapeutica de clebopride. En la prueba basal se encontro que los gerontes evacuan mas tardiamente que los controles (112' y 89').La accion del clebopride revelo un descenso significativo en ambos grupos, siendo el mismo, mas importante en los gerontes.Estos hallazgos sugieren su utilidad clinica en distintas situaciones patologicas donde es util acelerar el tiempo de evacuacion gastrica (reflujo gastrico esofagico), ulcera gastrica) y en el geronte con sitomas dispepticos y gastritis cronica, vinculada a la edad como unica patologia gastrica