Epidemiologia da gravidez na adolescência no município de Caruaru, PE / Epidemiology of adolescent pregnancy in the region of Caruaru, Pernambuco

Introdução: A gravidez na adolescência, tanto no Brasil como em diversos países do mundo, representa um problema de saúde pública, evidenciado pelo crescente índice de gestações precoces e incidência de intercorrências obstétricas e neonatais. O objetivo deste estudo foi comparar as características maternas das mães adolescentes, resultados perinatais, via de parto e dados sobre os seus recém-nascidos em relação às mães adultas. Métodos: Estudo transversal retrospectivo realizado com mães cadastradas no Sistema de Informações sobre Nascidos Vivos-Sinasc em Caruaru-PE, em 2006 e 2007. Resultados: Das 10.653 mães estudadas, 2.540 eram adolescentes. Registraram--se 32,0% de partos em mães adolescentes com 8 a 11 anos de estudo; 30,3% viviam em união consensual; fizeram sete consultas ou mais de pré-natal (51,4%); suas crianças nasceram de parto cesáreo (37,7%), prematuras (7,4%), de baixo peso (9,6%) e Ápgar no 5º minuto ≤ 7(0,7%). Ao comparar com mães adultas, observou-se que mães adolescentes possuem maior probabilidade de estar sem companheiros (OR 1,47; IC95% 1,33-1,61); apresentam risco aumentado para prematuridade (OR 1,39 IC95% 1,16-1,66) e baixo peso ao nascer (OR 1,36; IC95% 1,16-1,59) e o Ápgar no 5º minuto ≤ 7 (0,7%), duas vezes maior (OR 2,09; IC95%: 1,13-3,86). Adolescentes com mais de sete consultas apresentam desvantagem sob a forma de risco (OR 1,5; IC95% 1,37-1,64) quando comparadas as adultas, assim como o parto cesáreo apresenta-se como fator de proteção (OR 0,49; IC95% 0,45-0,54) às adolescentes. Conclusão: A gravidez na adolescência está associada à ausência de companheiro, prematuridade, baixo peso ao nascer e Apgar igual ou menor que sete no 5º minuto.

Introduction: Adolescent pregnancy in Brazil and in several countries of the world represents a public health problem, as evidenced by the increasing rate of early pregnancies and the incidence of obstetric and neonatal complications. The aim of this was to compare the maternal characteristics of adolescent mothers, perinatal outcomes, mode of delivery, and data on their newborns as compared to adult mothers. Methods: A retrospective cross-sectional study of mothers enrolled in the Information System on Live Births in Caruaru (SINASC-PE), in 2006 and 2007. Results: Of the 10,653 women studied, 2,540 were teenagers. We found 32.0% of births among teenage mothers with 8-11 years of schooling; 30.3% lived in consensual union, 51.4% made seven or more prenatal care visits, and their children were born by cesarean section (37.7%), were premature (7.4%), had low birth weight (9.6%) and had Apgar score at 5 minutes ≤ 7 (0.7%). As compared to adult mothers, adolescent mothers were found to be more likely to be without partners (OR 1.47, 95% CI 1.33 to 1.61), at increased risk for pre-term birth (OR 1.39 95% CI 1.16 to 1.66) and have newborns with low birth weight (OR 1.36, 95% CI 1.16 to 1.59) and 5th minute Apgar score ≤ 7 (0.7%), two times higher (OR 2.09; 95% CI: 1.13 to 3.86). Adolescents with over seven prenatal care visits are at a disadvantage concerning risk (OR 1.5, 95% CI 1.37 to 1.64) as compared to adults, just like cesarean delivery appears as a protective factor (OR 0, 49, 95% CI 0.45 to 0.54) for adolescents. Conclusion: Adolescent pregnancy is associated with the absence of a partner, prematurity, low birth weight and Apgar score ≤ 7 at 5 minutes.

Corps etrangers de voies respiratoires chez l'enfant Etude retrospective de 100 cas

Foreign body inhalation is a universal problem, most common cause of death from domestic accident in children aged five years and less. Over 15 years one hundred children aged less than six years were evaluated in hotel dieu de france; findings are comparable to previous data, with one avoidable death; boys are chiefly concerned [64%]; mean age is 22.5 months circumstances are often hazy [65%]; vegetables are prominently responsible [90%] especially peanuts and pistachios [48%]; foreign bodies are seldom radiopaque [1%]; automnal predominance is noted. Inhalation is not reported in 25% of cases; immediate risk is subglottic impaction; the child survives if the foreign body is expelled one way or another. The most frequent site is the bronchial system [87%] with a slight right predominance [49%]; symptoms include: dyspnea, persistent cough, and in case of bronchial obstruction: wheezing and asymmetry of breath sounds; 15% of children are free of symptoms. Delay before hospital care is long [21.5 days], mostly because diagnosis is misread particularly in case of bronchial foreign body; pulmonary distension is a frequent finding [45%]. In case of asphyxia, first aid resuscitation is performed immediately: in fact it is rarely useful, sometimes harmful. Extraction is mandatory with the stiff bronchoscope; otherwise, bronchopulmonary infection and destruction is the usual outcome [25%]. Management is revisited, and prevention is recalled

Is carcinoma breast a different disease in Pakistani population?

Carcinoma of the breast tends to be different in coloured and white races. Is this pattern also expressed in Pakistani population

Prognostic factors in stage-I breast cancer: a retrospective study

We studied the case records of all patients presenting with stage-I breast cancer [tumour < 2 cm, no axillary nodes or distant metastases]. All clinical and pathological features were evaluated and findings were correlated with short term treatment failures [local and distant recurrences within 2 years]. An early recurrence was seen in 28% patients. There was no significant differences in the mean age at presentation [44 vs 47 years] or menopausal status [8 Vs 7 years]. Estrogen receptor status was unknown in all the patients. A positive family history of breast cancer was noted in 40% women with tumour relapse against 6% in the non-relapsed group. Associated fibrocystic mammary dysplasia was found in 80% relapsed cases whereas 60% showed lymphatic invasion and tumour necrosis. Vascular invasion was reported in 40% cases. A poorly differentiated histology fibrocystic mammary dysplasia, lymphatic and vascular invasion and tumour necrosis were poor prognostic factors. It was concluded that adjuvant chemotherapy should be given to all patients presenting with stage-I breast cancer and showing poor prognostic factors regardless of the menopausal status

Evaluation of clinical pharmacy service impact on therapeutic drug monitoring of digoxin at a teaching hospital

A retrospective study was run to review serum digoxin concentration [SDC] orders during two years. A total of 1110 SDC determinations was used to identify hospital wards to highest request of SDC order and to report the number of digoxin over and under dose requests per ward. Also, studies were the outcomes of clinical pharmacy intervention on the number of serum digoxin orders, appropriateness of ordering SDC level and the clinical pharmacist's influence on appropriate h and ling and interpretation of the reported levels

Proteinuria selectivity in childhood nephrotic syndrome

To assess the value of proteinuria selectivity index [PSI] in predicting the response of children with nephrotic syndrome to corticosteroid therapy and its correlation with renal biopsy findings. Setting: Paediatric Department, Our Lady's Hospital for Sick Children, Dublin, Ireland. Design: Retrospective analysis of the records of 39 children admitted to the above hospital with nephrotic syndrome. PSI was performed for all children prior to therapy. All received corticosteroid therapy according to the protocol of International Study of Kidney disease in Children for initial attacks and relapses. Patients were divided into 3 groups according to their response to steroid; steroid responsive infrequent relapsers [n.15], steroid responsive frequent relapsers [10] and steroid resistant [8]. PSI of < 0.01 was statistically significant in differentiation between the steroid responsive and resistant nephrotic syndrome. All children in the latter group had non-minimal change lesions on biopsy. Protein selectivity index should continue to be one of the valuable initial tests in childhood nephrotic syndrome due to its useful additional predictive value on the response to steroid in those patients

Kikuchi's disease [histiocytic necrotizing lymphadenitis]: a chinicopathologic study of 10 cases

Ten patients having Kikuchi's Lymphadenitis diagnosed in our department between 1993 - 1996 were studied. There were 8 females and 2 males, ranging in age from 6 years to 43 years. All the patients presented with cervical lymph node enlargement. Associated clinical findings were fever and raised ESR. Histologically the lymph nodes showed cortical or paracortical patchy pale stained areas, conspicuous foci of necrosis with abundant nuclear and eosinophilic granular debris, surrounded by histiocytes, plasmacytoid monocytes and immunoblasts. Neutrophils were notably absent or scarce. Perinodal inflammation was common. Recognition of Kikuchi's disease by clinicians and pathologists is important, because it may mimic diseases which require specific treatment. Its distinction from malignant lymphoma and lupus lymphadenitis is emphasized in this paper

Intramedullary tumors at king Khalid University Hospital

A retrospective analysis of 16 consecutive cases of intramedullary lesions treated at King Khalid University Hospital between 1985-1995 was conducted to provide data regarding the characteristics of patients with intramedullary tumours in Saudi Arabia in comparison with the existing literature. Ninety four% of the patients were unable to walk independently atpresentation. This series is unusual in that it included a case of intramedullary tuberculoma, in the low incidence of low grade astrocytoma [13%], the high incidence of malignant astrocytoma [25%] and the relatively high incidence of tumour located in the thoracic [31%] and cervicomedullay region [19%]. Our 4 malignant astrocytoma patients were unique in that two showed growth of their neoplasm into the medulla, one had a multicentric tumour and the other developed neuroaxial dissemination. At a median follow-up of 12 months, 6 of the 13 survivors had a "favourable" outcome in that they were able to function and ambulate independently. This study shows that there is a slight difference in the characteristics of intramedullary tumours in Saudi Arabia compared to what is reported in literature. Patients with intramedullary tumours should be diagnosed by MRI and referred early speciaIised neurosurgical units capable of performing a tumour resection, as completely as possible

Near-drowning in Bahrain

Drowning is death from asphyxia while submerged or within 24 hours of submersion. Near-drowning is an episode after submersion of sufficient severity to warrant medical attention for the victim that may eventually lead to mortality or morbidity

Repair of distal hypospadius: decision making of a technique

The aim of this study is to evaluate alternative techniques in repair of different types of primary hypospadias, with suggested plan for decision making of suitable technique of repair. A retrospective study of 96 cases of primary distal hypospadias [glandular, coronal, distal penile with and without chordee] were performed over a period of three years, with a minimum follow up of six months. Methods of repar included MAGPI [40], extended MAGPI [12], Mathieu [24], modified Mathieu [4], tubularised uretheral plate [9] and preputial tubed island flap [7]. The results revealed that, MAGPI [40 patients] had no major complications in glandular type and 12.5% complication rate in coronal. Extended MAGPI [12 patients] had complication rate of 37.5% in distal penile. Classic Mathieu [24] had 15% complication rate and modified Mathieu [4 patients] 25% major complication in distal penile with chordee. Tubularised uretheral plate [9 patients] had 22.2% complication rate for coronal and distal penile. Preputial island flap [7] had 28.5% complication rate in distal penile with chordee. Total major complication rate was 15.6%. Best results were obtained from proper technique selection for different types of distal hypospadias. Decision making of proper technique depends on meatal location and variety, presence of chordee, gland configuration [flat or conical], uretheral plate [flat or grooved and/or a seat of chordee] and availability of shaft or preputial skin

Urologic and sexual complications in chronic spinal cord injury patients with its management overview: a review of 500 patients

A total of 500 patients with chronic SCI were studied clinically, radiologically, bacteriologically, urodynamically in a specialized SCI Center, over one year. Medical treatment, different endoscopic procedures [182 patients] and surgical procedures [77 patients] have been performed. The results revealed that hydronephrosis was reported in 100 patients [V-U reflux 65, stricture ureter 20, renal calculi 9, and infravesical obstruction 6]. Renal stones were occurred in 45, bladder stones in 65 and RF in 16 patients. Also, stricture urethera was occurred in 16, uretheral diverticulum in 3, dyssenergia in 60 in UMNL and 15 in LMNL. Urinary scrotal fistula was represented in 19, traumatic hypospadius in one, penile amputation and edema in 4 patients. Erection was preserved in 70% and antegrade ejaculation in 10% of patients. It was concluded that urologic manifestations of SCI are protean. Their management are controversial with wide range of treatments. The main goal in treatment is to control urosepsis and to provide adequate bladder drainage

Patterns of drug abuse in patients at UN/PAK model drug abuse treatment centre

The present study describes basic data about the extent and varieties of drug abuse problem, in cases registered at UN/PAK Model Drug Abuse Treatment centre at Sir Ganga Ram Hospital Lahore. Total number of cases presenting to the centre through Psychiatric OPD from October 1988 May 1997 was nine hundred and thirty six. Out of them 319 cases sought in-patient care for detoxification. Among admitted case, 247 had a new admission while 72 sought readmissions. Majority of the admitted cases presented with the problem of Heroin and poly drug abuse The findings would be discussed in terms of sociological perspectives and the lessons to be learnt from the experience of this centre

Snake bite in Al-Dahira region of Oman

Snake bite is a common preventable condition in most of the Sultanate of Oman. One hundred cases of snake bite at two Ibri hospitals [AI Dahira region] were studied retrospectively extending over a period between October 1992 and June 1996. The types and clinical presentations of snake bites prevalent in Oman in general and AI-Dahira region in particular are discussed. The patients presented very early to the health facilities, thereby reducing subsequent complications and mortality which was nil. This study is also compared at relevant places, with a similar study by me at Liaqat Medical College Hospital [LMCH], Sindh, Pakistan, in 1986, and by Pawar at Ibra in 1985. Striking differences are found and highlighted regarding dosage of anti-snake venom [ASV]. Average total dose of ASV administered per patient was 159 ml. This was a huge amount of ASV, as compared with only 32 ml per patient in LMCH study. The validity of ASV administration, the manufacturer's directions, and its dosage are critically analysed and correlated with the clinical presentations in this series. Its indications and relevant literature are reviewed

Direct donations: benefits and risks, a two-year analysis of donations at the dept. of blood services, Al-Wattayah

A retrospective analysis of records of the donor population from 1st January 1995 to 31st December 1996 was performed at the department of blood services, with the aim of highlighting the benefits and risks of directed or replacement donations. Of a total of 18,254 donations, 8,059 units were collected in the year 1995, and 10,195 units were collected in the year 1996. Of these, 15,782 [86.5%] were voluntary donations and 2,472 [13.5%] were directed donations. 61.5% of our donors were Omani nationals and 38.5% were non-Omani donors. The male: female ratio was 9:1 in these two years. Donor selection criteria established by our standard operating procedures manual were followed. All donations were screened for transfusion transmissible diseases, besides ABO grouping and Rh typing. The results show that the department of blood services has received more donors [an increase of 26.5%] in 1996 as compared to 1995. It was found that the directed donations show a significantly higher percentage of positive tests for the surface antigen of hepatitis B virus [HBsAg] and antibody to hepatitis C virus [anti-HCV] than voluntary donations [5.9% vs 4.25%, P < 0.001]. This study discusses the benefits and risks of directed donations, and stresses the need to improve the voluntary donor base which is a healthy indicator of the attitude of the community towards the sick

Etiology of obstructive jaundice: a comparative study

1. To re-appraise the etiology of obstructive jaundice. 2. To raise high index of suspicion for malignancy in cases of obstructive jaundice. DESIGN: retrospective study. SETTING: department of surgery, Rawalpindi General Hospital. PERIOD: Jan 1990 to Dec 1994. PATIENTS AND METHODS: 360 cases which presented with extra hepatic biliary tract disease, 52 had obstructive jaundice, the etiology of which is evaluated and compared with that of European published data. common bile duct stones accounted for obstruction in 21 patients [40.3%], whereas carcinoma of the pancreas produced obstruction in 14 patients [27%]. Carcinoma of gall bladder presented with obstructive jaundice in 8 patients [15.3%]. Pancreatitis caused obstruction in 4 [7.6%] and secondaries produced obstructive jaundice in 2 patients [3.8%]. The incidence of malignancy was 48.1% in this study in comparison with two studies from United Kingdom which shows an incidence of 59% and 29.45%. Choice of various operative procedures performed is also evaluated. CONCLUSIONS: It is concluded that malignancy accounts to almost half of the cases of obstructive jaundice which is higher than in Western countries

Disease processes in the peritoneum, omentum and mesentery: diagnosis with CT, a retrospective study

There is a wide range of pathological conditions that affect the peritoneum, mesentery and omentum that are frequently unrecognized on CT images. It is important for radiologists to be aware of these entities and their potential apearances. Not uncommonly, many of these disease processes appear similar on images, and many require a biopsy or fluid sampling to establish the diagnosis. In this study we review the diagnostic features of some of these pathological entities

Intracranial gliomas: MRI study

Gliomas represent one-third to 45% of all intracranial tumours. MRI has improved the detection and localization of intrinsic primary glial tumours, but has not yet been proven to add specificity beyond what can be obtained with Ct. The signal abnormalities produced by glial neoplasms can be devided into five types: intrinsic neoplasm; neoplasm-associated cysts; necrotic neoplasm; neoplasm-induced neovascularity with BBB breakdown and contrast enhancement; and neoplasm-produced edema. This study highlights some of the features of the intracranial gliomas on MR scanning