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.

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

Rupture of pregnant uterus

To evaluate the risk factors associated with rupture of the gravid uterus and to ascertain the maternal and perinatal outcome of cases presenting with this complication. Design: Retrospective 4 years study on all cases of uterine rupture. Setting: Lady Willingdon Hospital -a teaching institution affiliated to King Edward Medical College, Lahore. Sixty four cases with rupture of uterus admitted from January 1, 1990 through December 31,1993. Main outcome measures: Etiological factors, clinical features, fetomaternal complications and type of surgical procedure performed in each case. Thirty three [51.56%] had rupture of previous cesarean scar, 29 [45.31%] had spontaneous rupture, while 2 [3.13%] had traumatic rupture. Previous cesarean scar was the chief risk factor followed by obstructed labor, grand multiparity and injudicious use of oxytocin. No antenatal care was received during pregnancy by 90.62% cases. Perinatal and maternal mortality rates were 75% and 9.38% respectively. Repair of uterus was done in 34[53.13%] cases, while 30[46.87%] cases underwent hysterectomy. Conclusions: Rupture of uterus is still a common problem. It is associated with considerable perinatal and maternal morbidity and mortality. Previous cesarean scar is the commonest cause for rupture of uterus. Midwife education, regular antenatal care and hospital delivery of all cases with previous cesarean scar are important factors in prevention of this obstetric catastrophe

Manifestations cutaneo-muqueuses au cours de l'infeciton par le VIH: etude retrospective de 120 patients

Cutaneous and mucous membrane involvements in HIV patients are polymorphus, frequent and sometimes revealing the infection. We studied retrospectively 120 patients infected with HIV hospitalized in the infectious disease department of la Rabta Hospital. The age average was 30 years, the sex-ratio was 3.8M/1F. the risky behaviours were multiple sexual partners [51%] and drug addiction [50%]. Cutaneous and mucous membrane manifestations were present in 90% of HIV patients and 98% of AIDS patients Infectious findings were the most frequent, especially mycosis [86% of HIV patients]. Kaposi sarcoma were present in 10% of HIV patients. It was the only neoplasia noted in our patients. Most of our results were in accordance with the literature data

Traitement chirurgical du canal lombaire stenose

The authors report the results of a retrospective study of 38 lumbar spinal stenosis all operated in ten years [24 degeneratives, 12 congenital, 2 mixed]. All the patients had a low-back pain and a radicular pain, 76.3% had a polyradicular claudication with neurological defect for 4 patients. Surgery consisted of a posterior lateral spinal canal calibration and excision of a disc herniation at one or two levels in more than the half of cases. At a Mean follow-up of 6 years [18 months - 10 years] the global result was excellent or good in 86% of cases

Etude retrospective de l'association diabete et glaucome a angle ouvert a propos de 127 cas

Primary open angle glaucoma is an ocular affection which causes blindness, more frequent with diabetic patients whose age excess 40 years old. In our retrospective study for a period of 2 years we could estimate a primitive glaucoma frequency on patients operated for glaucoma. A review of literature allowed us to draw the diabetic ocular risks, to study means of treatment and prevention of glaucoma in diabetics by systematic ocular tonus measure

Treatment adherence of tuberculosis patients in Bethania hospital, Sialhot

A retrospective follow up study of 3950 consecutive TB patients carried out in Bethania Hospital, Sialkot-Pakistan from 1988-1990, shows that only 1 out of every 3 patients complete their treatment. Defaulting is very important in the first weeks of treatment. The influence of the following factors on the treatment adherence has been shown, treatment regimen, realisation of a pre-treatment sputum test [patients with smear test comply better than those without smear examination], age [15-44 years have highest compliance], sex [females comply better than males] and disease classification [pulmonary cases comply better than extra-pulmonary cases]

Profile of neurological problems in diabetes mellitus: retrospective analysis of data from 1294 patients

Data from 1294 patients with diabetes mellitus admitted to the Endocrinology Department of the Institute of Medical Sciences, Stringer, Kashmir, from 1986 to 1994, were analyzed for frequency of various neurological problems. Of 1294 patients, 46.29% had clinical evidence of one or more neurological problems. The frequency of neurological problems was significantly more in patients with type II diabetes mellitus [P< 0.001]. Predominant neurological problems included peripheral neuropathy [96.66%], stroke [5.51%], Parkinsonism [1.50%], seizure disorder [1.17%] and dementia [1%]. Mean [ +/- SD] age of patients with neurological problems was significantly more [P< 0.0001] than those without neurological problems [52.07 +/- 9.52] versus 47.45 +/- 12.87 years for type II diabetes mellituts; 26.73 +/- 8.40 versus 18.0 +/- 3.62 for type I diabetes mellitus]. Mean duration of diabetes in patients with neurological problems was significantly more than those without neurological problems [6.70 +/- 6.04 versus 3.95 +/- 4.22 years for type II diabetes mellitus; 5.63 +/- 3.67 versus 1.89 +/- 2.57 for type I diabetes mellitus]. At the time of admission, fasting blood glucose was lower in patients without neurological problems as compared to patients with problems [9.08 +/- 2.22 versus 11.05 +/- 4.91 mmol/L for type II diabetes mellitus; 9, 44 +/- 2.80 versus 13.01 +/- 5.01 mmol/L for type I diabetes mellitus; P< 0.001]

Etiology of ascites and the diagnostic value of serum-ascites albumin gradient in non-alcohol liver disease

This study was designed to determine the different etiologies of ascites and the diagnostic value of serum-ascites albumin gradient [SAAG] in patients with ascites of non-alcohlic liver disease in Southern Saudi Arabia. A total of 132 patients with ascites [96 males and 36 females, mean age 58.8 +/- 15.9 years] were studied for the different causes of acites. In 55 patients with liver disease and 22 patients with nonliver disease [malignancy and peritoneal tuberculosis], we compared SAAG with the three usual parameters of ascetic fluid biochemical analysis used in the differential diagnoses of ascites. The nonliver disease group showed higher ascetic fluid total protein [aTP] concentration [4.77 +/- 2.05 versus 1.98 +/- 1.56 g/dL], ascetic to serum ratio of total protein [a/sTP] concentration [0.75 +/- 0.43 versus 0.26 +/- 0.19], ascetic fluid lactic dehydrogenase [aLDH] level [565.4 +/- 353.4 versus 254.1 +/- 205.03 U/L] and a lower SAAG [0.6 +/- 0.30] versus 1.71 +/- 0.61]. P< 0.0001] for all parameters. The positive predictive values for aTP, a/sTP, a/s TP, aLDH and SAAG to detect ascites due to liver disease were 68%, 76, 76%, and 80%, respectively, while the negative predictive values were 96%, 96%, 84%, and 98%, respectively. Liver causes accounted for 69.7% of cases, followed by peritoneal tuberculosis 10.6%, malignancy 9.1%, congestive heart failure 7.6%, and nephritic syndrome 3.0%. ASSG is a useful diagnostic parameter which can be used to separate ascites of liver disease [nonalcoholic] from other causes of acites, with an efficiency of 91%. SAAG should replace the traditional parameters [aTP, a/sTP and aLDH] used in the differential diagnosis of ascites. In our series, liver disease is the major cause of ascites, followed by peritoneal tuberculosis

Hysteria: a clinical and sociodemographic profile of 40 patients admitted to a teaching hospital, 1985-1995

This is a retrospective clinical study of 40 inpatients diagnosed as suffering from hysteria, as defined in the Diagnostic and Statistical Manual of Mental disorders [DSM III-R], admitted to King Khalid University Hospital at Riyadh over a period 10 years [1985-95]. The female: male ratio was 3:1, 80% were less than 30 years of age and 60% were single. Hysterical conversion was the most common type [95%], whereas hysterical dissociation was rare [2.5%]. A stressful situation preceded the onset of symptoms in 62.5% of the cases

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

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