Violência por parceiro íntimo na gestação e repercussão na saúde da mulher e do concepto / Violence by intimate partner in pregnancy and repercussion on women's and concept health / Violencia por parte de la pareja íntima en el embarazo y repercusión en la salud de la mujer y del concept

Objetivo: Identificar as evidências científicas sobre as repercussões da Violência do Parceiro Íntimo (VPI) na gravidez sobre a saúde da mulher e do feto. Método: Trata-se de uma revisão integrativa da literatura. As buscas na literatura foram realizadas na Biblioteca Virtual de Saúde; Medline via Pubmed e Web of Science. Resultados: Foram incluídos 21 artigos. Os estudos demonstram que mulheres vítimas na gravidez apresentam maior vulnerabilidade a sofrimento psicológico, apresentando elevação nos níveis de estresse, tristeza, angústia, transtorno mental comum e ideação suicida. Elas são mais suscetíveis abaixa adesão ao pré-natal e a problemas ginecológicos e obstétricos, apresentando chances elevadas de infecção no trato urinário e vaginais, aumento do risco de internações pré-natais e maiores chances de evoluírem para morbidade materna aguda grave. Para a saúde do concepto, exposição a violência está relacionada a chance aumentada a ocorrência de aborto espontâneo, crescimento intrauterino restrito, parto prematuro, baixo peso ao nascer, morte perinatal, mortalidade infantil e na infância. Ainda foi demonstrado que a violência materna no período gestacional está associada a baixa adesão a imunização da criança, menor duração do aleitamento materno e com a necessidade de encaminhar a criança para o acompanhamento especializado para a triagem neonatal auditiva. Conclusão: O impacto da VPI em mulheres grávidas e em seus filhos evidencia a importância de uma maior atenção a essa problemática. No entanto, a desigualdade de gênero representa o cerne das possibilidades de romper o ciclo da VPI no período gestacional e suas consequências para saúde do binômio mãe-bebê.

Objective: To identify the scientific evidence on the repercussions of Intimate Partner Violence (IPV) in pregnancy on the health of the woman and the fetus. Method: This is an integrative literature review. Literature searches were performed in the Virtual Health Library; Medline via Pubmed and Web of Science. Results: 21 articles were included. Studies show that women victims of pregnancy are more vulnerable to psychological distress, with increased levels of stress, sadness, anguish, common mental disorder and suicidal ideation. They are more susceptible to poor adherence to prenatal care and to gynecological and obstetric problems, presenting high chances of urinary tract and vaginal infections, increased risk of prenatal hospitalizations and greater chances of progressing to severe acute maternal morbidity. For the health of the fetus, exposure to violence is related to an increased chance of spontaneous abortion, restricted intrauterine growth, premature birth, low birth weight, perinatal death, infant and childhood mortality. It has also been shown that maternal violence in the gestational period is associated with low adherence to the child's immunization, shorter duration of breastfeeding and the need to refer the child to specialized monitoring for neonatal hearing screening. Conclusion: The impact of IPV on pregnant women and their children highlights the importance of greater attention to this problem. However, gender inequality represents the coreof the possibilities of breaking the cycle of IPV in the gestational period and its consequences for the health of the mother-baby binomial.

Objetivo: Identificar la evidencia científica sobre las repercusiones de la Violencia de Pareja (VPI) en el embarazo sobre la salud de la mujer y el feto. Método: Esta es una revisión integradora de la literatura. Se realizaron búsquedas bibliográficas en la Biblioteca Virtual en Salud; Medline vía Pubmed y Web of Science. Resultados: se incluyeron 21 artículos. Los estudios muestran que las mujeres víctimas del embarazo son más vulnerables al malestar psicológico, con mayores niveles de estrés, tristeza, angustia, trastorno mental común e ideación suicida. Son más susceptibles a la mala adherencia al control prenatal ya los problemas ginecológicos y obstétricos, presentando altas posibilidades de infecciones urinarias y vaginales, mayor riesgo de hospitalizaciones prenatales y mayores posibilidades de progresar a morbilidad materna aguda severa. Para la salud del feto, la exposición a la violencia está relacionada con una mayor probabilidad de aborto espontáneo, crecimiento intrauterino restringido, parto prematuro, bajo peso al nacer, muerte perinatal, mortalidad infantil y en la niñez. También se ha demostrado que la violencia materna en el período gestacional está asociada con la baja adherencia a la vacunación del niño, la menor duraciónde la lactancia materna y la necesidad de derivar al niño a seguimiento especializado para el tamizaje auditivo neonatal. Conclusión: El impacto de la VPI en las mujeres embarazadas y sus hijos destaca la importancia de una mayor atención a este problema.Sin embargo, la desigualdad de género representa el núcleo de las posibilidades de romper el ciclo de la VPI en el período gestacional y sus consecuencias para la salud del binomio madre-bebé.

Tasas de conversiones tuberculínicas entre trabajadores de la salud / Tuberculin conversion rates among health care workers

Las tasas de conversiones tuberculínicas (TCT) permiten detectar tempranamente nuevos infectados entre los trabajadores de la salud (TS). Sobre 544 trabajadores con reacciones negativas, 275 aceptaron realizarse una nueva dosis de 2 UT de PPD al año siguiente. Se evaluaron enfermeras, médicos, técnicos, administrativos, bioquímicos, kinesiólogos, instrumentadoras, farmacéuticas, psicólogos y otros. Se consideró convertidor tuberculínico a aquel TS con reacción al PPD de 10 mm o mayores, al que se le indicó isoniazida a razón de 5 mg/kg una vez descartada tuberculosis en actividad. La media de edad fue de 45.6 ± 11.3 años y el sexo femenino constituyó el 76.3% de la muestra (210/275). Un 36.7% la integraron enfermeras (101/275), 17.7% fueron médicos, 14.9% técnicos, 10.9% administrativos, 5.1% bioquímicos y otros (14.5%). La tasa de conversión global fue de 8.3%, 11.8% en enfermeras, 10% en administrativos, 7.3% en técnicos, 7.1% en bioquímicos y 2% en médicos (p = NS). Se indicó isoniazida en 23 TS, con un cumplimiento del 52%. En el año de observación se denunciaron 8 casos nuevos de tuberculosis entre TS de nuestro hospital. La TCT en nuestro hospital es aún elevada, la actividad de enfermería es el grupo más vulnerable. Se considera ineludible la adopción de medidas de bioseguridad adecuadas.

Serological screening for celiac disease in symptomatic 12 to 36 month-old children.

CONTEXT: The correct diagnosis of celiac disease in environmentally deprived children is frequently hindered by the common presence of other causes for the classical celiac disease symptoms: malnutrition, failure to thrive and frequent diarrheas. OBJECTIVES: To determine the prevalence of celiac disease in a group of 12 to 36 month-old children using immunoglobulin antibodies against gliadin (IgG and IgA-AGA), against endomysium (IgA-EMA), and against human tissue transglutaminase (IgA-tTG) as screening method. METHODS: A total of 214 children (114 boys), aged 12 to 36 months, on gluten-containing diet, were admitted to the study. IgG and IgA-AGA, IgA-tTG and IgA-EMA tests were performed in all sera. Biopsy was obtained from all children showing positive result in one or more of the serologic tests, excluding those in which IgG-AGA had been the only positive result. In those cases, polymerase chain reaction (PCR) HLA genotyping for the identification of celiac disease predisposing alleles was applied. HLA genotyping was also performed to confirm the diagnosis in children identified as celiac by means of positive serologic testing and compatible biopsy results. RESULTS: Normal results were obtained in 131 children. Ten children out of 68 identified as positive exclusively on the IgG-AGA test disclosed the presence of celiac disease predisposing alleles on PCR and underwent jejunal biopsy with normal results. All serologic tests were positive in four children. A fifth child showed positive IgG and IgA-AGA and IgA-tTG results but disclosed a negative IgA-EMA test. Jejunal biopsy of these five children revealed characteristic lesions of celiac disease. CONCLUSION: A prevalence of 2.3% was found among symptomatic 12- to 36-month-old children that had not been previously diagnosed as celiac.

[Tuberculosis among health care workers]. / Tuberculosis en trabajadores de salud.

The objective of this work was to address the problem of tuberculosis (TB) infection among Health Care Workers (HCW), based on an experience in a TB Prevention and Treatment Programme at a General Acute Hospital in Buenos Aires City. The objectives of the programme were to provide health education and periodic screening of HCW, to detect TB cases and to implement control measures. TB infection was defined by a 10 mm reaction to 2 UT PPD. Two prevalence studies of TB infection were performed. In 1998 infection prevalence was 31.7% (n = 533), and in 2008 it was 35% (n = 670). Nurses presented the highest percentage. An increase in TB infection prevalence was observed in 2008 among physicians (p = 0.02). A sample of 45 HCW integrating the first prevalence study group was analysed by applying 2 UT PPD three month later. Eight tuberculin conversions were detected (17%), all of them in nurses; 163 HCW who had contact with other eight HCW who developed TB were evaluated, four of whom were nurses. PPD reactions were positive in 39.9% with no any new case of TB detected among them. In nurses, five tuberculin conversions were observed. Other 127 HCW from low risk areas were also evaluated, 25.9% of whom had positive reactions to 2 UT PPD, while this percentage was 39.9% in the previous group (p = 0.01).Despite the scarcity of human resources that limit the planning of TB incidence studies, personal protective measures, teaching HCW about TB and chemoprophylaxis might reduce the risk of TB in this group.

Serological screening for celiac disease in symptomatic 12 to 36 month-old children

CONTEXT: The correct diagnosis of celiac disease in environmentally deprived children is frequently hindered by the common presence of other causes for the classical celiac disease symptoms: malnutrition, failure to thrive and frequent diarrheas. OBJECTIVES: To determine the prevalence of celiac disease in a group of 12 to 36 month-old children using immunoglobulin antibodies against gliadin (IgG and IgA-AGA), against endomysium (IgA-EMA), and against human tissue transglutaminase (IgA-tTG) as screening method. METHODS: A total of 214 children (114 boys), aged 12 to 36 months, on gluten-containing diet, were admitted to the study. IgG and IgA-AGA, IgA-tTG and IgA-EMA tests were performed in all sera. Biopsy was obtained from all children showing positive result in one or more of the serologic tests, excluding those in which IgG-AGA had been the only positive result. In those cases, polymerase chain reaction (PCR) HLA genotyping for the identification of celiac disease predisposing alleles was applied. HLA genotyping was also performed to confirm the diagnosis in children identified as celiac by means of positive serologic testing and compatible biopsy results. RESULTS: Normal results were obtained in 131 children. Ten children out of 68 identified as positive exclusively on the IgG-AGA test disclosed the presence of celiac disease predisposing alleles on PCR and underwent jejunal biopsy with normal results. All serologic tests were positive in four children. A fifth child showed positive IgG and IgA-AGA and IgA-tTG results but disclosed a negative IgA-EMA test. Jejunal biopsy of these five children revealed characteristic lesions of celiac disease. CONCLUSION: A prevalence of 2.3 percent was found among symptomatic 12- to 36-month-old children that had not been previously diagnosed as celiac.

CONTEXTO: O diagnóstico correto da doença celíaca em crianças ambientalmente carentes é frequentemente dificultado pela presença usual de causas outras para os clássicos sintomas da doença celíaca. OBJETIVO: Determinar a prevalência de doença celíaca em um grupo de crianças com idades compreendidas entre 12 e 36 meses, utilizando a pesquisa de anticorpos antigliadina (IgG e IgA-AGA), antiendomísio (IgA-EMA) e antitransglutaminase recombinante humana (IgA-tTG) como método de rastreio. MÉTODOS: Foram incluídas no estudo 214 crianças (114 meninos), com 12 a 36 meses de idade, todas em uso de dieta contendo glúten. Em todos os soros foi pesquisada a presença de anticorpos anti-IgG e IgA-AGA, anti-IgA-EMA e anti-IgA-tTG humana. Biopsia jejunal foi sugerida e efetuada em todas as crianças com resultados positivos em um ou mais testes sorológicos, excetuando-se as crianças em que o IgG-AGA tinha sido o único teste positivo. Nesta última situação, efetuou-se genotipagem para identificação de possíveis alelos HLA predisponentes por meio do método de PCR. Para confirmação do diagnóstico, a genotipagem dos alelos HLA também foi efetuada nas crianças identificadas como celíacas com base a testes sorológicos positivos e resultado da biopsia jejunal compatível. RESULTADOS: Em 131 crianças os resultados dos testes sorológicos foram normais. Em 68 delas, foi detectada apenas a presença de anticorpos anti-IgG-AGA. Em 10 destas, por terem apresentado presença de alelos HLA predisponentes, foi realizada biopsia jejunal, que revelou mucosa sem alterações. Todos os testes sorológicos foram positivos em quatro crianças. Os testes igG e IgA-AGA e IgA-tTG foram positivos numa quinta criança que, no entanto, apresentou teste IgA-EMA negativo. A biopsia jejunal dessas cinco crianças revelou lesões de mucosa típicas e compatíveis com o diagnóstico de doença celíaca. CONCLUSÃO: Prevalência de 2,3 por cento foi encontrada entre crianças de 12 a 36 meses de idade, ...

Tuberculosis en trabajadores de salud / Tuberculosis among health care workers

El objetivo del presente trabajo fue abordar la problemática de la infección por tuberculosis (TB) en Trabajadores de la Salud (TS) a través de la experiencia en un programa de prevención y tratamiento de la TB en un Hospital General de Agudos de la Ciudad de Buenos Aires. Los objetivos del Programa fueron implementar acciones de educación para la salud, pesquisa periódica de TS, detección de casos de TB y efectuar acciones de control. Se definió infección TB como PPD 2 UT = 10 mm. Se realizaron dos estudios de prevalencia de infección. En 1998 fue de 31.7% (n = 533) y en 2008 de 35% (n = 670). Enfermería tuvo el mayor porcentaje de infectados. En 2008 se advirtió un aumento de la infección TB en los médicos (p = 0.02). Se estudiaron 45 TS en el grupo que repitió PPD a los tres meses del primer estudio de prevalencia. Se detectaron ochos virajes tuberculínicos (17%), todos en enfermeras. Se evaluaron 163 TS que estuvieron en contacto con 8 casos de TB diagnosticados en TS, 4 de los cuales eran enfermeras. El 39.9% presentó PPD positiva, no se detectaron casos nuevos de TB y se documentaron cinco conversiones tuberculínicas en enfermeras. Se evaluaron 127 TS de sectores con bajo riesgo, el 25.9% presentó PPD positiva (p = 0.01 comparando con el 39.9% en el grupo anterior). A pesar de las limitaciones en el recurso humano para realizar estudios de incidencia de TB, la protección personalizada, la educación en TB y la quimioprofilaxis podrían reducir los riesgos de TB en TS.

The objective of this work was to address the problem of tuberculosis (TB) infection among Health Care Workers (HCW), based on an experience in a TB Prevention and Treatment Programme at a General Acute Hospital in Buenos Aires City. The objectives of the programme were to provide health education and periodic screening of HCW, to detect TB cases and to implement control measures. TB infection was defined by a = 10 mm reaction to 2 UT PPD. Two prevalence studies of TB infection were performed. In 1998 infection prevalence was 31.7% (n = 533), and in 2008 it was 35% (n = 670). Nurses presented the highest percentage. An increase in TB infection prevalence was observed in 2008 among physicians (p = 0.02). A sample of 45 HCW integrating the first prevalence study group was analysed by applying 2 UT PPD three month later. Eight tuberculin conversions were detected (17%), all of them in nurses; 163 HCW who had contact with other eight HCW who developed TB were evaluated, four of whom were nurses. PPD reactions were positive in 39.9% with no any new case of TB detected among them. In nurses, five tuberculin conversions were observed. Other 127 HCW from low risk areas were also evaluated, 25.9% of whom had positive reactions to 2 UT PPD, while this percentage was 39.9% in the previous group (p = 0.01).Despite the scarcity of human resources that limit the planning of TB incidence studies, personal protective measures, teaching HCW about TB and chemoprophylaxis might reduce the risk of TB in this group.

Are neuropsychological changes relevant in subclinical hypothyroidism?

INTRODUCTION: Neuropsychological changes are still controversial in patients with subclinical hypothyroidism (SH). The objective of this study is to assess these changes. METHOD: Cross-sectional study comparing the results of the neurocognitive evaluation of 65 SH patients and 31 individuals without thyroid disease. Subclinical hypothyroidism was defined as at least two elevated serum TSH levels (> 4 microUI/ml) with normal serum free T4 levels (0.9-1.8 ng/dl). The participants underwent the following neuropsychological assessment: Buschkes Selective Reminding Procedure, Rey-Osterrieth Complex Figure Test, Warrington's Recognition Memory Test for Words and Faces, and the Vocabulary subtest of the WAIS-R. RESULTS: The groups were similar in regard to mean age, sex and educational level. No neuropsychological change was found in patients with SH when compared with euthyroid individuals. CONCLUSION: No difference was observed in the performance of the neuropsychological tests between both groups in regard to the functions studied.

Are neuropsychological changes relevant in subclinical hypothyroidism?

INTRODUCTION: Neuropsychological changes are still controversial in patients with subclinical hypothyroidism (SH). The objective of this study is to assess these changes. METHOD: Cross-sectional study comparing the results of the neurocognitive evaluation of 65 SH patients and 31 individuals without thyroid disease. Subclinical hypothyroidism was defined as at least two elevated serum TSH levels (> 4 æUI/ml) with normal serum free T4 levels (0.9-1.8 ng/dl). The participants underwent the following neuropsychological assessment: BuschkeÆs Selective Reminding Procedure, Rey-Osterrieth Complex Figure Test, WarringtonÆs Recognition Memory Test for Words and Faces, and the Vocabulary subtest of the WAIS-R. RESULTS: The groups were similar in regard to mean age, sex and educational level. No neuropsychological change was found in patients with SH when compared with euthyroid individuals. CONCLUSION: No difference was observed in the performance of the neuropsychological tests between both groups in regard to the functions studied.

INTRODUÇÃO: Até o presente momento, não se tem confirmação da presença de alterações neuropsicológicas em pacientes com hipotireoidismo subclínico (HS). O objetivo desta pesquisa foi avaliar essas alterações. MÉTODO: Estudo seccional comparando os achados neuropsicológicos de 65 pacientes com HS e 31 indivíduos eutireoidianos. HS foi confirmado por duas dosagens plasmáticas elevadas de TSH (> 4 æUI/ml) associadas com dosagem sérica de T4L na faixa da normalidade (0,9-1,8 ng/dl). Para avaliação neuropsicológica, foram utilizados o procedimento de Buschke, a figura de Rey-Osterrieth, o reconhecimento de palavras e faces de Warrington e o subteste Vocabulário do WAIS-R. RESULTADOS: Os grupos foram similares quanto a idade, sexo e nível de escolaridade. Não encontramos alterações neuropsicológicas nos pacientes com HS em comparação ao grupo eutireoidiano. CONCLUSÃO: Não foi encontrada nenhuma diferença nos resultados dos testes neuropsicológicos entre os dois grupos em relação às funções estudadas.

Neuropsychological, neuroimage and psychiatric aspects of primary Sjögren's syndrome.

We report a case of a 49-year-old woman diagnosed with primary Sjögrens Syndrome (pSS) who was submitted to extensive neuropsychobiological assessment. Examination revealed a Wechsler Adult Intelligence Scale-Revised (WAIS-R) Full Scale IQ of 97 with no Verbal/Performance IQ discrepancy and performance below estimated premorbid levels on arithmetic skills, visual tracking, naming and delayed paired associate learning/memory. CT scans of the brain were normal. However, there were subcortical hyperintensities on MRI and left parieto-temporal hypoperfusion on SPECT. Neuropsychological impairment is consistent with the pattern of neuroimage findings. We hypothesize that the pathophysiological mechanisms of pSS involve direct immune attack on neurons in addition to indirect effects through small-vessel angiopathy and thereby induce natural fracture lines in behavior according to location in the central nervous system.

Neuropsychological, neuroimage and psychiatric aspects of primary Sjögren's syndrome

We report a case of a 49-year-old woman diagnosed with primary Sjögrens Syndrome (pSS) who was submitted to extensive neuropsychobiological assessment. Examination revealed a Wechsler Adult Intelligence Scale-Revised (WAIS-R) Full Scale IQ of 97 with no Verbal/Performance IQ discrepancy and performance below estimated premorbid levels on arithmetic skills, visual tracking, naming and delayed paired associate learning/memory. CT scans of the brain were normal. However, there were subcortical hyperintensities on MRI and left parieto-temporal hypoperfusion on SPECT. Neuropsychological impairment is consistent with the pattern of neuroimage findings. We hypothesize that the pathophysiological mechanisms of pSS involve direct immune attack on neurons in addition to indirect effects through small-vessel angiopathy and thereby induce natural fracture lines in behavior according to location in the central nervous system

Seroprevalencia y factores de riesgo asociados con la infeccion por Helicobacter pylori en niños / Serological prevalence and risk factors associated to H. pylori in child

Objetivo: determinar la seroprevalencia y los factores de riesgo asociados a Helicobacter pylori en un grupo de niños.Método: es un estudio descriptivo prospectivo en niños sanos de dos entidades, una privada en Bogotá y una escuela de una población (Ubaté, Cundinamarca). Los padres respondieron un cuestionario sobre tipo de vivienda, número de cuartos, número de miembros y de niños que habitaban la vivienda, estrato socioeconómico, origen del agua de consumo, antecedentes de úlcera en padres y de cáncer gástrico en la familia; la infección por H.pylori fue evaluada por determinación de anticuerpos IgG en sangre, a través de inmunocromatografía Resultados: 119 niños fueron evaluados, 56 por ciento del sexo femenino, de edades entre 3 meses y 14 años; 59 provenían de la clínica privada y 60 de la escuela rural en Ubaté; un total de 32 por ciento de los niños presentaron anticuerpos para H. pylori, Un mayor riesgo de infección fue encontrado en niños de mayor edad (9,5 años vs 5,9 años, p=0,001); la serología fue positiva para el grupo de niños con edades comprendidas entre 6 y 10 años en un 39 por ciento y en mayores de 10 años en 62 por ciento. Igualmente, la frecuencia fue mayor en niños que vivían en casalote o inquilinato que en aquellos que vivían en casa o apartamento (p=0,02), cuando el número de miembros de la familia fue mayor (5 personas vs 4, p=0,016), cuando había mayor número de niños (2 vs 1, p=0,016) y cuando se tuvo menor estrato socioeconómico (estrato 2 vs 3, p=0,01). No se encontraron diferencias significativas entre prevalencia de H.pylori y tener diferentes número de cuartos por casa, raza, sexo, origen del agua, ni antecedentes de padres con úlcera péptica o cáncer gástrico en la familia. Conclusión: la infección por H.pylori aumenta progresivamente con la edad y es más notoria después de los 6 años. Los factores de riesgo se correlacionan con el tipo de vivienda, el número de miembros y el número de niños que viven en la casa, además del estrato socioeconómico

Enfermedad de Addison en un niño de raza negra / Addison's disease in a black boy

Se presenta la observación clínica de un niño de 4 años de raza negra, que fue admitido por una crisis addisoniana. La causa más frecuente de enfermedad de Addison es la adrenalitis autoinmune. Es una entidad rara en la infancia. Guiaron el diagnóstico la avidez por la sal, la severa deshidratación y los trastornos electrolíticos refractarios al tratamiento inicial. Lo confirmaron las dosificaciones hormonales y la excelente respuesta a la corticoterapia