Postextubation dysphagia in critically ill children: A prospective cohort study.

INTRODUCTION: Postextubation dysphagia (PED) is reported mainly in adults and is associated with poor outcomes. However, data on pediatric intensive care unit (PICU) patients are scarce. We aimed to assess the incidence, risk factors, and outcomes associated with PED in a PICU population. METHODS: Between 2019 and 2021, we conducted a prospective, observational cohort study of patients aged 1 month to 15 years. Within 24 h after extubation, a speech-language pathologist routinely screened all consecutive patients receiving mechanical ventilation (>24 h) for dysphagia. A Functional Oral Intake Scale (FOIS) score of less than 6 indicated dysphagia. RESULTS: A total of 161 patients were included, with a PED incidence of 69%. After adjusting for confounding variables, five variables were significantly associated with PED (odds ratio; 95% confidence interval): age <24 months (4.84; 1.5-15.60), neurological comorbidities (7.47; 1.36-40.96), iatrogenic withdrawal syndrome (5.52; 1.31-23.14), use of neuromuscular blocking agents (4.19; 1.18-14.82), and duration of intubation >72 h (3.22; 1.08-9.64). Dysphagia was significantly associated with longer PICU and hospital stays and a longer delay to oral feeding than patients without PED, 14 versus 7.5 days, 21 versus 15 days, and 6 versus 1 day, respectively. Ten participants (9%) failed to resume total oral intake at hospital discharge. CONCLUSIONS: These findings indicate that PED is highly prevalent in children and associated with adverse patient outcomes. Identifying a core of risk factors might improve prompt recognition of patients at risk for PED and implement preventive approaches and early interventions.

Study of the polymorphism rs3025058 of the MMP-3 gene and risk of pelvic organ prolapse in Brazilian women.

OBJECTIVE: To analyze the polymorphism -1171 5A / 6A rs3025058 of the MMP-3 gene and the risk for pelvic organ prolapse (POP). STUDY DESIGN: This is a cohort study. All patients attended the Urogynecology and Vaginal Surgery Section of the FMABC, from 2014 to 2016 and they were randomly recruited by the researchers at the first medical appointment. We selected 112 patients with symptomatic POPs and 180 patients with normal pelvic floors. The single nucleotide polymorphism (SNP) 5A / 6A of MMP-3 was determined by polymerase chain reaction (PCR) and analysis of the restriction fragments in both groups. Chi-squared test was used to compare the frequencies of polymorphisms between the groups. For those characteristics with statistical relevance, the crude odds ratio (OR) and its respective 95% confidence intervals were calculated; and, by logistic regression, were adjusted for each of the other characteristics, obtaining the adjusted OR. Hardy-Weinberg gene balance was determined using Pearson's Chi-squared test. Values of p < 0.05 were considered statistically significant. RESULTS: Logistic regression of factors associated with genital prolapse showed that age (adjusted OR = 11.89, 95% CI, 3.53-40) and home delivery (adjusted OR = 9.645, 95% CI, 3.35-27.7) remained risk factors for genital prolapse in the sample studied. There was no statistically significant difference between the groups in the distribution of genotypes, even after calculating the contribution of the 5A recessive allele in the aggregated genotypes (5A / 5A + 5A / 6A). CONCLUSION: The polymorphism -1171 5A / 6A rs3025058 of the MMP-3 gene was not associated with the risk for POP. Age and home delivery were significantly associated with increased risk for the disease.