ABSTRACT
BACKGROUND: Daily low-dose aspirin (LDA) is recommended in high-risk pregnancies. However, its safety profile in the first trimester has not been well documented. OBJECTIVES: To determine if LDA exposure during the first trimester of pregnancy is associated with higher odds of congenital structural anomalies. SEARCH STRATEGY: PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were systematically searched. SELECTION CRITERIA: Randomized controlled trials (RCTs) that assigned participants to LDA (≤150 mg) or placebo/no intervention at less than 14 weeks of pregnancy were eligible. DATA COLLECTION AND ANALYSIS: Random-effects models were performed using the inverse-variance method to calculate pooled effect sizes. Quality of evidence was appraised according to Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. MAIN RESULTS: Eight RCTs that included 7564 participants assigned to receive daily LDA and 7670 participants that served as controls were analyzed. Low-certainty evidence showed no significant difference in the odds of congenital anomalies (odds ratio 0.87, 95% confidence interval 0.62-1.23, I2 = 0%). CONCLUSIONS: In this meta-analysis, there is no evidence to suggest safety concerns regarding LDA teratogenicity. However, given the overall low quality of evidence, further research (e.g. individual participant data meta-analysis) is needed to confirm LDA safety profile.
Subject(s)
Aspirin , Pregnancy , Female , Humans , Pregnancy Trimester, First , Randomized Controlled Trials as Topic , Aspirin/adverse effectsABSTRACT
Elizabethkingia meningoseptica es un patógeno oportunista, con una elevada mortalidad y una incidencia en aumento en las terapias intensivas. Se presenta a una paciente de 4 años con antecedente de atresia de vías biliares y trasplante hepático a los 11 meses de vida, que se internó por infección respiratoria aguda baja con hipoxemia. Durante la internación, sufrió un empeoramiento clínico con requerimiento de asistencia respiratoria mecánica. Por fiebre e hipoxemia persistente, se realizó un minilavado broncoalveolar, con cultivo positivo para Elizabethkingia meningoseptica. Recibió vancomicina, trimetoprima/sulfametoxazol y ciprofloxacina durante 14 días, con buena respuesta. Una tomografía de tórax evidenció la presencia de hipoperfusión en mosaico, imágenes quísticas y bronquiectasias bilaterales. Durante los siguientes 2 años, presentó una buena evolución clínica, con escasas intercurrencias respiratorias, síntomas intercrisis aislados y buena tolerancia al ejercicio. En las imágenes de control, se evidenció la resolución de la mayoría de las lesiones iniciales a los 20 meses de su seguimiento.
Elizabethkingia meningoseptica is an opportunistic pathogen with a high mortality and an increasing incidence in the intensive care units. We present a 4-year-old patient with a history of atresia of the biliary tract and a liver transplant at 11 months of age, who was admitted for acute respiratory infection with hypoxemia. During the hospitalization, she required mechanical ventilation. Due to persistent fever and hypoxemia, mini bronchoalveolar lavage was performed with a positive culture for Elizabethkingia meningoseptica. She received vancomycin, trimethoprim/sulfamethoxazole and ciprofloxacin for 14 days with a good response. A chest tomography showed the presence of mosaic hypoperfusion, cystic images, and bilateral bronchiectasis. During the following 2 years, she presented good clinical progress, with scarce respiratory infections, isolated symptoms and good tolerance to exercise. The resolution of the majority of the initial lesions was evidenced at 20 months of follow-up.
Subject(s)
Humans , Female , Child, Preschool , Pediatrics , Pneumonia , Flavobacterium , Child , ChryseobacteriumABSTRACT
Elizabethkingia meningoseptica is an opportunistic pathogen with a high mortality and an increasing incidence in the intensive care units. We present a 4-year-old patient with a history of atresia of the biliary tract and a liver transplant at 11 months of age, who was admitted for acute respiratory infection with hypoxemia. During the hospitalization, she required mechanical ventilation. Due to persistent fever and hypoxemia, mini bronchoalveolar lavage was performed with a positive culture for Elizabethkingia meningoseptica. She received vancomycin, trimethoprim/sulfamethoxazole and ciprofloxacin for 14 days with a good response. A chest tomography showed the presence of mosaic hypoperfusion, cystic images, and bilateral bronchiectasis. During the following 2 years, she presented good clinical progress, with scarce respiratory infections, isolated symptoms and good tolerance to exercise. The resolution of the majority of the initial lesions was evidenced at 20 months of follow-up.
Elizabethkingia meningoseptica es un patógeno oportunista, con una elevada mortalidad y una incidencia en aumento en las terapias intensivas. Se presenta a una paciente de 4 años con antecedente de atresia de vías biliares y trasplante hepático a los 11 meses de vida, que se internó por infección respiratoria aguda baja con hipoxemia. Durante la internación, sufrió un empeoramiento clínico con requerimiento de asistencia respiratoria mecánica. Por fiebre e hipoxemia persistente, se realizó un minilavado broncoalveolar, con cultivo positivo para Elizabethkingia meningoseptica. Recibió vancomicina, trimetoprima/sulfametoxazol y ciprofloxacina durante 14 días, con buena respuesta. Una tomografía de tórax evidenció la presencia de hipoperfusión en mosaico, imágenes quísticas y bronquiectasias bilaterales. Durante los siguientes 2 años, presentó una buena evolución clínica, con escasas intercurrencias respiratorias, síntomas intercrisis aislados y buena tolerancia al ejercicio. En las imágenes de control, se evidenció la resolución de la mayoría de las lesiones iniciales a los 20 meses de su seguimiento.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Chryseobacterium/isolation & purification , Flavobacteriaceae Infections/diagnosis , Pneumonia, Bacterial/diagnosis , Child, Preschool , Female , Flavobacteriaceae Infections/drug therapy , Flavobacteriaceae Infections/microbiology , Follow-Up Studies , Humans , Intensive Care Units , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiologySubject(s)
Biliary Atresia/surgery , Calcineurin Inhibitors/administration & dosage , Immunosuppressive Agents/administration & dosage , Liver Transplantation , Tacrolimus/administration & dosage , Administration, Sublingual , Age Factors , Calcineurin Inhibitors/blood , Calcineurin Inhibitors/pharmacokinetics , Child , Child, Preschool , Drug Monitoring/methods , Female , Graft Rejection/immunology , Graft Rejection/prevention & control , Graft Survival/drug effects , Humans , Immunosuppressive Agents/blood , Immunosuppressive Agents/pharmacokinetics , Infant , Liver Transplantation/adverse effects , Male , Retrospective Studies , Tacrolimus/blood , Tacrolimus/pharmacokinetics , Treatment OutcomeABSTRACT
INTRODUCTION: Sedation of patients in pediatric ICU extubated and in weaning of mechanic ventilation is diffcult under regular sedation, because of the tolerance and/or abstinence generated by its sustained use. The objective of this study is to describe the use of Levomepromazine as sedative coadjuvant in these patients. POPULATION AND METHODS: Observational and longitudinal study in intensive care from Juan P. Garrahan Pediatric Hospital. Patients older than 2 years were included, extubated and in weaning of mechanic ventilation with requirements of additional sedation. The level of basal sedation and post-intervention (levomepromazine 0.5 mg/kg every 8 hours) were evaluated with Ramsay and Khalil scales. Doses of regular sedatives were compared before and after the indication. It was considered positive an increase of 1 in the scales, or a decrease of 20% in the regular sedatives doses. RESULTS: 36 patients, medium age of 8,5 years, average doses of levomepromazine 0.38 mg/kg. 97% showed positive result. The regular sedative doses were reduced more than 20% after the intervention. No adverse effects or deceased were registered.
Subject(s)
Hypnotics and Sedatives/therapeutic use , Methotrimeprazine/therapeutic use , Adolescent , Child , Child, Preschool , Drug Therapy, Combination , Humans , Intensive Care Units, PediatricABSTRACT
BACKGROUND: The aetiological relationship between human papillomavirus (HPV) infection and cervical cancer (CC) is widely accepted. Our goal was to determine the prevalence of HPV types in Mexican women attending at the Mexican Institute for Social Security from different areas of Mexico. MATERIALS AND METHODS: DNAs from 2,956 cervical samples were subjected to HPV genotyping: 1,020 samples with normal cytology, 931 with low-grade squamous intraepithelial lesions (LGSIL), 481 with high grade HGSIL and 524 CC. RESULTS: Overall HPV prevalence was 67.1%. A total of 40 HPV types were found; HPV16 was detected in 39.4% of the HPV-positive samples followed by HPV18 at 7.5%, HPV31 at 7.1%, HPV59 at 4.9%, and HPV58 at 3.2%. HPV16 presented the highest prevalence both in women with altered or normal cytology and HPV 18 presented a minor prevalence as reported worldwide. The prevalence ratio (PR) was calculated for the HPV types. The analysis of PR showed that HPV16 presents the highest association with CC, HPV 31, -33, -45, -52 and -58 also demonstrating a high association. CONCLUSIONS: The most prevalent HPV types in cervical cancer samples were -16, -18, -31, but it is important to note that we obtained a minor prevalence of HPV18 as reported worldwide, and that HPV58 and -52 also were genotypes with an important prevalence in CC samples. Determination of HPV genotypes is very important in order to evaluate the impact of vaccine introduction and future cervical cancer prevention strategies.
Subject(s)
Carcinoma, Squamous Cell/virology , Papillomaviridae/genetics , Papillomavirus Infections/virology , Squamous Intraepithelial Lesions of the Cervix/virology , Uterine Cervical Neoplasms/virology , Adolescent , Adult , Aged , Carcinoma, Squamous Cell/epidemiology , Female , Genotype , Human papillomavirus 16/genetics , Human papillomavirus 18/genetics , Human papillomavirus 31/genetics , Humans , Mexico/epidemiology , Middle Aged , Papillomavirus Infections/epidemiology , Prevalence , Squamous Intraepithelial Lesions of the Cervix/epidemiology , Uterine Cervical Neoplasms/epidemiology , Young AdultABSTRACT
INTRODUCCION: La escasez de profesionales calificados ha creado una gran amenaza para la disponibilidad y calidad de los cuidados críticos pediátricos. La falta de intensivistas, en gran parte no reconocida, puede poner en riesgo en un futuro próximo los servicios básicos para la población.OBJETIVO: Analizar la situación de recursos humanos en las Unidades de Cuidados Intensivos Pediátricos (UCIP) mediante un relevamiento de los profesionales médicos que allí se desempeñan o que han abandonado la actividad asistencial.METODOS: Estudio observacional, analítico, prospectivo, transversal y multicéntrico. Los datos se registraron mediante una encuesta de capacitación laboral, actividad profesional y síndrome de agotamiento profesional o burn out (BO) previamente validada. La encuesta estuvo dirigida a todos los profesionales en actividad en UCIP o que abandonaron la especialidad.RESULTADOS: De los 174 profesionales encuestados, un 73% presentó alto riesgo de BO. En el análisis bivariado se observó un menor riesgo de BO en aquellos profesionales certificados o con más de diez años de ejercicio de la especialidad. El 29% dijo que no continuaría ejerciendo la especialidad, y el 47% de los encuestados señaló su absoluto desacuerdo con la remuneración. Adicionalmente, más del 80% consideró que si se generan modificaciones en la práctica profesional (cargos de planta con guardias, jubilación temprana, guardias de 12 hs, etc.), se podría prolongar su expectativa de desarrollar actividades asistenciales en las UCIP.CONCLUSIONES: La mayoría de los médicos que trabajan en las UCIP de Argentina tienen un alto nivel de agotamiento profesional, y pocos esperan continuar trabajando en la especialidad en los próximos años. Los profesionales encuestados opinaron que si se generan modificaciones en la práctica profesional se podría prolongar su expectativa de desarrollar actividades asistenciales en las UCIP.
INTRODUCTION: Shortage of qualified professionals has created a big threat to the availability and quality of pediatric intensive care units. The lack of intensivists, mostly ignored, may put at risk the basic services for the population in the near future.OBJECTIVE: To analyze the situation of human resources by adressing medical professionals who work at Pediatric Intensive Care Units (PICU) or who have abandoned that activity.METHODS: The design was observational, analytical, prospective, cross-sectional and multicenter. Data was registered through a previously validated survey about job training, professional activity and burnout (BO) syndrome. The survey aimed to evaluate all professionals active in the PICU and those that had abandoned the specialty.RESULTS: 73% of the 174 surveyed professionals had a high risk of BO. According ot a bivariate analysis, there was less risk in certified professionals and professionals with more than ten years of experience in the specialty. 29% said they would not continue practicing the specialty, and 47% completely disagreed with the salaries. Over 80% considered that, if changes were introduced (permanent job with duty, early retirement, 12-hour duty, etc.), it would be possible to improve the prospects in PICU activities.CONCLUSIONS: Most of the doctors that work at PICU in Argentina have a high degree of BO, and few of them expect to keep on working there during the next years. According to the surveyed professionals, with some specific changes in the professional practice it would be possible to extend the expectations to develop health-care activities in PICU.
Subject(s)
Burnout, Professional , Professional Training , Health Workforce , Job Satisfaction , Intensive Care Units, Pediatric , Argentina , Public HealthABSTRACT
INTRODUCCION: La escasez de profesionales calificados ha creado una gran amenaza para la disponibilidad y calidad de los cuidados críticos pediátricos. La falta de intensivistas, en gran parte no reconocida, puede poner en riesgo en un futuro próximo los servicios básicos para la población.OBJETIVO: Analizar la situación de recursos humanos en las Unidades de Cuidados Intensivos Pediátricos (UCIP) mediante un relevamiento de los profesionales médicos que allí se desempeñan o que han abandonado la actividad asistencial.METODOS: Estudio observacional, analítico, prospectivo, transversal y multicéntrico. Los datos se registraron mediante una encuesta de capacitación laboral, actividad profesional y síndrome de agotamiento profesional o burn out (BO) previamente validada. La encuesta estuvo dirigida a todos los profesionales en actividad en UCIP o que abandonaron la especialidad.RESULTADOS: De los 174 profesionales encuestados, un 73% presentó alto riesgo de BO. En el análisis bivariado se observó un menor riesgo de BO en aquellos profesionales certificados o con más de diez años de ejercicio de la especialidad. El 29% dijo que no continuaría ejerciendo la especialidad, y el 47% de los encuestados señaló su absoluto desacuerdo con la remuneración. Adicionalmente, más del 80% consideró que si se generan modificaciones en la práctica profesional (cargos de planta con guardias, jubilación temprana, guardias de 12 hs, etc.), se podría prolongar su expectativa de desarrollar actividades asistenciales en las UCIP.CONCLUSIONES: La mayoría de los médicos que trabajan en las UCIP de Argentina tienen un alto nivel de agotamiento profesional, y pocos esperan continuar trabajando en la especialidad en los próximos años. Los profesionales encuestados opinaron que si se generan modificaciones en la práctica profesional se podría prolongar su expectativa de desarrollar actividades asistenciales en las UCIP.
INTRODUCTION: Shortage of qualified professionals has created a big threat to the availability and quality of pediatric intensive care units. The lack of intensivists, mostly ignored, may put at risk the basic services for the population in the near future.OBJECTIVE: To analyze the situation of human resources by adressing medical professionals who work at Pediatric Intensive Care Units (PICU) or who have abandoned that activity.METHODS: The design was observational, analytical, prospective, cross-sectional and multicenter. Data was registered through a previously validated survey about job training, professional activity and burnout (BO) syndrome. The survey aimed to evaluate all professionals active in the PICU and those that had abandoned the specialty.RESULTS: 73% of the 174 surveyed professionals had a high risk of BO. According ot a bivariate analysis, there was less risk in certified professionals and professionals with more than ten years of experience in the specialty. 29% said they would not continue practicing the specialty, and 47% completely disagreed with the salaries. Over 80% considered that, if changes were introduced (permanent job with duty, early retirement, 12-hour duty, etc.), it would be possible to improve the prospects in PICU activities.CONCLUSIONS: Most of the doctors that work at PICU in Argentina have a high degree of BO, and few of them expect to keep on working there during the next years. According to the surveyed professionals, with some specific changes in the professional practice it would be possible to extend the expectations to develop health-care activities in PICU.
Subject(s)
Intensive Care Units, Pediatric , Burnout, Professional , Professional Training , Job Satisfaction , Public Health , ArgentinaABSTRACT
La tos prolongada puede ser un desafío diagnóstico y terapéutico. Presentamos el caso de un enfermo de 62 años con tos seca y quebrantamiento del estado general durante cuatro semanas, seguido de un síndrome febril prolongado cuyo diagnóstico final fue arteritis de la temporal, con confirmación por anatomía patológica. El dolor en los pabellones auriculares al adoptar el decúbito lateral fue otro síntoma interesante. La tos prolongada puede ser una manifestación inicial de la arteritis temporal en adultos mayores.
Prolonged cough could be a diagnostic and therapeutic dilemma. We present here the case of an elder man who suffered from a dry cough and malaise during four weeks, followed by a fever of unknown origin. After many studies and review of symptoms, a biopsy of the temporal artery confirmed a giant cell arteritis. Cough and malaise could be an early symptom of temporal arteritis in elderly patients. Pain in the outer ear on the lateral decubitus could be another interesting symptom in this disease.
Subject(s)
Humans , Male , Middle Aged , Cough/diagnosis , Giant Cell Arteritis/diagnosis , Cough/pathology , Diagnosis, Differential , Ear Diseases/diagnosis , Giant Cell Arteritis/pathology , Pain/diagnosisABSTRACT
Prolonged cough could be a diagnostic and therapeutic dilemma. We present here the case of an elder man who suffered from a dry cough and malaise during four weeks, followed by a fever of unknown origin. After many studies and review of symptoms, a biopsy of the temporal artery confirmed a giant cell arteritis. Cough and malaise could be an early symptom of temporal arteritis in elderly patients. Pain in the outer ear on the lateral decubitus could be another interesting symptom in this disease.
