Azithromycin therapy in hospitalized infants with acute bronchiolitis is not associated with better clinical outcomes: a randomized, double-blinded, and placebo-controlled clinical trial.

OBJECTIVE: To test the hypothesis that azithromycin reduces the length of hospitalization and oxygen requirement in infants with acute viral bronchiolitis (AB). STUDY DESIGN: We performed a randomized, double-blinded, placebo-controlled trial in southern Brazil, from 2009 to 2011. Infants (<12 months of age) hospitalized with AB were recruited in 2 hospitals. Patients were randomized to receive either azithromycin or placebo, administered orally, for 7 days. At enrollment, clinical data were recorded and nasopharyngeal samples were collected for viral identification through immunofluorescence. Main outcomes were duration of oxygen requirement and length of hospitalization. RESULTS: One hundred eighty-four patients were included in the study (azithromycin 88 subjects, placebo 96 subjects). Baseline clinical characteristics and viral identification were not different between the groups studied. A virus was detected in 112 (63%) patients, and of those, 92% were positive for respiratory syncytial virus. The use of azithromycin did not reduce the median number of days of either hospitalization (P = .28) or oxygen requirement (P = .47). CONCLUSIONS: Azithromycin did not improve major clinical outcomes in a large sample of hospitalized infants with AB, even when restricting the findings to those with positive respiratory syncytial virus samples. Azithromycin therapy should not be given for AB because it provides no benefit and overuse increases overall antibiotic resistance.

Neurocitoma central atípico: relato de caso / Atypical central neurocytoma: case report

Neurocitomas centrais são tumores do sistema nervoso central de comportamento usualmente benigno, que costumam ocorrer nos ventrículos laterais de indivíduos jovens. Apresentamos o caso de um paciente do sexo masculino, de 31 anos de idade, com uma lesão expansiva intraventricular ocasionando quadro de hidrocefalia e queixas visuais. O paciente foi submetido à ressecção completa da lesão. Apresentou hidrocefalia persistente no pós-operatório, necessitando de derivação ventrículo-peritoneal. A evolução foi favorável e o paciente recebeu alta para seguir acompanhamento ambulatorial. Exame anatomopatológico evidenciou neurocitoma central atípico. O objetivo deste relato é apresentar um caso clássico de uma neoplasia rara, realizando uma revisão da literatura e mostrando sua importância, dado o prognóstico favorável.

Central neurocytomas are central nervous system tumors. They are usually benign and tend to occur in the lateral ventricles of young adults. We report the case of a 31-year-old male patient with an intraventricular lesion, causing hydrocephalus and visual complaints. The patient was submitted to a complete surgical resection of the lesion. However, he persisted with hydrocephalus in the postoperative period and required a ventriculoperitoneal shunt. The clinical course was favorable and the patient was discharged to follow-up. Anatomic pathology test revealed an atypical central neurocytoma. The objective of this case report is to describe a classic presentation of a rare neoplasm, including a review of the literature, highlighting the importance of this diagnosis because of the favorable prognosis.

Efeitos do fumo materno durante a gestação e complicações perinatais / Effects of maternal smoking during pregnancy and perinatal complications

Objetivos: Avaliar o perfil de puérperas tabagistas no Hospital de Clínicas de Porto Alegre (HCPA), determinar a prevalência do tabagismo nestas pacientes e avaliar efeitos do fumo sobre a gestação e os recém-nascidos (RNs). Métodos: Estudo prospectivo, transversal, com dados coletados a partir de um questionário estruturado. Foram incluídas pacientes hígidas, com gestação a termo. Foram excluídas puérperas que tiveram gestações múltiplas, RNs com crescimento intrauterino restrito, anormalidades cromossômicas, malformações ou infecção intrauterina, e puérperas com dados incompletos no prontuário. As pacientes foram divididas em dois grupos: gestantes fumantes e não-fumantes. Foram avaliadas variáveis demográficas, clínicas e relacionadas à gestação, e variáveis relacionadas ao recém-nascido. Resultados: Foram incluídas no estudo 718 puérperas, sendo que 23% eram fumantes ativas durante a gestação. Não houve diferença estatística com relação à idade materna, número de cesarianas ou abortos e idade gestacional no momento do parto. Foram fatores de risco para o tabagismo na gravidez o maior número de gestações prévias, ser solteira ou separada, não branca, com menor escolaridade e não realizar pré-natal. O peso dos RNs foi estatisticamente menor no grupo das gestantes tabagistas, com uma variação média de 143g a menos nesse grupo. O número de RNs pequenos para idade gestacional foi significativamente maior no grupo de gestantes fumantes. A evolução clínica do RN, o peso da placenta e o índice de Apgar não foram diferentes entre os grupos. Conclusão: Este estudo foi relevante para o melhor conhecimento do perfil das puérperas fumantes do HCPA e aponta para a importância da realização de pré-natal e a busca de estratégias de tratamento para estas pacientes como forma de prevenção de complicações gestacionais e perinatais.

Aims: To evaluate the clinical profile of smoker post-pregnant women at Hospital de Clínicas de Porto Alegre (HCPA), to determine the prevalence of smoking in these patients and to evaluate the effects of smoking on pregnancy and on the newborns. Methods: This is a cross-sectional prospective study, with data collected through a structured questionnaire. Healthy patients with term pregnancies were included. Exclusion criteria were multiple pregnancies, newborns with intrauterine growth restriction, chromosomal abnormalities, malformations or intrauterine infection, and incomplete data on medical records. Patients were divided in two groups: smokers and non-smokers. Demographic and clinical variables were evaluated, as well as data related to the pregnancy and to the newborn. Results: Seven hundred and eighteen post-pregnant women were included in the study, of whom 23% were current smokers during pregnancy. There was no statistic difference regarding maternal age, number of cesarean sections or abortions, and gestational age at childbirth. Higher number of previous pregnancies, being single/separated, non-white, less education and no prenatal follow up visits were risk factors for smoking in pregnancy. The weight of the newborns was statistically lower in the smoking pregnant group, with a negative variation of 143 grams in average in this group. The number of newborns small for gestational age was significantly higher in the smoking pregnant group. Clinical evolution of the newborn, placenta weight and the Apgar score were not different between the groups. Conclusion: This study was relevant to improve the knowledge about the profile of post pregnant smokers at HCPA, underscores the importance of prenatal follow up visits and the need for treatment strategies to these patients as preventive measures to avoid perinatal and gestational complications.