Knowledge, attitude and practice regarding pharmacological methods of labor analgesia / Conhecimento, atitude e prática em relação aos métodos farmacológicos de analgesia de parto

ABSTRACT BACKGROUND AND OBJECTIVES: Labor pain is caused by several physiological changes and may cause psychological damage to the parturient and her relatives and, therefore, must be relieved. The objective of this study was to evaluate the knowledge, attitude, and practice of obstetricians concerning pharmacological methods of labor analgesia. METHODS: Cross-sectional study (38 obstetricians working at public maternity hospitals). A structured questionnaire was applied about knowledge, attitude and practice concerning systemic and regional pharmacological methods. The agreement magnitude was assessed by kappa coefficient. RESULTS: We observed adequate knowledge about the indications of all methods (31 to 86%), the contraindications of opioids (92%) and the adverse effects of non-opioid analgesics /antispasmodics on the fetus (76%). Concerning attitude, they agree that non-opioid analgesics/antispasmodics do not minimize labor pain (98%) but should be available at the maternity wards (89%) and that epidural analgesia is effective (100%) and should be available (94%). In practice, the indication of non-opioid analgesics/antispasmodic and epidural analgesia prevailed. In most of the requirements in each dimension (knowledge: K=-0.092 to 0.158; p=0.057 to 1.0 and attitude: K=-0.005 to 0.472; p=0.004 to 1.0), there was minimal agreement with practice, except for the non-opioid analgesics/antispasmodics (K=0.421, p=0.009), and epidural analgesia (K=0.472, p=0.004), with a moderate agreement. CONCLUSION: Knowledge was heterogeneous. The attitude was unanimous concerning the effectiveness and the need of having epidural available, and the ineffectiveness of non-opioid analgesics/ antispasmodics, and the practice of prescribing them. There was a minimal agreement between knowledge and practice, and between attitude and practice on most of the other requirements in each dimension.

RESUMO JUSTIFICATIVA E OBJETIVOS: A dor do parto é causada por diversas alterações fisiológicas e pode causar danos psicológicos à parturiente e seus familiares, portanto, deve ser aliviada. O objetivo deste estudo foi avaliar o conhecimento, atitude e prática de obstetras sobre métodos farmacológicos de analgesia de parto. MÉTODOS: Estudo transversal, com amostra de conveniência (38 obstetras que atuam em maternidades públicas). Foi aplicado um questionário estruturado sobre conhecimento, atitude e prática em relação a métodos farmacológicos sistêmicos e regionais. Magnitude de concordância avaliada pelo coeficiente Kappa. RESULTADOS: Observou-se conhecimento adequado nas indicações de todos os métodos (31 a 86%), contraindicações dos opioides (92%) e efeitos adversos de analgésicos simples/antiespasmódicos no feto (76%). Na atitude, concordam que os analgésicos simples/antiespasmódicos não funcionam no alívio da dor do parto (98%), mas devem estar disponíveis nas maternidades (89%), e que a analgesia peridural é eficaz (100%) e deve estar disponível (94%). Na prática, prevaleceu a indicação de analgésicos simples/antiespasmódicos e da analgesia peridural. Na maioria dos quesitos, em cada dimensão (conhecimento: K=-0,092 a 0,158; p=0,057 a 1,0 e atitude: K=-0,005 a 0,472; p=0,004 a 1,0), houve concordância mínima com a prática, excetuando analgésicos simples/antiespasmódicos (K=0,421; p=0,009) e analgesia peridural (K=0,472; p=0,004), com concordância moderada. CONCLUSÃO: O conhecimento foi heterogêneo. A atitude foi unânime quanto à eficácia e necessidade da analgesia peridural estar disponível, e ineficácia dos analgésicos simples e antiespasmódicos, e a prática de prescrevê-los. Houve concordância mínima entre o conhecimento e a prática, e entre a atitude e a prática, na maioria dos outros quesitos em cada uma das dimensões.

Extramammary Paget Disease of the Vulva - Case Report.

Extramammary Paget disease (EPD) is a rare malign neoplasm that may affect the vulva and has manifestations common to benign diseases such as itching, pain and eczema. This leads to delay in diagnosis and consequent worse prognosis. The definitive diagnosis is obtained by biopsy of the vulva, which shows Paget cells. The treatment of choice is wide excision with margins, which leads to sequelae, functional and aesthetic. Recurrence is common. This article reports the case of a 48-year-old female patient with history of vulvar itching for the past 2 years, who had been submitted to various treatments for benign pathologies. The patient was biopsied and was diagnosed with extensive EPD, being submitted to vulvectomy. This article aims to draw attention to the need for biopsy of pruritic vulvar lesions that do not respond to usual treatment.

Extramammary Paget Disease of the Vulva - Case Report / Relato de Caso: Doença de Paget Extramamária da Vulva

Abstract Extramammary Paget disease (EPD) is a rare malign neoplasm that may affect the vulva and has manifestations common to benign diseases such as itching, pain and eczema. This leads to delay in diagnosis and consequent worse prognosis. The definitive diagnosis is obtained by biopsy of the vulva, which shows Paget cells. The treatment of choice is wide excision with margins, which leads to sequelae, functional and aesthetic. Recurrence is common. This article reports the case of a 48-year-old female patient with history of vulvar itching for the past 2 years, who had been submitted to various treatments for benign pathologies. The patient was biopsied and was diagnosed with extensive EPD, being submitted to vulvectomy. This article aims to draw attention to the need for biopsy of pruritic vulvar lesions that do not respond to usual treatment.

Resumo A doença de Paget extramamária (DPEM) é uma neoplasia maligna incomum que pode acometer a vulva, e que tem manifestações comuns a doenças benignas como prurido, dor e eczema. Isto leva a atraso no diagnóstico e, consequente, piora do prognóstico. O diagnóstico de certeza se dá pela biópsia de vulva que evidencia células de Paget. O tratamento de escolha é a excisão com margens amplas, que leva a sequela funcional e estética. A recidiva é frequente. Este artigo relata o caso de uma paciente do sexo feminino, de 48 anos, com história de prurido vulvar há 2 anos com diversos tratamentos para patologias benignas. A biopsia da paciente confirmou diagnóstico de DPEM extensa sendo submetida a vulvectomia. Este artigo visa chamar a atenção para a necessidade de biópsia das lesões vulvares pruriginosas que não respondem ao tratamento habitual.

[Renal vein thrombosis in the puerperium: case report]. / Trombose de veia renal no puerpério: relato de caso.

Pregnancy and puerperium are periods of blood hypercoagulability and, therefore, of risk for thromboembolic events. Renal vein thrombosis is a serious and infrequent condition of difficult diagnosis. This study reported a case of renal vein thrombosis in the puerperium, and described the clinical case, risk factors, diagnostic methods, and treatment instituted.

Trombose de veia renal no puerpério: relato de caso / Renal vein thrombosis in the puerperium: case report

Resumo Durante a gravidez e o puerpério, existe um estado de hipercoagulabilidade sanguínea e, portanto, de risco para eventos tromboembólicos. A trombose de veia renal é uma condição grave, pouco frequente e de difícil diagnóstico. Este estudo relatou um caso de trombose de veia renal numa puérpera, descrevendo caso clínico, fatores de risco, métodos diagnósticos e o tratamento instituído.

Abstract Pregnancy and puerperium are periods of blood hypercoagulability and, therefore, of risk for thromboembolic events. Renal vein thrombosis is a serious and infrequent condition of difficult diagnosis. This study reported a case of renal vein thrombosis in the puerperium, and described the clinical case, risk factors, diagnostic methods, and treatment instituted.