Early Amplitude-Integrated Electroencephalogram as a Predictor of Brain Injury in Newborns With Very Low Birth Weight: A Cohort Study.

PURPOSE: To evaluate the relationship between abnormal early amplitude integrated electroencephalography (EEG) and severe lesions in imaging tests performed during the neonatal period in very low birth weight infants. METHODS: An amplitude-integrated EEG was performed in 70 patients with a mean birth weight of 1226 g during the first 48 hours of life. Severe lesions on magnetic resonance imaging (MRI) or ultrasonography (US) during the neonatal period were considered as adverse conditions. Variables were compared using the χ2 test or analysis of variance. Sensitivity, specificity, and positive likelihood ratio were calculated. RESULTS: Adverse outcomes were observed in 6 patients. There was a significant relationship ( P < .001) between abnormal amplitude-integrated EEG background and severe lesions on MRI and US. Sensitivity and specificity were 100% and 89%, respectively. CONCLUSION: Early amplitude-integrated EEG with moderate/severe abnormalities in the background is associated with severe structural lesions detected in imaging studies and should be considered as an auxiliary screening tool for the detection of neonatal brain lesions in very low birth weight infants.

Barreiras de acesso na atenção primária à saúde à travestis e transexuais na região central de São Paulo / Access barriers in Primary Health Care to transvestites and transsexuals in the central region of São Paulo

Historicamente, no Brasil e no mundo, o setor saúde tem se relacionado de forma ambivalente com travestis e transexuais (TT) promovendo acesso ao processo transexualizador, por um lado, mas condicionando-o ao diagnóstico de Tanstorno de Identidade de Gênero (TIG), patologizando assim a experiência da diversidade de gênero. As medidas preventivas adotadas na década de 80 com a epidemia do HIV, também acentuaram o estigma sofrido por este grupo, segregando o acesso aos serviços de saúde especializados. Pesquisas revelam, no entanto, necessidades de saúde relacionadas, não apenas ao acesso às tecnologias mais especializadas, mas de forma integral, associadas às marcas de opressão sofridas por essa população, à necessidade de vínculo aos serviços de saúde e à possibilidade de desenvolver autonomia. No que diz respeito, especificamente, aos dados epidemiológicos, essa população apresenta altos índices de transtornos mentais, uso de substâncias, violência e uso indiscriminado de hormônio. Apontam, ainda, a invisibilidade no que se refere à Atenção Primária à Saúde (APS) e a população TT. --------|a A Política Nacional de Atenção à Saúde Integral da População Lésbicas, Gays, Bisexuais, Travestis e Transexuais (LGBTT) vem como resposta a estas necessidades de cuidado integral, indo além do estigma patologização. Em consonância com esta política, o presente estudo teve como objetivo geral: elaborar um manual de acolhimento à população travesti e transexual para a APS e objetivos específicos: caracterizar o perfil da população TT; identificar os motivos pelos quais o usuário usa ou deixa de usar a APS; identificar barreiras que dificultam o acesso da população à APS; propor estratégias de superação das barreiras de acesso da população TT à APS. O projeto de pesquisa foi submetido ao Comitê de Ética da Escola de Enfermagem da Universidade de São Paulo (EEUSP) e da Secretaria Municipal de Saúde de São Paulo (SMSSP), bem como à gestão do Centro de Cidadania LGBT (CCLGBT) Luiz Carlos Ruas. Método: trata-se de um estudo qualitativo exploratório que realizou entrevistas semiestruturadas na Unidade Básica de Saúde-Sé (UBS-Sé) e no CCLGBT-Luiz Carlos Ruas, ambos na região central de São Paulo. O conteúdo das entrevistas foi registrado e, posteriormente submetido à diversas leituras para análise temática de conteúdo segundo a proposta de Bardin (2006). Análise dos dados: foram identificadas categorias empíricas a partir do referencial teórico relativo ao acesso enquanto dispositivo transformador da realidade, segundo Abreu de Jesus (2006) e às barreiras no acesso aos serviços de saúde à população LGBTT (Albuquerque et. al, 2016).Com relação aos dados quantitativos estes foram organizados em uma planilha para a análise dos dados. Resultados: Foram entrevistadas vinte pessoas trans, entre elas, treze se identificaram como mulheres trans, uma como travesti e seis como homens trans. Com idade média de 33 anos, em sua maioria solteiros (80%), com baixo grau de escolaridade (40% da amostra, referiram ter ensino médio incompleto ou menor grau de escolaridade) e apenas 30% inseridos no mercado de trabalho formal, evidenciando o panorama de vulnerabilidades da população trans. Com relação às barreiras no acesso à APS foram identificadas barreiras tecnoassistenciais relacionadas: 1) ao paradigma heteronormativo e de gênero como equivalência de sexo na APS; 2) pouca oferta do cartão do SUS com nome social e não uso do nome social; 3) falta de uma escuta qualificada; além de barreiras relacionadas às: 4) implicações da transfobia no acesso do serviço de saúde; 5) educação permanente: desconhecimento dos fluxos e conceitos da rede da pessoa trans; e 6) Transfobia nos serviços da APS. A partir das barreiras identificadas foram elaboradas proposições de superação das mesmas que integraram o Manual de acolhimento de Transexuais e Travestis à Atenção Primária à Saúde. Dentre as propostas de superação com relação às barreiras tecnoassitencias: estratégias de uso correto do nome social, a superação de paradigmas biologizantes e a valorização da dimensão relacional do trabalho em saúde, como o uso de uma comunicação responsiva e do acolhimento. Com relação às barreiras associadas à educação permanente, destaca-se a necessidade de ampliar o conhecimento dos trabalhadores com relação às informações a respeito das características da população TT, tais como: conceitos básicos envolvidos na temática, suas principais demandas e fluxos de apoio na rede. Investindo em metodologias ativas de ensino que se pautem em um modelo de saúde ampliado, evidenciando a visão política transformadora do trabalho no SUS. A superação da transfobia nos serviços de saúde está relacionada à promoção de educação permanente neste contexto. Outros estudos poderão avaliar a compreensão e utilização do Manual pelos profissionais da APS e a satisfação das necessidades da população TT.

Historically, in Brazil and in the world, health has related itself in an ambivalent way with transsexuals and transvestites (TT). Understood as pathology and not as diversity and freedom of gender by international disease manuals, this diagnosis allows access to medical procedures for changes in sexual characteristics. In Brazil, health places attention on the TT population beginning at the HIV/AIDS epidemic in the 80's, increasing this group's stigma and segregation, limiting access to specialized services, marking the ambivalence of the health system. Research describe, however, health care needs that go beyond HIV and physical transformations desired by trans people: high rates of mental disorders, substance use, violence, and indiscriminate use of hormones. Research also point out the invisibility in relation to Primary Health Care (PHC). The National Policy for Attention to Comprehensive Health Care for the Lesbian, Gay, Bi-sexual, Transvestite, and Transsexual (LGBTT) Population comes as a response to these needs for comprehensive care, going beyond the stigma and pathologization of gender identity. In line with this policy, the present study had as general objective: develop a manual for embracing the transvestite and transsexual population in the PHC; and specific objectives: characterize the TT population's profile, identify the reasons why users use or not the PHC, identify barriers that hinder the population's access to the PHC, and propose strategies for overcoming the TT population's access barriers to the PHC. Method: this is a qualitative and exploratory study in which 20 semi-structured interviews were carried out in Sé's Basic Health Unit -(BHU) and in Center for LGBT Citizenship (CLGBTC), both in the downtown area of Sao Paulo. The empirical material was analyzed through thematic analysis. Results: Twenty trans people were interviewed, among them thirteen identified themselves as trans women, one as transvestite and six as trans men. With a mean age of 33 years, mostly unmarried (80%), with a low level of schooling (40% of the sample, reported having incomplete high school or lower education) and only 30% inserted in the formal job market, evidencing the panorama of vulnerabilities of the trans population. Technical-care barriers were identified related to: 1) the paradigm of hetero-normative and gender as sex equivalence in the PHC; 2) offer little of the SUS (Brazilian Public Health Care System) card with social name social printed and the non-use of the social name; 3) lack of qualified listening. In addition to the related barriers: 4) implications of transphobia in access to the health service; 5) permanent education: lack of knowledge of flows and concepts of the trans person's network; 6) Transphobia in the PHC services. Based on the barriers identified, proposals were made to overcome them, which integrated the "Handbook on the reception of Transsexuals and Transvestites for Primary Health Care". Among the proposals for overcoming in relation to the tecnoassitencias barriers: strategies of correct use of the social name, the overcoming of biologizing paradigms and the valorization of the relational dimension of health work, such as the use of a responsive and welcoming communication. Regarding the barriers associated with lifelong education, the need to broaden workers' knowledge regarding information about the characteristics of the TT population, such as: basic concepts involved in the theme, its main demands and support flows in the public health system. Investing in active teaching methodologies that are based on an expanded health model, evidencing the transformative political vision of the SUS work. The overcoming of transphobia in the health services is related to the promotion of permanent education in this context. Other studies may assess the understanding and use of the Manual by PHC professionals and the satisfaction of the needs of the TT population. From the identified barriers, propositions for improvement of these were built, as well as the "Embracing Transvestites and Transsexuals (TT) in Primary Health Care (PHC) Manual".

Treatment of refractory neonatal seizures with topiramate.

OBJECTIVE: The objective of this study is to describe the usefulness of topiramate in refractory neonatal seizures. RESULTS: We reported the clinical off-label use of topiramate in three cases of refractory neonatal seizures of unclear origin with no response to conventional antiepileptic drugs. In all cases, the seizures were completely controlled with adding topiramate. All patients became seizure free during hospitalization and were followed by approximately 1 year after hospital discharge, with monotherapy with topiramate. COMMENTS: The clinical off-label use of topiramate in neonatal seizures is still incipient. When searching publications in this matter, only one report was identified. Because of its efficacy for both seizures and neuroprotection, topiramate could be a useful choice in refractory neonatal seizures.

Síndrome de Waardenburg: relato de casos / Waardenburg syndrome: case reports

JUSTIFICATIVA E OBJETIVOS: A síndrome de Waardenburg é uma doença genética que na forma clássica, os pacientes apresentam várias características físicas marcantes e também surdez neurossensorial. Assim, a partir da exposição dos casos espera-se que os profissionais de saúde tomem conhecimento da doença e possam levantar a hipótese diagnóstica diante de um pacientecom fenótipo sugestivo, tendo em vista que possui baixa frequência na população e seu diagnóstico precoce melhora muito a qualidade de vida dos pacientes.RELATO DOS CASOS: Trata-se de três casos dentro de uma mesma família com características diferentes, inclusive, em relação à surdez genética. Características marcantes estão presentes nos casos, como: dystopia canthorum, epicanto, base nasal proeminente e alargada, maxila encurtada, poliose, encanecimento precoce e surdez congênita neurossensorial. CONCLUSÃO: A grande maioria dos casos desta síndrome é acompanhada de surdez congênita. As características físicas que acompanham a doença permitem o seu diagnóstico clínico, e o ideal seria que esses pacientes fossem diagnosticados ainda na infância para que possam ter acesso precocemente à reabilitação auditiva, contribuindo para melhor desenvolvimento neuropsíquico, levando-se em conta que eles também deverão receber aconselhamento genético.

BACKGROUND AND OBJECTIVES: Waardenburg syndrome is a rare genetic disease that shows variable penetrance and expressivity. In its classic form, patients have several outstanding characteristics, such as deafness. Thus, from the exposure of cases, it is important to be aware of this clinical disease, to health professionals, for early diagnosis, avoiding unnecessary examinations, and achieving effective therapeutic approach.CASE REPORTS: These are three cases in one family with different characteristics, including in relation to genetic deafness. Striking features are present in cases like: dystopia canthorum, epicanthus, prominent and broad nasal base, shortened jaw, poliosis, premature graying and congenital sensorineural deafness. CONCLUSION: Most cases of this syndrome is accompanied by congenital deafness. Therefore, early diagnosis will certainly help in hearing rehabilitation, improving the capacity of developing hearing and communication skills of these individuals.

Prevalence of non-nutritive sucking habits and its relation with anterior open bite in children seen in the Odontopediatric Clinic of the University of Pernambuco

OBJECTIVE: The aim of this work was to establish the prevalence of non-nutritive sucking habits (pacifier and/or digit sucking) and to assess its relation with anterior open bite. METHODS: The sample consisted of 980 records of children of both genders, with ages between 3 and 12 years, who were treated at the Pediatrics Clinic of the University of Pernambuco (FOP/UPE), from February 2000 trough December 2005, both sexes. Pearson's Chi-square test at 5% level of significance was used for statistical assessment. RESULTS: It was observed that 17,7% of the sample had some habit at the moment of the anamnesis (9,6% of digit sucking habit, 8,8% of pacifier sucking habit and 0,7% of both habits) and that the prevalence of open bite was 20,3%. The prevalence of sucking habits in girls was much higher than in boys (22,6% and 12,9%, respectively) and this difference was statistically significant (p = 0,000). A correlation between habits and open bite was proved statistically (p = 0,000): Children with sucking habits had 8 times more chances of developing anterior open bite. CONCLUSIONS: Anterior open bite was associated to the presence of non nutritive sucking habits; sucking habits were more prevalent in girls and in children between three and six years of age.

Avaliação funcional do transplante autólogo heterotópico de ovários: estudo experimental em ratas / Functional assessment of autologous heterotopic transplant of ovaries: An experimental study on female mice

Introduction: Two facts have been constantly reported in the literature over the lastdecades, namely: the increased number of reproductive-age women with cancer and theincreased age of primiparas. Both facts have encouraged studies on strategies to preserve women?s fertility. Objectives: To perform vaginal swab and morphological study to assess the functional viability of transplanted ovarian tissue. Methods: 30 female Wistar ablbinus mice with preserved hormonal function were randomly distributed in six groups: G1. Control ? laparotomy; G2. Bilateral oophorectomy. G3. Bilateral oophorectomy with intact ovarian implant in the femoral region; G4. Bilateral oophorectomy, with sliced ovarian implant in the femoral region; G5. Bilateral oophorectomy with intact ovarian implant in the great epiploon; G6. Bilateral oophorectomy with sliced ovarian implantat in the great epiploon. Vaginal swab and removal for morphological study of the transplanted ovaries were carried out on the 35th and 120th days after surgery. Groups G3 and G6 were submitted to new vaginal swab on the 150th day. Results: All G1 mice had hormonal function. All G2mice remained in diestrus. The patterns of four G3 mice were consistent with estrus on the 35th day, and one mouse ovulated on the 120th day. Only one G4 mouse remained in diestrus after transplantation. All G5 had functioning ovary. Four G6 mice manifested hormonal function on the 35th day and only three on the 120th day. All the 150th-day swabs were classified as diestrus.Conclusions: Autologous ovarian transplant is technically feasible in female mice as much as vaginal swab for hormonal function assessment.

Infecção em humanos por varíola bovina na região de Ibertioga, estado de Minas Gerais / Human infection with bovine smallpox in the Ibertioga region, State of Minas Gerais, Brazil

Introdução e objetivo: a varíola bovina é uma zoonose causada pela proliferação do vírus do gênero ortopoxvírus, sendo os bovinos a fonte primária de infecção humana. É importante apresentar relatos de casos dessa doença para que os profissionais de saúde, em especial os médicos, fiquem atentos para seu diagnóstico e tratamento corretos. Resultados: quatro casos de varíola bovina em humanos foram identificados e comprovados por exames sorológicos na região de Ibertioga, Minas Gerais. Todos os pacientes apresentavam sintomas em comum, como febre alta, falta de apetite, mialgia e lesões de pele. Conclusão: deve ser dada mais atenção aos casos dessa zoonose, no sentido de seu correto diagnóstico, adequada terapia de suporte e boa orientação para os pacientes, para que possa se evitar a transmissão intrafamiliar, bem como para animais com os quais venham a ter contato, considerando que a quase totalidade dos casos ocorre em áreas rurais.

Introduction and objective: Bovine smallpox is a zoonosis caused by Ortopxvirus proliferation, bovines being the primary source for human infection. Case reports of this disease are important to raise health professionals? consciousness of correct diagnosis and treatment.Results: Four cases of human infection with bovine smallpox were identified and confirmed by serologic exams in the Ibertioga region, State of Minas Gerais, Brazil Patients shared common symptoms such as high fever, decreased appetite, myalgia, and skin injury. Conclusion:The cases of this zoonosis should be paid more attention in order to enhance diagnosis, support therapy and guidance for patients witha view to avoiding intra-familiar and further animal transmission (as virtually all cases are reported in rural areas).

O formato dos arcos dentários em tomografia computadorizada por feixe cônico / The dental arch form in cone beam computed tomography

O formato dos arcos dentários tem implicações para a funcionalidade oclusal, estética do sorriso e da face, assim como para a estabilidade em longo prazo das correções ortodônticas. Desse modo, o objetivo neste estudo foi avaliar comparativamente o formato dos arcos maxilar e mandibular em imagens por tomografia computadorizada por feixe cônico (TCFC) e modelos de gesso. A amostra consistiu de imagens por TCFC e modelos de gesso pré-tratamento de 30 pacientes ortodônticos, de ambos os gêneros, com média de idadede 5,3 ± 25,4 anos. Um examinador treinado avaliou o formato dos arcos visualmente em imagens axiais por TCFC, adquiridas com o aparelho i-CAT (lrnaging Sciences, Hatfield, PA,EUA) e modelos de gesso, com o auxílio do gabarito Ortho Form (3M Unitek, Monrovia, CA, EUA).A análise estatística foi realizada por meio do teste de coincidência de McNemar-Bowker(a = 0,05). Para os arcos maxilar e mandibular, os formatos cônico de menor dimensão (40%-43,3%) e ovoide (26,7%) foram os mais frequentes. Não houve diferenças significantesentre os métodos na classificação do formato dos arcos maxilares e mandibulares. Conclui-se que as imagens por TCFC apresentam desempenho satisfatório para avaliação do formatodos arcos dentários durante diagnóstico e planejamento ortodôntico.

The dental arch form has been implicated in the occlusal function, smile andfacial esthetics, as well as in long-term stability of corrective orthodontic treatment. Thus, the aim of this study was to assess maxillary and mandibular arch form in cone beam computedtomography (CBCT) in comparison with the categorization by means of plaster models. The sample consisted of pre-treatment CBCT images and plaster models of 30 orthodontic patients, of both genders and mean age of 25.4 ± 5.3 years. A trained examiner assessed arch form by visual inspection on axial CBCT images, acquired with the i-CAT tomograph (Imaging Sciences, Hatlield, PA, USA), and plaster models using the Ortho Form template (3M Unitek,Monrovia, CA, USA). Statistical analysis was carried out using the McNemar-Bowker test of symmetry (a = 0.05). For maxillary and mandibular arches, parabolic with short dimension(40%-43.3%) and elliptical (26.7%) forms were the most frequent ones. No significant differences were found between the classification methods for maxillary and mandibular arches. It may be concluded that CBCT images demonstrated satisfactory performance for the assessment of dental arch form during orthodontic diagnosis and treatment planning.

Effect of breast- and bottle-feeding duration on the age of pacifier use persistence.

This study evaluated the effect of breast- and bottle-feeding duration on the age of pacifier use persistence. Questionnaires (n = 723) with information on nutritive and nonnutritive sucking habits of children aged 3-6 years were assessed. The sample was divided according to breastfeeding duration: G1 - non-breastfed, G2 - up to 3 months, G3 - discontinued between 4 and 6 months, G4 - discontinued between 7 and 12 months, and G5 - longer than 12 months. The children were also assigned to 4 groups by age of pacifier use persistence, as well as by age of bottle-feeding persistence: no habits, up to 2 years, 3-4 years and 5-6 years. Associations between nutritive sucking habits and pacifier use were analyzed using logistic regression. The larger breastfeeding groups were G2 (37.9%) and G4 (19.4%). Many children discontinued pacifier use and bottle-feeding at 3-4 years of age (24.9% and 40.1%, respectively). Chances of non-breastfed children (G1) with prolonged pacifier-sucking habits, in the three age ranges, were progressively higher in comparison with group G4 (OR: 4.0-7.5, p < 0.01). When comparing bottle-fed with non bottle-fed children, the age range at which bottle-feeding had been discontinued was significantly associated with that of pacifier use cessation: up to 2 years (OR = 6.2), 3-4 years (OR = 7.6) and 5-6 years (OR = 27.0), p < 0.01. It may be suggested that breastfeeding duration has an inversely proportional effect on the age of pacifier use persistence. Bottle-fed children who use pacifiers tend to discontinue these habits at the same period.

Effect of breast- and bottle-feeding duration on the age of pacifier use persistence

This study evaluated the effect of breast- and bottle-feeding duration on the age of pacifier use persistence. Questionnaires (n = 723) with information on nutritive and nonnutritive sucking habits of children aged 3-6 years were assessed. The sample was divided according to breastfeeding duration: G1 - non-breastfed, G2 - up to 3 months, G3 - discontinued between 4 and 6 months, G4 - discontinued between 7 and 12 months, and G5 - longer than 12 months. The children were also assigned to 4 groups by age of pacifier use persistence, as well as by age of bottle-feeding persistence: no habits, up to 2 years, 3-4 years and 5-6 years. Associations between nutritive sucking habits and pacifier use were analyzed using logistic regression. The larger breastfeeding groups were G2 (37.9 percent) and G4 (19.4 percent). Many children discontinued pacifier use and bottle-feeding at 3-4 years of age (24.9 percent and 40.1 percent, respectively). Chances of non-breastfed children (G1) with prolonged pacifier-sucking habits, in the three age ranges, were progressively higher in comparison with group G4 (OR: 4.0-7.5, p < 0.01). When comparing bottle-fed with non bottle-fed children, the age range at which bottle-feeding had been discontinued was significantly associated with that of pacifier use cessation: up to 2 years (OR = 6.2), 3-4 years (OR = 7.6) and 5-6 years (OR = 27.0), p < 0.01. It may be suggested that breastfeeding duration has an inversely proportional effect on the age of pacifier use persistence. Bottle-fed children who use pacifiers tend to discontinue these habits at the same period.