RESUMO
Introducción: investigación que permitió determinar los factores asociados al retiro temprano de Jadelle® en las usuarias que asisten al programa de planificación familiar en la ESE Santiago de Tunja. La relevancia del estudio radica en la importancia de conocer los motivos y las causas de retiro que los profesionales de la salud deben informar a las usuarias para lograr una mayor comprensión y aceptación de las reacciones adversas, para así evitar el retiro temprano del implante. Métodos: estudio descriptivo, cuantitativo, de corte transversal. La información se recolectó mediante la revisión de historias clínicas de 678 usuarias que se retiraron el Jadelle® entre julio de 2013 y junio de 2017. Resultados: el porcentaje de retiro temprano del implante fue de 36,8%, con mayor número de retiro durante el periodo de uso entre 24 y 30 meses y entre 36 y 42 meses. La principal causa de retiro se asoció con la presencia de alguna reacción adversa por el uso del dispositivo, principalmente la hemorragia uterina disfuncional. Conclusión: es frecuente el uso del Jadelle®, especialmente en mujeres jóvenes, y la tasa de continuidad de este dispositivo se puede aumentar si se detectan y se vigilan los factores asociados al retiro temprano, principalmente las reacciones adversas.
Introduction: This research aimed to determine the factors associated with the early removal of Jadelle® in the users who are part of the family planning program at ESE Santiago of Tunja. This is a relevant study aim to identify the reasons and causes of removal which should be inform by health professionals to women in order to achieve a better understanding and acceptance of adverse effects, avoiding early removal of the implant. Methods: Descriptive, quantitative, cross-sectional study. The information was collected by analyzing medical records of 678 subjects who removed the Jadelle® between July 2013 and June 2017. Results: The percentage of the implant early removal was 36.8%, there was a greater amount of removals during the period between 24 and 30 months and 36 and 42 months of use. The main cause of removal was associated with the presence of an adverse reaction produce by the device, mainly dysfunctional uterine bleeding. Conclusion: The use of Jadelle® is common, especially in young women. The continuity rate of this device can be increased if the factors associated with early removal are detected and monitored, especially adverse reactions.
Introdução. Investigação que permitiu determinar os fatores associados à retirada antecipada do implante Jadelle® nos usuários que frequentam o programa de planejamento familiar na ESE Santiago de Tunja. Estudo importante para conhecer os motivos e as causas de retirada que os profissionais de saúde devem informar aos usuários para melhor compreensão e aceitação das reações adversas, evitando a retirada antecipada do implante. Métodos. Estudo descritivo, quantitativo, transversal. As informações foram coletadas através da revisão de registros médicos de 678 usuários que retiraram o Jadelle® entre julho de 2013 e junho de 2017. Resultados. A percentagem de retirada antecipada do implante foi de 36,8%, com maior número de retiradas no período entre 24 e 30 meses e 36 e 42 meses de uso. A principal causa de retirada foi associada à presença de uma reação adversa devido ao uso do dispositivo, principalmente hemorragia uterina disfuncional. Conclusão. O uso do implante Jadelle® é frequente, principalmente em mulheres jovens; a taxa de continuidade deste dispositivo pode ser aumentada se os fatores associados à retirada antecipada forem detectados e monitorados, especialmente as reações adversas.
RESUMO
The Latin American 2015-2016 Zika virus (ZIKV) outbreak was associated with an increase in microcephaly predominantly in northeastern Brazil. To comparatively investigate infectious causes of congenital malformations, we performed a nested case-control study in 32 mothers of cases of suspected congenital Zika syndrome (CZS) and 160 age-matched controls from Bahia, northeastern Brazil. We collected clinical and imaging data and assessed past exposure to ZIKV, Chikungunya virus (CHIKV), dengue virus, and 8 established TORCH (Toxoplasma gondii, Treponema pallidum, rubella virus, cytomegalovirus, herpes simplex virus 1 [HSV-1] and HSV-2, varicella-zoster virus, parvovirus B19) pathogens using multiple serological tests. Heterogeneous symptoms prevented unequivocal diagnosis of CZS on clinical grounds. Only ZIKV and CHIKV seroprevalence rates differed significantly between cases and controls (93.8% versus 67.8% for ZIKV [Fisher's exact text, P = 0.002] and 20.7% versus 8.2% for CHIKV [χ2, P = 0.039]). High ZIKV seroprevalence rates in cases could not be explained by previous dengue virus infections potentially eliciting cross-reactive antibody responses affecting ZIKV serological tests. In conditional logistic regression analyses, only ZIKV was significantly associated with congenital malformations (P = 0.030; odds ratio, 4.0 [95% confidence interval, 1.1 to 14.1]). Our data support an association between maternal ZIKV exposure and congenital malformations. Parallels between the discrepant ZIKV and CHIKV seroprevalence rates between cases and controls and similar seroprevalence rates between cases and controls for the sexually transmitted T. pallidum and HSV-2 may suggest the occurrence of predominantly vector-borne transmission in our study population. High seroprevalence of TORCH pathogens suggests that exhaustive diagnostics will be necessary in the aftermath of the ZIKV outbreak and provides baseline data for longitudinal studies on ZIKV pathogenesis.IMPORTANCE The Latin American Zika virus (ZIKV) outbreak had a major impact on reproductive health worldwide. The reasons for the massively increased reports of neonatal microcephaly in northeastern Brazil are still unclear. Beyond the technical limitations of laboratory diagnostics, unambiguous diagnosis of ZIKV as the cause of congenital malformations is hampered by similar clinical pictures elicited by other pathogens known as TORCH pathogens. We performed a case-control study comparing mothers of children with congenital malformations to age-matched controls from Salvador, Brazil, one of the areas most extensively affected by the ZIKV outbreak. The ZIKV and Chikungunya virus seroprevalence rates differed significantly, whereas the levels of maternal exposure to TORCH pathogens were similar between cases and controls. Our data support a link between maternal ZIKV infection and congenital malformations and suggest the occurrence of predominantly vector-borne ZIKV transmission in these cases. In addition, some highly prevalent TORCH pathogens may be misinterpreted as representative of ongoing ZIKV activity in the absence of exhaustive diagnostics in northeastern Brazil.
