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- ItemAcesso aberto (Open Access)Antibiotic prophylaxis in reduction mammaplasty: study protocol for a randomized controlled trial(Biomed Central Ltd, 2016) Garcia, Edgard Silva [UNIFESP]; Veiga, Daniela Francescato [UNIFESP]; Veiga-Filho, Joel; Cabral, Isaias Vieira; Larcher Pinto, Natylia Lana; Novo, Neil Ferreira [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]Background: The role of antibiotics in surgical procedures where the risk of surgical site infection (SSI) is low remains uncertain. There is, to date, no evidence to justify the routine use of antibiotics in postoperative reduction mammaplasty. The aim of this study is to evaluate the effect of postoperative antibiotic treatment on the occurrence of SSI after breast reduction surgery. Methods: This is a double-blind randomized clinical trial with 124 breast hypertrophy patients allocated to two treatment groups: antibiotic (n = 62) and placebo (n = 62). All patients will undergo reduction mammoplasty, performed by the same surgical team. The surgeons will raise the nipple-areola complex by the superomedial pedicle technique. The patients will receive antibiotics intravenously during anesthetic induction and every 6 hours thereafter during their 24-hour hospital stay. During discharge from the hospital, each patient will receive a numbered package containing either cephalexin or placebo capsules and will be directed to take one capsule every 6 hours for 7 days. Neither the surgery team nor the patients will know the contents of the capsules. Patients will be monitored for the occurrence of SSI once weekly during the first 30 days following hospital discharge by a single surgeon who is blinded to their treatment group. SSI will be evaluated based on the definition adopted by the Centers for Disease Control and Prevention. Discussion: Due to the variety of risk factors for SSI and limited case studies, conclusions regarding the effect of antibiotics on the occurrence of SSIs following reduction mammaplasty are potentially biased. In recent studies, perioperative antibiotic prophylaxis was effective in preventing infection and is therefore recommended in clinical practice. However, antibiotic use in the postoperative period still remains controversial.
- ItemSomente MetadadadosAvaliação da composição corporal dos pacientes com migrânea em tratamento profilático com Topiramato(Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Caverni, Camila Naegeli [UNIFESP]; Tengan, Celia Harumi [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Migraine is a primary headache that affects 15% of the Brazilian population. The use of prophylactic medication, such as topiramate, may be necessary to manage crisis, however, these medications may lead to the loss of weight and appetite. Additionally, there is a relation between migraine and body mass index, meaning that obese individuals are more susceptible to develop more frequent and disabling crisis. Through an anthropometric evaluation it is possible to study certain body constituents, such as percentage of body fat and fat free mass, allowing to determine which of these constituents are indicative of the current health condition and, therefore, of quality of life. Objective: The purpose of this study was to evaluate the body composition of female patients with migraine using topiramate before and after three months of treatment. Methods: 50 female patients, between 18 and 45 years old were included. The patients were initially evaluated by a neurologist to diagnose the type of migraine between migraine with or without aura and/or chronic migraine and initiate the prophylactic treatment: topiramate 50mg/day, throughout three months. In the beginning and at the end the patients were evaluated by a nutritionist the define the body composition and its change during the study, through a detailed anthropometric evaluation. Results: a total of 37 patients were evaluated in the end of the study, with average age of 31 years, average initial body mass index of 25.89kg/m2, initial average body fat of 36.1% and initial average fat free mass of 42.7kg. After 3 months of prophylactic treatment, the patients reduced significantly the frequency of days of headache per month from 21 days to 7 days (p <0.0001). Regarding the anthropometric parameters, there was a reduction of the body mass index, from 25.89kg/m2 to 25.19kg/m2 (p 0,0001) and percentage of body fat, from 36.1% to 33.2% (p <0.0001). On the other side, the treatment lead to an increase of fat free mass, from 42.7kg to 43.6kg (p 0.0074), mainly to the group with chronic migraine, which increased from 43.2kg to 44;3kg (p 0.0173). Fat free mass increase for patients with overweight (from 44.8kg to 45.8kg; p 0.0128) and obese patients (from 40.3kg to 44.2kg; p 0.0102), but there were no change on eutrophic patients. Considering age, it was observed that the increase of fat free mass, from 42.9kg to 44,3kg (p 0.0087) occurred on patients with lower age range, between 31 and 45 years old. Conclusion: The study demonstrated that the treatment with topiramate has modified the patient’s body composition by reducing the body mass index and body fat, while increasing fat free mass. The group that benefited the most from this treatment was overweight or obese patients, with chronic migraine and over 31 years old. These results suggest that the improvement of body composition may be a parameter of improvement of chronic migraine, however, further studies are required to evaluate the importance of the body composition in patients under treatment for migraine and chronic migraine.
- ItemAcesso aberto (Open Access)Avaliação da profilaxia do tromboembolismo venoso em hospital de grande porte(Colégio Brasileiro de Cirurgiões, 2010-06-01) Carneiro, João Luiz De Aquino; Targueta, Gabriel Pelegrineti [UNIFESP]; Marino, Lucas Oliveira; Colégio Brasileiro de Cirurgiões; Universidade Federal do Espírito Santo Departamento de Cirurgia; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Espírito SantoOBJECTIVE: This study aimed at assessing the adequacy of thromboprophylaxis in a high complexity hospital in Vitória - ES, analysing the possible predictors of inadequate prescriptions and/or procedures. METHODS: A cross-sectional study was carried out through prompt-book analysis. The included patients were hospitalized in 2007 and had their Venous thromboembolism (VTE) risk stratified using the 8th Edition of the American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines. The thromboprophylaxis adequacy was determined through a comparison between the adopted prescriptions and/or procedures and the guideline recommendations. EpiInfo 3.4.3 and SPSS 13.0 were the software applications used. RESULTS: In 47% of the patients the thromboprophylaxis was inadequate, being the non-prescription of the indicated medication the major reason (33%). There was no statistically significant difference in inadequate tromboprophylaxis rate between clinical and surgical patients, or ward and Intensive care unit (ICU) ones. An inverse relationship was observed between the inadequate tromboprophylaxis rate and the number of VTE risk factors presented by the patients, as well as their age, and the length of hospital stay (p < 0,05). CONCLUSION: The results show alarming levels of thromboprophylaxis inadequacy, inacceptable in these times of well-established published guidelines. Therefore, a continuing education program should be implanted for all the assistance team.
- ItemSomente MetadadadosNutritional status and metabolic disorders in HIV-exposed uninfected prepubertal children(Elsevier B.V., 2013-07-01) Claudio, Cristiane Chiantelli [UNIFESP]; Patin, Rose Vega [UNIFESP]; Palchetti, Cecilia Zanin [UNIFESP]; Machado, Daisy Maria [UNIFESP]; Menezes Succi, Regina Celia de [UNIFESP]; Oliveira, Fernanda Luisa Ceragioli [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: the objective of the study was to assess the nutritional status and metabolic alterations in HIV-exposed uninfected (HIVe) children compared with HIV-unexposed (HIVn) children.Methods: A cross-sectional study was carried out with 76 children distributed into two groups: HIVe (n = 31) and HIVn (n = 45). Biochemical data (hematologic test, lipid profile, insulin resistance, hepatic profile, and C-reactive protein) were evaluated. Anthropometric parameters and body composition analyses were performed.Results: the groups were similar regarding body mass index-for-age z-scores (P = 0.297) and height-for-age z-scores (P = 0.666). HIVe had a higher dyslipidemia prevalence (38.7% versus 11.1%; P = 0.010), altered total cholesterol (TC) values (19.4% versus 2.2%; P = 0.016) higher LDL-C mean levels (97.8 mg/dl versus 86 mg/dl; P = 0.028), borderline low-density lipoprotein cholesterol (LDL-C) (40% versus 14%; P = 0.011) and TC (41.9% versus 20%; P = 0.038) compared with HIVn.Conclusion: Despite the similar nutritional status between groups, our data clearly demonstrated a higher prevalence of dyslipidemia, altered TC, higher LDL-C levels and also LDL-C and TC borderline values in HIVe children. (C) 2013 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Prophylactic treatment of vestibular migraine(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2017) Salmito, Marcio Cavalcante [UNIFESP]; Duarte, Juliana Antoniolli [UNIFESP]; Golcalves Morganti, Ligia Oliveira [UNIFESP]; Caus Brandao, Priscila Valeria [UNIFESP]; Nakao, Bruno Higa [UNIFESP]; Villa, Thais Rodrigues [UNIFESP]; Gananca, Fernando Freitas [UNIFESP]Introduction: Vestibular migraine (VM) is now accepted as a common cause of episodic vertigo. Treatment of VM involves two situations: the vestibular symptom attacks and the period between attacks. For the latter, some prophylaxis methods can be used. The current recommendation is to use the same prophylactic drugs used for migraines, including beta-blockers, antidepressants and anticonvulsants. The recent diagnostic definition of vestibular migraine makes the number of studies on its treatment scarce. Objective: To evaluate the efficacy of prophylactic treatment used in patients from a VM outpatient clinic. Methods: Review of medical records from patients with VM according to the criteria of the Barany Society/International Headache Society of 2012 criteria. The drugs used in the treatment and treatment response obtained through the visual analog scale (VAS) for dizziness and headache were assessed. The pre and post-treatment VAS scores were compared (the improvement was evaluated together and individually, per drug used). Associations with clinical subgroups of patients were also assessed. Results: Of the 88 assessed records, 47 were eligible. We included patients that met the diagnostic criteria for VM and excluded those whose medical records were illegible and those of patients with other disorders causing dizziness and/or headache that did not meet the 2012 criteria for VM. 80.9% of the patients showed improvement with prophylaxis (p < 0.001). Amitriptyline, Flunarizine, Propranolol and Topiramate improved vestibular symptoms (p < 0.001) and headache (p < 0.015). The four drugs were effective in a statistically significant manner. There was a positive statistical association between the time of vestibular symptoms and clinical improvement. There was no additional benefit in hypertensive patients who used antihypertensive drugs as prophylaxis or depressed patients who used antidepressants in relation to other prophylactic drugs. Drug association did not show statistically significant results in relation to the use of a single drug. Conclusions: Prophylactic medications used to treat VM improve the symptoms of this disease, but there is no statistically significant difference between the responses of prophylactic drugs. The time of vestibular symptom seems to increase the benefit with prophylactic treatment. (C) 2016 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda.
- ItemAcesso aberto (Open Access)Randomized comparison of prophylaxis and on-demand regimens with FEIBA NF in the treatment of haemophilia A and B with inhibitors(Wiley-Blackwell, 2014-01-01) Antunes, S. V. [UNIFESP]; Tangada, S.; Stasyshyn, O.; Mamonov, V.; Phillips, J.; Guzman-Becerra, N.; Grigorian, A.; Ewenstein, B.; Wong, W. -Y.; Universidade Federal de São Paulo (UNIFESP); Baxter Healthcare Corp; Ukrainian Natl Acad Med Sci; Dept Reconstruct Orthoped Surg Hemophilia Patient; Wellington HospFactor replacement therapy for the treatment of moderate to severe haemophilia A and B can be complicated by the production of inhibitory alloantibodies to factor VIII (FVIII) or factor IX. Treatment with the nanofiltered anti-inhibitor coagulant complex, Factor Eight Inhibitor Bypassing Activity (FEIBA NF), is a key therapeutic option for controlling acute haemorrhages in patients with high-titre inhibitors or low-titre inhibitors refractory to replacement therapy. Given the high risk for morbidity and mortality in haemophilia patients with inhibitors to FVIII or FIX, we conducted this Phase 3 prospective study to evaluate whether prophylaxis with FEIBA NF is a safe and effective treatment option. Over a 1-year period, 17 subjects were treated prophylactically (85 +/- 15Ukg(-1) every other day) while 19 subjects were treated on demand. the median (IQR) annualized bleeding rate (ABR) during prophylaxis was 7.9 (8.1), compared to 28.7 (32.3) during on-demand treatment, which amounts to a 72.5% reduction and a statistically significant difference in ABRs between arms (P=0.0003). Three (17.6%) subjects (ITT) on prophylaxis experienced no bleeding episodes, whereas none treated on demand were bleeding episode-free. Total utilization of FEIBA NF for the treatment of bleeding episodes was significantly higher during on-demand therapy than prophylaxis (P=0.0067). There were no differences in the rates of related adverse events between arms. This study demonstrates that FEIBA prophylaxis significantly reduces all types of bleeding compared with on-demand treatment, and the safety of prophylaxis is comparable to that of on-demand treatment.
- ItemAcesso aberto (Open Access)Sydenham's chorea: clinical and evolutive characteristics(Associação Paulista de Medicina - APM, 2002-01-03) Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Roja, Suzana Campos [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Faustino, Patricia Corte [UNIFESP]; Roberto, Adriana Madureira [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT: During the last 12 years we have observed an increase in the frequency of Sydenham's chorea in our country. We have observed that some of our patients have presented recurrence of the chorea despite regular treatment with benzathine penicillin. OBJECTIVE: The aim of our study was to evaluate clinical and evolutive characteristics of Sydenham's chorea in a group of patients followed in our Pediatric Rheumatology Unit. TYPE OF STUDY: Retrospective study. SETTING: Section of Pediatric Rheumatology - Discipline of Allergy, Clinical Immunology and Rheumatology - Department of Pediatrics - UNIFESP - EPM. PARTICIPANTS: Two hundred and ninety patients with rheumatic fever followed between 1986 and 1999. METHODS: We reviewed the records of 290 patients with rheumatic fever followed between 1986 and 1999. All patients were diagnosed according to the revised Jones criteria (1992). We included 86 patients that presented Sydenham's chorea as one of the major criteria (one or more attacks) and evaluated their clinical and evolutive characteristics as well the treatment. RESULTS: Fifty-five patients were girls and 31 were boys. The mean age at onset was 9.7 years and mean follow-up period was 3.6 years. The 86 Sydenham's chorea patients presented 110 attacks of chorea. We observed isolated chorea in 35% of the patients, and 25 (29%) presented one or more recurrences. We included only 17 of the 25 patients for further analysis, with a total of 22 recurrences of which 14 were attacks of chorea, because it was not possible to precisely detect the interval between attacks in the other patients. The approximate interval between the attacks ranged from 4 to 96 months. In 71% of the patients there was no failure in the secondary prophylaxis with benzathine penicillin, which was performed every 3 weeks. CONCLUSION: Despite the regular use of secondary benzathine penicillin prophylaxis, children with rheumatic fever have a high risk of Sydenham's chorea recurrence.
- ItemSomente MetadadadosTrends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002-2009(Elsevier B.V., 2013-07-01) Stoszek, Sonia K.; Duarte, Geraldo; Hance, Laura Freimanis; Pinto, Jorge; Gouvea, Maria I.; Cohen, Rachel A.; Santos, Breno; Teles, Elizabete; Succi, Regina [UNIFESP]; Alarcon, Jorge O.; Read, Jennifer S.; NISDI Perinatal LILAC Study Grp; WESTAT Corp; Universidade de São Paulo (USP); Universidade Federal de Minas Gerais (UFMG); Hosp Servidores Estado Saude; Hosp Nossa Senhora da Conceicao; Hosp Femina; Universidade Federal de São Paulo (UNIFESP); Univ Nacl Mayor San Marcos; Eunice Kennedy Shriver Natl Inst Child Hlth & Hum; US Dept HHSObjective: To describe temporal management and outcome trends among HIV-1-infected pregnant women and their infants enrolled in the NISDI Perinatal and LILAC cohorts. Methods: A prospective cohort of 1548 HIV-1-infected pregnant women and their 1481 singleton live-born infants was analyzed. Participants were enrolled at 24 Latin American and Caribbean sites and followed-up for at least 6 months postpartum. Variables were compared by 2-year enrollment periods from September 27, 2002, to June 30, 2009, using logistic and linear regression modeling. Results: Antiretroviral (ARV) use during pregnancy remained high (99.0%). ARVs became increasingly used for treatment (P < 0.001). Regimens containing 2 nucleoside reverse transcriptase inhibitors plus a protease inhibitor became more common in later years (P < 0.001). the proportion of women with viral loads below 1000 copies/mL at hospital discharge after delivery (HD) increased over time (P = 0.0031). Median CD4 lymphocyte counts also rose at HD, from 441 cell/mm(3) to 515 cells/mm(3) (P < 0.05). Elective cesarean deliveries increased from 30.5% to 42.0% (P = 0.018). Most infants received ARV prophylaxis (99.7%). Few infants were breastfed (0.5%) or became infected with HIV-1 (1.2%). Conclusion: the results indicate that national HIV-1 treatment and transmission prevention policies are effective among patients with healthcare access in the region. (c) 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.
- ItemAcesso aberto (Open Access)Tromboprofilaxia venosa em pacientes clínicos: análise de sua aplicação(Associação Médica Brasileira, 2013-06-01) Kerbauy, Mariana Nassif [UNIFESP]; Moraes, Fabio Ynoe de; Kerbauy, Lucila Nassif; Conterno, Lucieni de Oliveira [UNIFESP]; El-fakhouri, Silene; Universidade Federal de São Paulo (UNIFESP); Hospital Sírio-Libanês Centro de Oncologia Departamento de Radioterapia; Universidade de São Paulo (USP); Faculdade de Medicina de Marília Núcleo de Epidemiologia Clínica; FAMEMAOBJECTIVE: Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter. METHODS: This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a university hospital. The review was based on a defined guideline. RESULTS: 146 patients were included in the review. At least one risk factor for venous thromboembolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drugwas prescribed, even though itwas not indicated. CONCLUSION: Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.