Instituto De Medicina Integral Research Articles

Misoprostol prior to inserting an intrauterine device in nulligravidas: a randomized clinical trial

How effective is the vaginal administration of misoprostol in dilating the cervix prior to inserting an intrauterine device (IUD) in nulligravidas? The use of misoprostol at a dose of 400 µg administered vaginally 4 h prior to IUD insertion increased the ease of insertion and reduced the incidence of pain during the procedure, although the frequency of cramps increased following misoprostol use. Misoprostol has been widely used in Obstetrics and Gynecology; however, its usefulness and efficacy in facilitating IUD insertion in nulligravidas have yet to be established. The present study shows that the benefits of misoprostol use prior to IUD insertion include facilitating insertion and reducing pain during the procedure; therefore, weighing up the benefits encountered against the only negative side effect (cramps prior to insertion), these results suggest that misoprostol use should become standard practice to facilitate IUD insertion in nulligravidas. A randomized, double-blind clinical trial was conducted. Nulligravid women of reproductive age were submitted to IUD insertion between July 2009 and November 2011 at the Instituto de Medicina Integral Prof. Fernando Figueira in Recife, Pernambuco, Brazil. A total of 179 women were randomly allocated to two groups: 86 to receive 400 µg of misoprostol vaginally 4 h prior to IUD insertion and 93 to receive placebo. Risk ratios (RRs) were calculated as measures of relative risk, together with their 95% confidence intervals (95% CI). The number needed to treat (NNT) and the number needed to harm (NNH) were also calculated. Significant differences were found between the groups for all the immediate end points studied, with less difficulty in inserting the IUD [RR = 0.49 (23/86 versus 51/93); 95% CI: 0.33-0.72; P = 0.00005], a lower risk of dilatation <4 mm [RR = 0.48 (24/86 versus 54/93); 95% CI: 0.33-0.70; P = 0.0001], a reduction in moderate-to-severe pain at IUD insertion [RR = 0.56 (32/86 versus 62/93]; 95% CI: 0.41-0.76; P = 0.00008), as well as a lesser likelihood of experiencing a disagreeable or very disagreeable sensation [RR = 0.49(29/86 versus 64/93); 95% CI: 0.35-0.68; P = 0.000004] in the group that was given misoprostol compared with the group that received placebo. There was no significant difference between the groups in relation to complications during IUD insertion. There were no cases of uterine perforation in either group. The frequency of cramps was 40% higher in the misoprostol group. The present study showed a positive balance between the benefits and risks of the use of misoprostol; however, it is not feasible to conclude that its use is imperative prior to IUD insertion in nulligravidas and IUD insertion should not be canceled when the medication is unavailable. In view of its effect in promoting cervical dilatation, misoprostol may be used prior to IUD insertion both in nulligravidas and in any women with cervical stenosis irrespective of parity. This study was funded by the Instituto de Medicina Integral Prof Fernando Figueira. None.

The correlation between body mass index and intraocular pressure in children

There is evidence from some studies that support an association between obesity in adults and higher intraocular pressure (IOP). However, this association has not been completely studied in children. Our aim is to evaluate the association between child body mass index (BMI) and IOP. Ninety-six children attending the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) in Brazil were studied. Thirty-three were overweight/obese with a mean BMI of 29.7 ± 5.2 and 63 with a mean BMI of 20.8 ± 3.3. IOP was measured using the Goldmann applanation tonometer and was corrected for corneal thickness. The coefficient of correlation between BMI and IOP was calculated. There was no significant difference in the IOP of children with or without overweight/obesity. The mean IOP was 13.5 and 13.0 mmHg for the right eye and 13.1 and 12.9 mmHg for left eye, respectively (p=0.38 and p=0.71). The results remained the same after correction by pachymetry; 13.0 and 13.1 mmHg for the right eye and 12.4 and 12.9 mmHg for the left eye, respectively (p=0.88 and p=0.41). The coefficient of correlation between BMI and IOP was 0.070 (p=0.496). These results do not show a correlation between body mass index and IOP in children. Further studies are warranted to clarify the association between BMI and IOP in children.

Factors associated with mother‐to‐child transmission of the human immunodeficiency virus in Pernambuco, Brazil, 2000–2009

To identify risk factors associated with mother-to-child transmission of HIV in the Brazilian state of Pernambuco. Retrospective cohort study with 1200 HIV-exposed children born in Pernambuco, registered up to the age of 2months in a public programme to prevent vertical transmission. Univariate and multivariate logistic regression analyses were conducted for maternal and peripartum characteristics and prophylactic interventions, to identify risk factors for mother-to-child transmission of HIV. The transmission rate was 9.16% (95% CI: 7.4-10.9). The following risk factors were independently associated with transmission: non-use of antiretroviral during pregnancy (OR: 7.8; 95% CI: 4.1-15); vaginal delivery (OR: 2.02; 95% CI: 1.2-3.4); prematurity (OR: 2.5; 95% CI: 1.3-4.7); and breastfeeding (OR: 2.6; 95% CI: 1.4-4.6). This mother-to-child transmission rate is unacceptably high, as prophylactic interventions such as antiretroviral therapy and infant feeding formula are free of charge. Absence of antiretroviral therapy during pregnancy was the main risk factor. Therefore, early identification of exposed mothers and initiating prophylactic interventions are the main challenges for controlling transmission.

Linha de base da leucemia linfocítica aguda para a vigilância da saúde ambiental no território de abrangência da refinaria de petróleo do Estado de Pernambuco, Brasil, 2004 a 2008

Objective: to describe the occurrence of Acute Lymphocytic Leukemia (ALL) in the state of Pernambuco, Brazil, where a petroleum refinery will be installed. Methods: descriptive study of ALL in minors under age 15 assisted at two referral centers for childhood cancer – Centro de Oncohematologia Pediatrico/Hospital Oswaldo Cruz; and Instituto de Medicina Integral Professor Fernando Figueira [Instituto Materno-Infantil de Pernambuco (IMIP)] – in the period 2004-2008, from the municipalities of Cabo de Santo Agostinho, Escada, Ipojuca, Jaboatao dos Guararapes and Moreno. Results: the authors identified, in both referral centers, 18 cases of ALL in minors under 15 living in these municipalities; the highest frequency occurred in the group with children under 4, with male predominance. Conclusion: it is necessary to organize the surveillance system on children's environmental health in the region, with the participation of the Primary Health Care.

Exame simples de urina no diagnóstico de infecção urinária em gestantes de alto risco

To identify the accuracy of urinalysis in the diagnosis of urinary tract infection in pregnant women at high risk.a prospective, cross-sectional study was conducted on 164 pregnant women admitted to the high-risk the ward of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) during the period from January to June 2011. Patients who had been taking antibiotics in the last ten days were excluded. All patients were subjected to simple urine tests and urine culture at the beginning of their admission. The agreement between the results of the examinations was evaluated by Kappa indices (K), and accuracy, sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were also determined.When only the presence of pus cells in urinalysis was used as a diagnostic criterion suggesting bacteriuria, there was a poor agreement when compared to uroculture (K=0.16). Accuracy was 61%, sensitivity 62.5%, and specificity 60.6%. PPV was 27.78% and NPV was 87%.The presence of alteration of urinalysis does not necessarily indicate an ongoing urinary tract infection, with urine culture being necessary. However, when urinalysis data are normal, uroculture may be avoided.

Celiac disease prevalence in children and adolescents with myocarditis and dilated cardiomiopathy

To determine the prevalence of celiac disease in patients with myocarditis and dilated cardiomyopathy. Fifty-six patients between 1 and 18 years old with dilated cardiomyopathy or myocarditis were evaluated and followed up at Instituto de Medicina Integral Professor Fernando Figueira. Patients with previous diagnosis of celiac disease were excluded. The functional classification was determined according to the American Heart Association criteria (classes I, II, III and IV). Diagnosis of myocarditis was reported in the patients' medical records. Dilated cardiomyopathy was diagnosed by echocardiogram with systolic dysfunction of one or both ventricles, ejection fraction lower than 55%, ventricular dilatation, and left ventricular diastolic diameter bigger than 112%. Patients answered a questionnaire about gastrointestinal and cardiac symptoms; next, anti-tissue transglutaminase (tTG) and anti-endomysial (EMA) antibodies were dosed. Those with positive antibody results were referred to intestinal biopsy and histological evaluation to detect celiac disease according to Marsh classification. One of the 56 children (1.8%) had positive tTG antibody level, but negative EMA. Intestinal histological evaluation showed total villous atrophy. Approximately, 30% of patients had heart failure. Gastrointestinal symptoms and signs were frequent, especially abdominal pain (70%, 39/56). Celiac disease prevalence in pediatric patients with dilated cardiomyopathy or myocarditis was 1.8%. It is important to investigate celiac disease in patients with these conditions to avoid the progression of such diseases and patients' clinical deterioration.

Perinatal characteristics among early (10–14 years old) and late (15–19 years old) pregnant adolescents

BackgroundPregnancy in adolescents is a worldwide health problem and has been mostly common in poor populations. It is not clear if socioeconomic or biological factors are the main determinants of perinatal adverse outcomes in pregnant adolescents. Adolescents under 15 years old may present a high growth rate which may contribute to impair fetal growth. Our aim is to compare perinatal characteristics among early (aged 10 to 14 years) and late (aged 15 to 19 years) pregnant adolescents.MethodsA cross-sectional study was performed using data from Pernambuco State 2009, obtained from DATASUS/SISNAC, a Brazilian Government, open-access public health database. Maternal and neonatal outcomes were compared between early (aged 10–14 years) and late (aged 15–19 years) pregnant adolescents. Family income was compared between early and late pregnant adolescents using a sample of 412 subjects evaluated at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) during 2011. Statistical comparisons were made using the chi-square test was used with a significant level of 0.05; bivariate and multivariate analysis were performed. This project was approved by the Institutional Ethics Review Board.ResultsData from 31,209 pregnant adolescents were analyzed. 29,733 (95.2%) were aged 15 to 19 years and 1,476 (4.7%) were aged 10 to 14 years. There were significant differences with respect to marital status, education level and number of prenatal visits of mothers aged 10 to 14 years compared to 15 to 19 years. Of importance, early adolescents had a greater rate of neonates born premature and with low birth weight. Prematurity and low birth weight remained statistically significant after multivariate analysis.ConclusionsEarly aged adolescents may have an increased risk of prematurity and low birth weight. These findings highlight the potential role of biological factors in newborn outcomes in pregnant adolescents.

1429P - Assessment of Quality of Life of Patients with Cervical Cancer During and After Treatment with Radiotherapy in Instituto De Medicina Integral Professor Fernando Figueira, Recife, Brazil

ABSTRACT Introduction Cervical cancer is the 2nd most frequent neoplasm among women in Brazil. Radiotherapy is one of the modalities used in the treatment of cervical cancer and may cause adverse events that compromise quality of life. The purpose of this study was assess quality of life in women with cervical cancer before, during the last week and six months after radiotherapy at a hospital in Northeast, Brazil. Method We performed an exploratory, before and after longitudinal study, with 35 women with cervical cancer treated with adjuvant radiotherapy, exclusively or concurrently with chemotherapy in Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between August 2012 and May 2012. The patients underwent three interviews (pre-treatment, last week and six months after treatment). To assess the quality of life it was used FACT-Cx score (Functional Assessment of Cancer Therapy-Cervix). The mean scores were compared using Student's t and ANOVA test, with significance level of 5%. Results The mean age was 50 (± 13.9) years. Most were single or widowed (58.8%) and only 2.9% were employed. About 75% attended just until elementary school. The FACT-Cx pre-treatment average scores was 110.9 and in the last week was 110.8, with no statistically significant difference (p = 0.966). The results corresponding to six months after therapy will be presented at the Meeting. Conclusion The immediate results after radiotherapy showed no difference in quality of life. Analysis after six months may be different. These findings may modify therapeutic decision. Disclosure All authors have declared no conflicts of interest.

Atividade eletromiográfica do músculo bíceps braquial de recém nascidos pré-termo submetidos à posição canguru

OBJETIVOS: avaliar o perfil da atividade eletromiográfica do músculo bíceps braquial de recém nascidos pré-termo (RNPT) antes de realizarem a posição canguru e até 48h após a permanência nesta posição. MÉTODOS: coorte prospectivo, avaliando 20 RNPT internados no alojamento mãe canguru do Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE. A atividade eletromiográfica do músculo bíceps braquial foi avaliada imediatamente antes de sua introdução à posição canguru, sendo acompanhados a cada 24h durante três dias consecutivos. O registro era feito no período de um minuto com eletromiógrafo. Eram colocados eletrodos auto-colantes entre o ponto motor e a junção miotendínea. Para comparação dos valores médios foi usado análise de variância para medidas repetidas. RESULTADOS: a atividade eletromiográfica diferiu estatisticamente entre os intervalos [F(3,67)=6,01; p=0,005], sendo que em 48 h foi maior do que em 0h, mas não em 24 h. CONCLUSÕES: a posição canguru é capaz de induzir um aumento da atividade eletromiográfica em crianças pré-termo.

Frequência de Escherichia coli e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda

OBJETIVOS: determinar a frequência de Escherichia coli diarreiogênica e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda. MÉTODOS: estudo prospectivo tipo corte transversal realizado no Instituto de Medicina Integral Prof. Fernando Figueira, entre janeiro de 2010 e fevereiro de 2011. Foram excluídas as crianças com diagnóstico de imunodeficiência ou usando antimicrobianos. Para cada paciente foi feito uma única coleta de swab retal nas primeiras 24 horas de internação. Os patógenos foram identificados na coprocultura e sorotipagem. Os antibiogramas foram obtidos por disco-difusão. RESULTADOS: 140 crianças foram arroladas, em sua maioria provinham de famílias de baixa renda da Região Metropolitana do Recife. Foram isolados 99 microorganismos: 9 (6,4%) E. coli enteropatogênica (EPEC) e 4 (2,9%) E. coli enteroinvasora (EIEC) e 80 (57,1%) outras E.coli não EPEC, não EIEC, 3 (2,1%) Shigella spp e 3 (2,1%) Salmonella spp. O perfil de sensibilidade aos antimicrobianos demonstrou níveis elevados de resistência à ampicilina e sulfametoxazol-trimetoprima. CONCLUSÕES: a baixa frequência de EPEC observada pode estar associada às condições de saneamento básico favoráveis apresentadas pelos pacientes do estudo. A análise local do perfil da sensibilidade da E. coli aos antimicrobianos reforça a recomendação da Organização Mundial de Saúde para o uso racional dessas drogas visando prevenção da resistência bacteriana.

Do pacifiers increase the risk of nosocomial diarrhoea? A cohort study

DesignProspective cohort study.SettingTeaching paediatric hospital—Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Northeast Brazil.Participants378 of 536 infants admitted in paediatric wards from April to October 2009 were daily assessed...

O traço francês na arquitetura do Recife: o Hospital Pedro II

Pedro II Hospital was inaugurated in Recife in 1861 and for several decades was the leading center of its kind in the state of Pernambuco and in Northeast Brazil. Its construction followed French design, as developed by physician Jacques-René Tenon, that is, the so-called pavilion style that was the norm in Pernambuco and in Brazil for many years. After being nearly abandoned in 1982, the hospital was reformed shortly thereafter and reopened its doors to offer a variety of services, thanks to negotiations between the Instituto de Medicina Integral Professor Fernando Figueira and the Archdiocese of Olinda and Recife.

Severity of viral coinfection in hospitalized infants with respiratory syncytial virus infection

We have read with special interest the article by De Paulis et al.1 on viral co-detection in hospitalized infants with bronchiolitis. The authors studied a cohort of hospitalized infants in Sao Paulo and found high rates of viral co-detection, which were not associated with disease severity. In the editorial published in the same issue of Jornal de Pediatria, Sly and Jones2 highlight that previous clinical studies are contradictory regarding the association between co-detection and severity of viral infections of the lower respiratory tract. In Recife, we had the opportunity to prospectively follow 407 children under five years of age with acute respiratory infection (ARI) who received emergency care at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between April 2008 and March 2009.3 The disease severity spectrum was categorized as very mild (upper ARI), mild (lower ARI without hospitalization), moderate (lower ARI with hospitalization, but no need for supplemental oxygen), and severe (lower ARI with hospitalization and need for oxygen). Nasopharyngeal aspirate samples were collected from all children during the acute phase of disease, and 17 respiratory pathogens were investigated using molecular diagnostic techniques (multiplex RT-PCR): respiratory syncytial virus (RSV), metapneumovirus, parainfluenza viruses 1, 2, 3, 4, influenza viruses A and B, bocavirus, adenovirus, coronavirus229E, NL63, OC43, KHU1, rhinovirus, Mycoplasma pneumoniae (Mpp), and Chlamydia pneumoniae (Cpp). One or more pathogens were detected in 85.5% of samples, with a co-detection rate of 39.6%. The most common co-detections included adenovirus, RSV, bocavirus, and rhinovirus. While children with RSV and Mpp infection were more likely to be hospitalized than children without these pathogens, the proportion of children in whom a pathogen was detected was similar across the disease severity groups and between ambulatory and hospitalized patients. Similarly, no difference in disease severity was found in children in whom one, two, three or four pathogens were detected. Although our study did not have statistical power to detect whether particular pathogen combinations were associated with more severe disease, our findings corroborate those of De Paulis et al.1 Severity of viral coinfection in hospitalized infants with respiratory syncytial virus infection

Resultado de pesquisa sobre a frequência de aleitamento materno exclusivo varia de acordo com a forma de abordagem na entrevista

To compare the frequency of exclusive breastfeeding using two different interview approaches. This was a cross-sectional study of 309 mothers of children aged 0 to 6 months, with a median age of 11 days. Mothers were interviewed at the Instituto de Medicina Integral Prof. Fernando Figueira during November and December of 2009. Two approaches to the interview were tested: firstly, the mother was asked if complementary foods had been given during the preceding 24 hours. Secondly, they were asked if at any point during the child's life any other foods had been given. The marginal homogeneity test was applied and the significance level was 5%. According to the 24-hour recall, the frequency of exclusive breastfeeding was 78.0%. According to the wider-ranging recall period, the frequency was 59.2% (p < 0.001). The frequency of the exclusive breastfeeding is overestimated using the 24-hour recall compared with the whole-life recall.

Avaliação de preditores do óbito neonatal em uma série histórica de nascidos vivos no Nordeste brasileiro

OBJETIVOS: avaliar tendência dos preditores do óbito neonatal entre os nascidos vivos e qualidade do preenchimento do Sistema de Informações para Nascidos Vivos (Sinasc) institucional. MÉTODOS: série histórica do Sinasc do Instituto de Medicina Integral Prof. Fernando Figueira (1995-2006) em Recife, Pernambuco, Brasil. Foram avaliadas: completitude de preenchimento das variáveis e tendência dos indicadores de risco para mortalidade infantil (baixo peso ao nascer; anóxia; prematuridade; cesariana; ausência de pré-natal; mãe adolescente; analfabetismo e nenhum filho nascido vivo e morto). Significância estatística para teste t de Student foi de 5% em um modelo de regressão linear. RESULTADOS: 58.689 nascidos vivos com contínuo incremento a partir de 2002; baixo peso ao nascer, 22,8%; Apgar &lt;7 1º minuto 15,3%; prematuros 22,4%; parto cesáreo 38,2%; mães adolescentes 27,2%; analfabetas 2,7% e 89% sem filho nascido morto. Prevaleceu 1% de variáveis ignoradas. Tendência de aumento (p&lt;0,05): Apgar no 1º minuto, baixo peso ao nascer, prematuridade e parto cesáreo; tendência de declínio(p&lt;0,05): nenhuma consulta de pré-natal, mães adolescentes, analfabetismo e nenhum filho nascido morto. CONCLUSÕES: valores progressivos dos preditores do óbito infantil sugerem problemas na qualidade do pré-natal. Predomínio de 1% de informação ignorada, excelente qualidade de preenchimento do Sinasc institucional. Avaliação rotineira dos nascimentos promove agilidade da informação e intervenções oportunas na prevenção dos óbitos neonatais no nível local.

História e memórias do banco de leite humano do Instituto de Medicina Integral Prof. Fernando Figueira (1987-2009) em Recife, Pernambuco, Brasil

OBJETIVOS: reconstituir a história do Banco de Leite Humano (BLH) do Instituto de Medicina Integral Professor Fernando Figueira (IMIP), enfocando os idealizadores e a inauguração do serviço. MÉTODOS: estudo descritivo, transversal com enfoque histórico, orientado pela metodologia da história oral. Privilegiou-se a consulta a fontes bi¬bliográficas e a entrevista direta a sete participantes, com roteiro estruturado. A análise das falas desvelou duas categorias: "Criação do banco de leite humano do IMIP: os idealizadores e suas influências"; e "A inauguração". RESULTADOS: o BLH do IMIP foi criado em 1987, com a idealização e o incentivo do Professor Fernando Figueira e da Dra. Vilneide Braga, e para suprir as necessidades da Maternidade e da unidade de terapia intensiva neonatal. Da inauguração, participaram autoridades políticas, autoridades em aleitamento materno, celebridades da mídia e profissionais do hospital. CONCLUSÕES: o entrelaçamento entre história e memória, conduzido pelas trilhas da história oral, foi matriz para a construção da origem e evolução do BLH do IMIP, a partir da fala de sujeitos envolvidos nos fatos. A história do BLH do IMIP é um processo inacabado, vivo, é uma força geradora de transformação, sonhos e esperança, que mantém aceso o ideal de um mundo melhor para as crianças, para as mães e para a sociedade.

Risk factors for death in children with visceral leishmaniasis.

BackgroundDespite the major public health importance of visceral leishmaniasis (VL) in Latin America, well-designed studies to inform diagnosis, treatment and control interventions are scarce. Few observational studies address prognostic assessment in patients with VL. This study aimed to identify risk factors for death in children aged less than 15 years admitted for VL treatment in a referral center in northeast Brazil.Methodology/Principal FindingsIn a retrospective cohort, we reviewed 546 records of patients younger than 15 years admitted with the diagnosis of VL at the Instituto de Medicina Integral Professor Fernando Figueira between May 1996 and June 2006. Age ranged from 4 months to 13.7 years, and 275 (50%) were male. There were 57 deaths, with a case-fatality rate of 10%. In multivariate logistic regression, the independent predictors of risk of dying from VL were (adjusted OR, 95% CI): mucosal bleeding (4.1, 1.3–13.4), jaundice (4.4, 1.7–11.2), dyspnea (2.8, 1.2–6.1), suspected or confirmed bacterial infections (2.7, 1.2–6.1), neutrophil count <500/mm3 (3.1, 1.4–6.9) and platelet count <50,000/mm3 (11.7, 5.4–25.1). A prognostic score was proposed and had satisfactory sensitivity (88.7%) and specificity (78.5%).Conclusions/SignificancePrognostic and severity markers can be useful to inform clinical decisions such as whether a child with VL can be safely treated in the local healthcare facility or would potentially benefit from transfer to referral centers where advanced life support facilities are available. High risk patients may benefit from interventions such as early use of extended-spectrum antibiotics or transfusion of blood products. These baseline risk-based supportive interventions should be assessed in clinical trials.

1010 Antimicrobial Resistance in Uropathogens in Children From Brazil

Background and aims: To prevent urosepsis and reduce risk of renal scarring in children with urinary tract infection (UTI), empirical antibiotic treatment is started soon after the collection of urine specimens for culture and should be based on local epidemiology of uropathogens and their antimicrobial susceptibility. The aim of this study was to describe pathogens and their antimicrobial resistance in urine cultures of children under five, attending the Instituto de Medicina Integral Professor Fernando Figueira (IMIP), a teaching hospital in Recife, Brazil.Methods: cross sectional study comparing an earlier (January 1999 to August 2001) and a later (January to December 2008) period of time. It was recorded the urine culture positivity rate, pathogen species; antimicrobial resistance (Kirby-Bauer diffusion disks) of isolates in urine cultures of children with suspected UTI.Results: 601 (15%) of 4113 urine cultures were positive. The most frequent isolates in the earlier and later periods were, respectively: E.coli (30% and 41%), Klebsiella spp (27% and 25%), P aeruginosa (5% and 9%), P. mirabilis (7% and 7%) and Candida spp. (11% and 4%). In 2008, the resistance of E.coli was (in descending order): cotrimoxazole (68%), nalidixic acid (52%), cephalotin (30%), ciprofloxacin (15%) and nitrofurantoin (8%). When all pathogens are considered, the highest antimicrobial coverages would be reached by ciprofloxacin (88%, CI95%=83.4-91.6%) and nitrofurantoin (75%, CI95% = 68.6-80.5 %).Conclusions: Nitrofurantoin and ciprofloxacin remain viable alternatives, respectively for uncomplicated and complicated UTI. Trends of antimicrobial resistance should be monitored at the local level as important changes occur over time.

Citologia de impressão conjuntival em crianças desnutridas graves hospitalizadas

OBJETIVOS: avaliar os achados da citologia de impressão conjuntival (CIC) em crianças com desnutrição energético protéica (DEP) grave, hospitalizadas no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP). MÉTODOS: estudo descritivo, tipo série de casos, realizado no período de agosto de 2005 a maio de 2006, envolvendo 41 crianças de um a 60 meses, com desnutrição grave (peso/altura &lt; -3DP e/ou edema - padrão NCHS). A técnica para a realização da CIC seguiu normas padronizadas segundo estudo de validação. A leitura das lâminas foi realizada por dois observadores independentes. RESULTADOS: a idade dos casos variou de um a 47 meses, com a mediana de nove meses. Observou-se padrão de anormalidade da CIC em 46,3% das crianças. Entre os casos com CIC anormal (marginal (-) e deficiente), 40% apresentaram edema. CONCLUSÕES: a prevalência elevada de resultados anormais de CIC, resumindo as classificações marginal (-) e padrão deficiente, justifica, na experiência aqui relatada, o cuidado normativo de se utilizar doses elevadas de vitamina A no tratamento hospitalar de desnutridos graves.

Long-term Follow-up Outcomes of Perinatally HIV-infected Adolescents: infection Control but School Failure

Perinatally human immunodeficiency virus (HIV)-infected children are fighting acquired immune deficiency syndrome (AIDS) and becoming adolescents. The objective of this study was to examine long-term outcomes among perinatally HIV-1-infected adolescents. Cross-sectional clinical and laboratory data were collected for 49 perinatally HIV-infected adolescents followed at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP's) Hospital from 1987 to 2007. The mean age of these adolescents was 12.5 years, the majority were female (73.5%) with a mean follow-up duration of 9.0 years, 71.4% of adolescents had no signs of HIV infection, 81.6% had normal CD4(+) lymphocyte count, and 53.1% had undetectable HIV viral load. HIV disclosure to the adolescent was reported in 31 (63.3%) participants. The majority were in school (89.8%) but failure and drop-out were reported by 51% and 28.6% of the subjects, respectively. All five domains of quality of life (QOL) measured revealed high scores. The majority of long-term adolescent survivors showed HIV-infection control and high scores of QOL, but with problems in schooling functioning that need early detection and intervention.