Instituto De Medicina Integral Research Articles

Excesso de peso em crianças e adolescentes sobreviventes de leucemia linfoide aguda: estudo de coorte

A leucemia linfoide aguda (LLA) e a neoplasia maligna mais comum na infância. A taxa de cura e hoje em torno de 80% e entre os sobreviventes tem sido descrito um aumento de risco de obesidade. Entretanto, nao ha estudos sobre esse risco em paises em desenvolvimento, especialmente naqueles que atravessam um momento de transicao nutricional, como o Brasil. O objetivo do estudo foi verificar a frequencia de excesso de peso em criancas e adolescentes sobreviventes de leucemia linfoide aguda. Foi realizado um estudo de coorte retrospectivo com 101 criancas e 19 adolescentes sobreviventes de leucemia linfoide aguda. Todos esses pacientes foram tratados no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), entre os anos de 1998 e 2002. O seguimento foi de quatro anos e meio, sendo o indice de massa corporea (IMC) calculado no momento do diagnostico, ao final de tratamento e dois anos apos o termino da terapia. A idade media do diagnostico foi de 4,6 (2,1) anos nas criancas e de 12,2 (1,9) anos nos adolescentes. O tempo de tratamento foi de 2,6 (1,0) anos. O IMC aumentou de 16,1 (2,3) para 19,1 (3,5) apos o tratamento; p<0.001. A frequencia de excesso de peso passou de 17/120 (14,2%) para 55/120 (45,8%) apos o tratamento; p < 0,001. Nao houve variacoes significativas da frequencia de excesso de peso e do IMC, entre o termino do tratamento e dois anos apos: 55/120 (45,8%) vs 46/120 (38,3%), p = 0,295, e IMC de 19,1 (3,5) vs 19,4 (3,5); p = 0,178. O tratamento da leucemia linfoide aguda aumenta o risco de excesso de peso entre as criancas e adolescentes sobreviventes.

Validação do diagnóstico ultrassonográfico de anomalias fetais em centro de referência

To validate ultrasound diagnoses of fetal anomalies made in a Fetal Medicine Center in Pernambuco. A cross sectional study was performed to validate the diagnosis test, including all high risk pregnant women submitted to obstetrical morphological ultrasound at the 'Instituto de Medicina Integral Professor Fernando Figueira (I.M.I.P.)', from March 2002 to March 2006. Prenatal diagnosis was confirmed after birth. Socio demographic characteristics and pre and postnatal frequencies of fetal anomalies were the variables studied. Agreement between pre and postnatal diagnoses from congenital anomalies were evaluated with the Kappa indicator. Youden's test was applied to validate prenatal ultrasound diagnoses. Nine hundred and eighty nine patients were eligible. After evaluation of inclusion and exclusion criteria 457 patients were included in study. The average maternal age was 24.8 + 6.5 years. Fetal anomaly diagnoses postnatal were confirmed in 257 (56.2%) pregnant women. Prenatal ultrasound diagnosis of fetal anomalies disclosed 96% of sensibility and 79% of specificity, good agreement (K=0.76) between pre and postnatal diagnoses when compared to postnatal results and good diagnostic validity (Y=0.75). Prenatal diagnoses of fetal anomalies at a Fetal Medicine center in Pernambuco demonstrate good sensibility, specificity, agreement pre and postnatal and good diagnostic validity.

Fatores associados à bacteriúria após sondagem vesical na cirurgia ginecológica

To determine the frequency and risk factors associated to bacteriuria after urinary catheterization in women submitted to elective gynecological surgery. A cohort study was carried out among women submitted to gynecological surgery after urinary catheterization. This study took place at the 'Instituto de Medicina Integral Professor Fernando Figueira' from January to May of 2007. Uroculture samples were collected during two periods: in the first 24 hours and seven to ten days after catheter removal. To demonstrate the association between risk factors and bacteriuria, the relative risk was calculated with a confidence interval of 95%. This study included 249 women. At 24 hours after catheter removal, 23.6% of the urocultures collected were positive, while on days 7 to 10 this was reduced to 11.1%. Of all participants studied only 2.4% had symptomatic bacteriuria. Risk of bacteriuria at 7/10 days was reduced when the patient reported a positive history of treatment for vulvovaginitis in the previous three months. However this association was not found after multivariate analysis. There was no significant association with age, education, stage of reproductive phase, number of pregnancies and deliveries, type and duration of surgery, type of anesthetics, use of prophylactic antibiotic, professional who introduced the catheter and time of urinary catheterization. Frequency of bacteriruria was 23.6% at 24 hours and 11.1% seven days after catheter removal. There was no association between bacteriuria at 7/10 days and any of the variables analyzed.