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The factors contributing to high neonatal morbidity and mortality in Limpopo ProvinceRamaboea, Moyahabo Joyce 11 1900 (has links)
A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M.A. (Health Studies)
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Factors influencing women's preference for home births in the Mutare District, ZimbabweMuranda, Engeline 06 1900 (has links)
The study attempted to identify factors influencing women’s preference for home births in the Mutare District, Zimbabwe. A quantitative, descriptive, exploratory, cross sectional survey, gathering data by conducting structured interviews with 150 women, was used. All 150 women attended antenatal clinics but did not deliver their babies at health care facilities. The research results indicated that home deliveries might decline if:
• the hospital/clinic fees were reduced or removed
• transport would be available for women in labour to reach hospitals/clinics
• shelters were built for pregnant women at hospitals/clinics
• clinics were well equipped and had sufficient numbers of midwives
• women had received more effective health education on the advantages of institutional deliveries and on the danger signs of pregnancy/labour complications
• nurses/midwives would treat patients respectfully.
Unless these factors are addressed, the number of home deliveries might not decline, and the high maternal/infant mortality and morbidity rates in this district will persist. / Health Studies / M. Public Health
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Assoziation des PDCD1 rs11568821 GG-Genotyps mit stärkerer Morbidität bei Intensivpatienten mit Krankheitsbild Sepsis: Vergleich der SOFA-Sub-Scores / Association of the PDCD1 rs11568821 GG-genotype with higher morbidity of patients with sepsis at ICU: Comparison of the SOFA-sub-scoresGerber, Sebastian 30 June 2016 (has links)
No description available.
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以疾病為導向之醫療風險管理-以心臟冠狀動脈繞道手術為例 / Disease-oriented control of medical risks- analyzed with coronary artery bypass grafting surgery程毅君, Cherng, Yih-Giun Unknown Date (has links)
背景與目的:
每一項疾病都有其潛在的風險,但要有效的降低死亡率及併發症發生率,必須找出關鍵性指標加以改善或預防。我們以心臟冠狀動脈繞道手術之患者為例,希望藉由統計分析的方式,找出造成死亡以及術後併發症最相關的因素,目的不只在預測,而在於防範。
研究對象與方法:
在我們的實驗設計上,風險因子分布在手術前、手術中、以及手術後三個階段,對象是某醫學中心接受心臟冠狀動脈繞道手術的220例患者。分析採用迴歸統計建立模型,其中羅吉斯迴歸中的依變數為死亡率與罹病率,線性迴歸的依變數為加護病房留置天數以及總住院日數。ROC curve亦將被建立,以判斷模型是否能區別病患是否罹病或死亡。所得資料亦計算EuroScore及其ROC曲線面積,並與歷史資料做比較。
結果:
所建立的死亡估計模型的有兩個,預測值都在97%以上,ROC曲線面積亦都超過0.96;併發症估計模型由六個變數所構成,預測率及ROC曲線面積分別為94%和0.984。加護病房留置天數及住院天數估計模型分別由八個及十三個因子來解釋,調整後的R square分別為0.527及0.6。EuroScore對死亡與併發症的預測率,分別為93.7%和82%,ROC曲線面積分別是0.864和0.797,均高於歷史文獻記錄,未來應該廣泛應用。
結論與建議:
經由適當的風險分級和危險因子分析,我們可以找出風險高低的標準和依據,了解影響死亡率與罹病率的關鍵因子是什麼,儘可能的做事前的防範與處置,希望能夠改善結果並提高手術的存活率。
EuroScore是個值得採用的預測工具,可以廣泛應用在死亡率與併發症發生率的估計,但是必須搭配風險因子的改善,才能發揮實際的功效。我們認為,體外循環時間與再次手術是最具有空間來降低死亡率與罹病率的兩個要素,有效率的控制時間、改善造成再手術的前因後果,除了死亡率與併發症發生率的下降外,還可以及早脫離對加護病房照顧的需求並減少留置的天數。
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The factors contributing to high neonatal morbidity and mortality in Limpopo ProvinceRamaboea, Moyahabo Joyce 11 1900 (has links)
A quantitative descriptive, retrospective and cross-sectional study was conducted. The purpose of the study was to identify and describe factors that contributed to high sickness and death rate of babies admitted in the Neonatal Unit at a tertiary institution in Limpopo Province. Data were collected from the patient’s records by administering an auditing tool. The tool included initial assessment on antenatal care, intra-partum and neonatal care. Analysis of data was performed by IBM Statistical Package for Social Sciences (SPSS) Statistics 22 computer software version. Frequency tables and pie graphs were used to present the data. The findings revealed that 42% of the mothers whose babies were admitted in the Neonatal Unit were in their childbearing period, 71% of the mothers started antenatal care at the second trimester and 75% babies were admitted within the first six hours of life. Respiratory distress, 77% and prematurity, 43% were the common conditions for admission in the Neonatal Unit. Spontaneous preterm and immaturity were the common causes of death. Recommendations are that education and training on record keeping to be done on continuous basis, to conduct quality improvement programmes and implement maternal and neonatal guidelines in the clinical area throughout. / Health Studies / M. A. (Health Studies)
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Epidemiologická analýza vlivu znečištění ovzduší na zdraví v regionálním měřítku / Epidemiology analysis of the effect of air pollution on health at regional scaleRychlíková, Eva January 2014 (has links)
Epidemiology analysis of the effect of air pollution on health at regional scale MUDr. Eva Rychlíková ABSTRACT Work involves a health impact assessment of the air pollution of aerosol particles at the some important steps. It describes evidence on air pollution exposure in vulnerable groups of population and searches for the effects. An exposure is a component of causal chains of diseases coming from external origin. And just because it is the main condition. If there is no exposure, there is no health risk. For a possibility to prevent disease we need to know an exposure. We investigated exposure with an activity questionaire in the three groups of population whose would be to the environmental factors, mainly air pollution, vulnerable. The personal exposure was monitored in a group of children. In preparing the questionnaire, we respect the recommendation of US EPA and WHO. Sensitivity is determined by the properties of the organism, specific period of its evolution, lifestyle and behaviour, the circumstances under which exposure to pollution occurs. We evaluated the effects on health which included short-time mortality, long-time mortality and respiratory morbidity in children.The air pollution and its development were evaluated in the Ustecky Region, Region of Prague and Moravskoslezsky region. The...
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Gestações gemelares com pesos discordantes: estudo da predição ultra-sonográfica e dos resultados neonatais / Twin growth discordance: sonographic prediction and factors related to perinatal outcomeMachado, Rita de Cassia Alam 01 November 2006 (has links)
A gemelaridade apresenta algumas intercorrências específicas, como a discordância de peso entre fetos e recém-nascidos (RNs). O objetivo do presente estudo foi predizer a discordância de peso do exame ultra-sonográfico comparada à do parto e avaliar a morbidade e a mortalidade neonatais nas gestações gemelares discordantes quanto ao peso. Este foi um estudo retrospectivo, com levantamento dos casos do período de 1998 a 2004, no Setor de Gestações Múltiplas da Clínica Obstétrica do HCFMUSP. Na avaliação da predição ultra-sonográfica, foram inseridas 221 gestações gemelares e, na avaliação da morbidade e da mortalidade, 151 gestações com partos nessa instituição. A discordância de peso foi definida como >= 20%, sendo excluídos os casos de malformações fetais (n=43) e da Síndrome da transfusão feto-fetal (n=24). Para análise da adequação do peso ao nascimento, utilizou-se a curva de Alexander et al., 1998, para gêmeos. No estudo da predição, foram utilizados quatro intervalos de tempo em relação ao parto (0 a 7 dias - n = 96; 8 a 14 dias - n = 66; 15 a 21 dias - n = 58; 22 a 28 dias - n = 59 gestações), somando 279 avaliações. No grupo de 0 a 7 dias, a estimativa da sensibilidade foi de 93,6%, especificidade de 79,4%, valor preditivo positivo de 89,2%, valor preditivo negativo de 87,1% e acurácia de 88,6%. Nos demais grupos, a sensibilidade e a acurácia foram de 95,8% e 84,9%, 95,6% e 84,5%, 90,9% e 84,8%, respectivamente. Em relação à morbidade, 111 gestações eram concordantes (73,5%) e 40 discordantes quanto ao peso. No grupo discordante, 75% das gestações gemelares apresentaram pelo menos um recém-nascido com Restrição de Crescimento Fetal (RCF). Nesta análise, as gestações gemelares concordantes monocoriônicas obtiveram menor média de idade gestacional no parto (34,3 versus 36,2 semanas, p=0,004), menor peso médio (2067 versus 2334 gramas, p=0,0016) e maior tempo de internação (10,6 versus 7,3 dias, p=0,0023) que as gestações concordantes dicoriônicas. Nas gestações discordantes, não houve diferença significativa em relação à corionicidade. As gestações discordantes, com pelo menos um RN abaixo do percentil 10, apresentaram menor média de idade gestacional (35,2 versus 36,8 semanas, p=0,009) e maior tempo de internação (17,5 versus 8,2 dias, p=0,026). Não foi observada diferença significativa de morbidade e mortalidade entre RNs concordantes e discordantes, com pesos entre os percentis 10 e 90. Os fetos menores das gestações discordantes demonstraram maior freqüência de índice de Apgar inferior a 7 (27,5% versus 7,5%, p=0,01). A avaliação da mortalidade não demonstrou diferença significativa em relação aos grupos concordantes (3,7%) e discordantes (4,5%; p = 1,00). No presente estudo, conclui-se que os quatro grupos apresentaram adequada correlação entre a discordância de peso à ultra-sonografia e no nascimento, porém com melhor predição até sete dias antes do parto. A morbidade neonatal esteve relacionada à RCF do menor feto. A discordância de peso e a corionicidade não interferiram na mortalidade neonatal. / The aim of this study was to evaluate the ability of prenatal ultrasound scans to predict fetal growth discordance in twin pregnancies and perinatal morbidity/mortality associated with these cases. This was a retrospective study (1998-2004) involving twin pregnancies that were scanned and had their delivery at our Institution (HCFMUSP). Cases with fetal malformations (n=43) or twin to twin transfusion syndrome (n=24) were excluded. The study of ultrasound scans consisted of 221 twin pregnancies. The final morbidity/mortality study group consisted of 151 twin pregnancies. Birth weight was evaluated based on twin growth charts published by Alexander et al (1998) and weight discordance as a difference >= 20%. Small for gestacional age (SGA) was defined as birth weight below the 10th centile. The study of ultrasonographic prediction of interwin discordance was made using four different intervals between ultrasound examination and delivery (0 to 7 days, n = 96; 8 to 14 days, n = 66; 15 to 21 days, n = 58; 22 to 28 days, n = 59 pregnancies), with a total of 279 ultrasound examinations. In group 0 to 7 days, the sensitivity was 93,6%, specificity was 79,4%, positive predicted values was 89,2%, negative predicted values was 87,1% and accuracy was 88,6%. In the groups 8 to 14 days, 15 to 21 days and 22 to 28 days the sensitivity and accuracy were 95,8% and 84,9%, 95,6% and 84,5%, 90,9% and 84,8%, respectively. Birthweight discordance was observed in 40 sets of twins (26.5%) and 12 cases were monochorionic MC (30%). Twenty five cases (22.5%) in the non discordant group were MC. In the non discordant group, monochorionic pregnancies showed lower gestational age at delivery (34.3 versus 36.2 wks, p=0.004), lower mean birth weight (2067g versus 2334g, p=0.0016) and longer length of stay in hospital (10.6 versus 7.3 days, p=0.0023) compared to dichorionic twins. In the group with twin birthweight discordance, there were no significant differences between MC and DC pregnancies and 75% of the cases had at least one newborn with SGA. These cases were showed lower gestational age at delivery (35.2 versus 36.8wks, p=0.009) and longer length of stay in hospital (17.5 versus 8.2 days, p=0.026). In the discordant group, the smaller twin had a higher frequency of first minute Apgar score < 7 (27.5% versus 7.5%, p=0.01). Perinatal mortality rate was similar in both groups (discordant 4.5% and concordant 3.7%, p=1.0). There were no significant differences in morbidity and mortality between concordant and discordant twins when birth weight was between the 10 th and 90 th centile. In conclusion, there was a good correlation between fetal growth discordance predicted by prenatal scan and actual birth weight discordance. Neonatal morbidity was related to SGA. Excluding fetal malformation and TTTS cases, birth weight discordance in twin pregnancies is not a significantly associated with neonatal mortality.
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Relação entre os polimorfismos da paraoxonase 1 e do citocromo P450 em pacientes com imunodeficiência comum variável em uso de medicamentos ou exposição a poluentes ambientais / Relation between paraoxonase 1 and cytochrome P450 gene polymorphisms and patients with common variable immunodeficiency and in use of medication or exposed to enviromental pollutantsSini, Bruno Carnevale 05 December 2017 (has links)
INTRODUÇÃO. A Imunodeficiencia comum variável (ICV) é uma doença heterogênea caracterizada pela redução dos niveis de IgG, IgA e/ou IgM e da função de anticorpo. As manifestações clínicas incluem a presença de infecções recorrentes ou crônicas, doenças inflamatórias/autoimunes e incidência aumentada de malignidades como linfomas e carcinomas, caracterizando-se, consequentemente, por um estado de ativação imune persistente e alterações do metabolismo oxidativo. Tanto a paraoxonase 1(PON1) quanto o polimorfismo do citocromo p450 (CYP) 2E1 têm importante participação nos processos oxidativos, controlando a extensão dos danos causados por alterações na concentração de oxidantes. Acredita-se que, tal qual ocorre na população normal, tanto a PON1 quanto a CYP2E1 tenham importante papel na gravidade e na sobrevida dos pacientes com ICV. OBJETIVO: estudar os polimorfismos de PON1 e CYP2E1, bem como a atividade arilesterase da PON1, e sua relação com o perfil lipídico, características clínicas, morbidade e mortalidade em pacientes com ICV. MÉTODOS/RESULTADOS: Foram avaliadas as frequências alélicas dos polimorfismos de PON1 e CYP2E1, o perfil lipídico e a atividade arilesterase da PON1 em 101 pacientes com ICV e 16 pacientes com hipogamaglobulinemia secundária (HS) e 130 controles saudáveis. Nos dois grupos de pacientes foi analisada a presença de parâmetros clínicos e laboratoriais, morbidade e gravidade da doença. Houve diferença na frequência dos genótipos de PON1-L55M entre pacientes primários e secundários, sendo o alelo 55L e o genótipo 55LM mais frequente no grupo HS. A atividade arilesterase de PON1 mostrou-se menor nos pacientes com ICV em relação ao grupo controle, com pacientes do genótipo 55MM apresentando os menores valores de atividade. Pacientes com o genótipo 55MM apresentaram doença mais grave quando comparados aos demais grupos genotípicos, sendo essa diferença causada não por uma característica deletéria deste genótipo, mas pelo papel protetor desempenhado pelo alelo 55L; pacientes portadores desse alelo apresentaram menor prevalência de manifestações graves como neoplasias, hepatomegalia, sepse e óbitos, bem como maior sobrevida daqueles que apresentavam ao menos uma cópia deste alelo. CONCLUSÃO: Este constitui o primeiro relato demonstrando maior frequência do genótipo 55LM e do alelo 55L em pacientes com hipogamaglobulinemia secundária e de menor atividade arilesterase em pacientes com ICV portadores do genótipo 55MM. Nossos resultados são sugestivos de que a presença do alelo 55L possa desempenhar papel protetor na ICV. Além disso, foi constatado que a presença de linfonodomegalia, hepatomegalia, esplenomegalia, sepse e hipertensão portal possam ser fatores preditivos tanto de um quadro de doença mais grave quanto de maior mortalidade / Introduction: Common Variable Immunodeficiency (CVID) is a heterogeneous disease characterized by reduced levels of IgG, IgA and / or IgM and antibody function. Clinical manifestations include the presence of recurrent or chronic infections, inflammatory/autoimmune diseases, and increased incidence of malignancies such as lymphomas and carcinomas, which is characterized by a state of persistent immune activation and alterations in oxidative metabolism. Both paraoxonase 1 (PON1) and cytochrome p450 (CYP) 2E1 polymorphism have an important role in oxidative processes, controlling the extent of damage caused by changes in oxidant concentration. It is believed that, as in the normal population, both PON1 and CYP2E1 play an important role in the severity and survival of patients with CVID. Objectives: to study the polymorphisms of PON1 and CYP2E1, as well as the arilesterase activity of PON1, and its relation with the lipid profile, clinical characteristics, morbidity and mortality in patients with CVID. Methods/Results: The allelic frequencies of the PON1 and CYP2E1 polymorphisms, the lipid profile and the arilesterase activity of PON1 in 101 patients with CVID and 16 patients with secondary hypogammaglobulinemia (HS) and 130 healthy controls were evaluated. The presence of clinical and laboratory parameters, morbidity and severity of the disease were analyzed in both groups of patients. There was a difference in the frequency of PON1-L55M genotypes between primary and secondary patients, being the 55L allele and the 55LM genotype more frequent in the HS group. The arilesterase activity of PON1 was lower in patients with CVID than in the control group, with patients of the 55MM genotype showing the lowest values. Patients with the 55MM genotype presented a more severe disease when compared to the other genotype groups, this difference is being caused not by a deleterious characteristic of this genotype, but by the protective role played by the 55L allele; patients with this allele had a lower prevalence of severe manifestations such as malignancies, hepatomegaly, sepsis and deaths, as well as a longer survival of those who had at least one copy of this allele. CONCLUSION: This is the first report showing a higher frequency of the 55LM genotype and the 55L allele in patients with secondary hypogammaglobulinemia and of lower arilesterase activity in patients with CVID with 55MM genotype. Our results suggest that the presence of the 55L allele may play a protective role in CVID. In addition, it was found that the presence of lymph node enlargement, hepatomegaly, splenomegaly, sepsis and portal hypertension may be predictive factors of both a more severe disease and a higher mortality rate
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Avaliação do impacto de mudanças técnicas introduzidas na operação de tromboendarterectomia pulmonar ao longo de 10 anos: estudo retrospectivo no InCor-HCFMUSP / Evaluation of the impact of technical changes introduced in the operation of pulmonary thromboendarterectomy over 10 years: retrospective study in InCor-HCFMUSPScudeller, Paula Gobi 03 May 2018 (has links)
INTRODUÇÃO: A hipertensão pulmonar tromboembólica crônica (HPTEC) é uma doença vascular pulmonar progressiva, cuja incidência varia de 0,56% a 3,2% em indivíduos com embolia pulmonar aguda (EPA) recorrente. Apesar do avanço nas opções de tratamento para HPTEC, a tromboendarterectomia pulmonar (TEAP) continua sendo padrão ouro, levando a melhora hemodinâmica e aumento da sobrevida. OBJETIVOS: Avaliar o impacto que mudanças técnicas intraoperatórias implementadas tiveram na evolução dos pacientes submetidos à TEAP em relação à morbimortalidade imediata e tardia, e também sobre o desenvolvimento do ato operatório. MÉTODOS: Estudo retrospectivo em portadores de HPTEC, submetidos à TEAP, no período de janeiro/2007 a maio/2016, divididos em 3 grupos, de acordo com intervenções implementadas. A 1ª intervenção consistiu em mudanças na circulação extracorpórea (CEC) e no tempo de parada circulatória total (PCT), e a 2ª intervenção incluiu alterações na CEC, técnicas anestésica e cirúrgica. A avaliação dos dados incluiu análise univariada para associações entre intervenções com variáveis de morbimortalidade e técnica operatória. O modelo de regressão multivariado foi aplicado para validar se as melhorias resultaram das intervenções implementadas. A análise de sobrevida foi feita por Kaplan-Meier. RESULTADOS: Foram avaliados 102 indivíduos, 62,8% mulheres, idade média de 49,1±14,8 anos, 65,7% estavam em classe funcional III-IV (NYHA). A avaliação hemodinâmica demonstrou hipertensão pulmonar importante, com valores médios elevados de pressão média na artéria pulmonar (PmAP; G1=52,9±14,45mmHg; G2=53,2±12,4mmHg; G3=53,3±12,5mmHg, p=0,992) e resistência vascular pulmonar (RVP; G1=828,4±295,13 dynas.s.cm-5; G2=838,9±428,4 dynas.s.cm-5; G3=969±417,3 dynas.s.cm-5, p=0,313). Os pacientes submetidos à TEAP mostraram aumento do tempo total de CEC entre os grupos (G1=192,3±39,4min; G2=251,7±33,4min; G3=298,2±40,2min, p < 0,001), como resultado da padronização dos tempos de esfriamento (G1=47,9±18,5min; G2=66,9±5,9min; G3=70,6±3,7min, p < 0,001), aquecimento (G1=66,8±17,7min; G2=87,2±8,1min; G3=107,7±23,5min, p < 0,001) e reperfusão (G1=25,5±7,6min; G2=20,7±8,4 min; G3=18,6±9,4min, p=0,007). A diminuição do número de operações com mais de 2 PCT (G1= 89%; G2= 60%; G3: 55%, p=0,002) foi decorrente do aumento da duração média de cada PCT (G1=15,5±2,9min; G2=17,8±1,7min; G3=19,2±2,0min, p < 0,001). Complicações pós-operatórias foram observadas em 88,5% dos pacientes, havendo redução significativa das complicações cirúrgicas (p=0,035), infecciosas (p=0,017) e neurológicas com sintomas permanentes (p=0,048) na comparação entre os 3 grupos. No seguimento após a alta, 85% estavam em classe funcional I-II (NYHA), sem melhora hemodinâmica significativa entre os grupos. Após a análise multivariada, o G3 apresentou 4,7 menos chances de complicação cirúrgica que G1 (p=0,034) e tempo de aquecimento menor que 83 minutos aumentou 4 vezes a chance de complicação infecciosa (p=0,002). A redução da mortalidade hospitalar e da sobrevida não foi significativa entre os grupos. CONCLUSÕES: Em relação à morbimortalidade imediata e tardia, o impacto das intervenções foi evidenciado pela redução das complicações neurológicas com sintomas permanentes, complicações cirúrgicas e infecciosas. Em relação ao ato operatório, o impacto foi evidenciado pelo aumento dos tempos totais de CEC, de esfriamento, de aquecimento, tempo médio das PCT, redução nos números de PCT e no tempo total de reperfusão / INTRODUCTION: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease which incidence varies from 0.56% to 3.2% in individuals with recurrent acute pulmonary embolism (APE). Despite advances in treatment options for CTEPH, pulmonary endarterectomy (PE) remains a gold standard, leading to hemodynamic improvement and increased survival. OBJECTIVES: Evaluate the impact of intraoperative technical changes on the evolution of patients submitted to PE related to immediate and late morbimortality, as well as on the development of the operative procedure. METHODS: Retrospective study of patients with CTEPH, submitted to PE, between January 2007 and May 2016, divided into 3 groups, according to the implemented interventions. The first intervention consisted of changes in cardiopulmonary bypass (CPB) and total circulatory arrest time (CAT), and the second intervention included changes in CPB, anaesthetic and surgical techniques. The data analysis included a univariate analysis for associations between interventions with morbidity variables and operative technique. The multivariate regression model was applied to validate whether the improvements resulted from the interventions implemented. Survival analysis was performed using Kaplan-Meier. RESULTS: We evaluated 102 individuals, 62.8% were women, mean age was 49.1 ± 14.8 years, and 65.7% were in functional class III-IV (NYHA). The hemodynamic evaluation showed significant pulmonary hypertension, with mean values of mean pulmonary artery pressure (mPAP, G1 = 52.9 ± 14.45 mmHg, G2 = 53.2 ± 12.4 mmHg, G3 = 53.3 ± 12.5 mmHg, p = 0.992) and pulmonary vascular resistance (PVR, G1 = 828.4 ± 295.13 dynas.s.cm-5, G2 = 838.9 ± 428.4 dynas.s.cm-5, G3 = 969 ± 417.3 dynas.s.cm-5, p = 0.313). The patients submitted to PE showed an increase in the total CPB time between the groups (G1 = 192.3 ± 39.4min, G2 = 251.7 ± 33.4min, G3 = 298.2 ± 40.2min, p < 0.001), as a result of the standardization of cooling times (G1 = 47.9 ± 18.5min, G2 = 66.9 ± 5.9min, G3 = 70.6 ± 3.7min, p < 0.001), heating (G1 = 66.8 ± 17.7min, G2 = 87.2 ± 8.1min, G3 = 107.7 ± 23.5min, p < 0.001) and reperfusion (G1 = 25.5 ± 7.6min, G2 = 20.7 ± 8.4 min, G3 = 18.6 ± 9.4min, p = 0.007). The decrease in the number of operations with more than 2 CAT (G1 = 89%, G2 = 60%, G3: 55%, p = 0.002) was due to the increase in the average duration of each CAT (G1 = 15.5 ± 2, 9min, G2 = 17.8 ± 1.7min, G3 = 19.2 ± 2.0min, p < 0.001). Postoperative complications were observed in 88.5% of the patients, with a significant reduction in surgical (p = 0.035), infectious (p = 0.017) and neurological complications with permanent symptoms (p = 0.048) in the comparison between the three groups. In the post-discharge follow-up, 85% were in functional class I-II (NYHA), with no significant hemodynamic improvement between groups. After the multivariate analysis, G3 presented 4.7 less chance of surgical complication than G1 (p = 0.034) and warming time less than 83 minutes increased 4 times the chance of infectious complication (p = 0.002). The reduction in hospital mortality and survival was not significant between the groups. CONCLUSIONS: Regarding immediate and late morbimortality, the impact of interventions was evidenced by the reduction of neurological complications with permanent symptoms, surgical and infectious complications. Regarding the operative event, the impact was evidenced by the increase in total CPB, cooling, heating, mean CAT time, CAT reduction and total reperfusion time
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"Varicela -Zóster em crianças de creches municipais de Taubaté" / Varicella-Zoster in children attended in day cares of TaubatéMarcitelli, Ricardo 21 July 2005 (has links)
Objetivos: Descrever a morbidade associada à varicela em crianças usuárias de creches Municipais de Taubaté e o conhecimento de seus familiares sobre a doença. Casuística e Métodos: Estudo de corte transversal, realizado através de inquérito com responsáveis por 664 crianças que contraíram varicela após admissão às creches. Os responsáveis pelas crianças foram entrevistados por um único examinador, que utilizou um formulário previamente testado. Os dados foram compilados em banco de dados e analisados utilizando o programa Epi-info versão 6.01. Resultados: A varicela acometeu crianças de seis meses a sete anos de idade (mediana = 36 meses) e 8,4% tiveram a doença antes de um ano. Os principais sintomas foram: exantema (100,0%), febre (85,4%), anorexia (39,6%) e cefaléia (15,3%) / Objective: To evaluate the morbidity associated to varicella in day cares centers of Taubaté and the parent's knowledge about the disease. Subjects and Methods: Cross-sectional study, including 664 children that had varicella after admission to the day care centers. Parents of children were interviewed by one of the participant of the study that filled in previously tested form. Data were compiled in database and analyzed in program Epi-info version 6.01. Results: Children had varicella at six months to seven years of age, (median = 36 months) and 8.4% of cases occurred in children under 12 months of age. The most frequent symptoms were: exantema (100.0%), fever (85.4%), anorexia (39.6%) and headache (15.3%). Five hundred and seventeen children (77.9%) were taken for medical visits, 80.6% were medicated, and 73 children (11.0%) were medicated with anti-inflammatory drugs and 52 children (7.8%) with antibiotics
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