Browsing by Author "Moreira, M"
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- Determinantes da colonização materna e da infecção neonatal por Streptococcus do grupo BPublication . Areal, A; Moreira, M; Nunes, S; Faustino, MA; Cardoso, L; Sá, CAim and Objective: During the past three decades, group B Streptococcus (GBS) neonatal infection has been the subject of little research. The aim of this study was to evaluate the association between maternal risk factors, as established by the Center for Disease Control and Prevention (CDC), and maternal colonization. We also analysed the association between risk factors present in newborns and early-onset GBS disease. Study design: Cross-sectional study. Population: All pregnant women admitted for delivery in our institution and their newborns, between 1st February and 31st July 2005. Methods: Maternal and neonatal characteristics were collected from hospital clinical data, including information on risk factors established by the CDC. Descriptive statistics was used to characterize the study sample. Qui-square and Mantel-haenszel tests were applied to compare proportions and to measure the strength of associations, respectively, setting significance at p < 0,05. Results: In this sample only 47% of women were screened for GBS colonization in suitable time and 34,9% of these women were colonized. The incidence of early neonatal infection by SGB was 9/1000 neonates. Significant associations between GBS maternal colonization ant the following parameters were observed: maternal age [p=0,012; OR=1,659 (IC a 95%, 1,218-2,260)], gestational age at labour [p=0,001; OR= 2,621 (IC a 95%, 1,641- 4,188)], and urinary GBS infection during pregnancy (p<0,001). Maternal colonization occurred in women without CDC defined risk factors. Early neonatal infection by SGB was strongly associated with unscreened women (p=0,014). Conclusion: In this study, maternal GBS colonization occurred in the absence of CDC defined risk factors and varied according to maternal age and gestational week. Neonatal GBS infection was more frequent in unscreened women.
- Factors Influencing Performance of Cholangioscopy-Guided Lithotripsy Including Available Different Technologies: A Prospective Multicenter Study with 94 PatientsPublication . Alexandrino, G; Lopes, L; Fernandes, J; Moreira, M; Araújo, T; Campos, S; Loureiro, R; Figueiredo, L; Lourenço, LC; Horta, D; Bana e Costa, T; Costa, P; Canena, JBackground: Peroral cholangioscopy (POC)-guided lithotripsy is an effective treatment for difficult biliary stones. A clear definition of factors associated with the efficacy of POC-guided lithotripsy in one session and the performance of electrohydraulic lithotripsy (EHL) and laser lithotripsy (LL) have not clearly emerged. Methods: This was a non-randomized prospective multicenter study of all consecutive patients who underwent POC lithotripsy (using EHL and/or LL) for difficult biliary stones. The primary endpoint of the study was the number of sessions needed to achieve complete ductal clearance and the factors associated with this outcome. Secondary endpoints included the evaluated efficacies of LL and EHL. Results: Ninety-four patients underwent 113 procedures of EHL or LL. Complete ductal clearance was obtained in 93/94 patients (98.94%). In total, 80/94 patients (85.11%) achieved stone clearance in a single session. In the multivariate analysis, stone size was independently associated with the need for multiple sessions to achieve complete ductal clearance (odds ratio = 1.146, 95% confidence interval: 1.055-1.244; p = 0.001). Using ROC curves and the Youden index, 22 mm was found to be the optimal cutoff for stone size (95% confidence interval: 15.71-28.28; p < 0.001). The majority of the patients (62.8%) underwent LL in the first session. Six patients failed the first session with EHL after using two probes and therefore were crossed over to LL, obtaining ductal clearance in a single additional session with a single LL fiber. EHL was significantly associated with a larger number of probes (2.0 vs. 1.02) to achieve ductal clearance (p < 0.01). The mean procedural time was significantly longer for EHL than for LL [72.1 (SD 16.3 min) versus 51.1 (SD 10.5 min)] (p < 0.01). Conclusions: POC is highly effective for difficult biliary stones. Most patients achieved complete ductal clearance in one session, which was significantly more likely for stones < 22 mm. EHL was significantly associated with the need for more probes and a longer procedural time to achieve ductal clearance.
- A infecção peri-natal por Streptococcus agalactiae pode ser evitada: prevalência da colonização em parturientes no Hospital de S. Marcos, factores de risco e sua relação com a infecção peri-natalPublication . Areal, A; Nunes, S; Moreira, M; Faustino, MA; Cardoso, L; Sá, Cntrodução: O Streptococcus agalactiae (SGB) é o agente mais frequente de infecção neonatal precoce, sendo possível a sua prevenção. Em Portugal é desconhecida a prevalência de mulheres colonizadas por SGB. O estudo da Unidade de Vigilância Pediátrica refere uma prevalência nacional de infecção neonatal por SGB de 0,5:1000 nados-vivos. Objectivo: Determinar a prevalência da colonização materna e da infecção perinatal por SGB no Hospital de S. Marcos, Braga (HSM), de modo a avaliar a importância da implementação do rastreio universal e o uso de medidas profiláticas. Método: De 1 de fevereiro a 31 de julho de 2005 foi realizado um estudo transversal com análise de coortes anichada, avaliando todas as grávidas assistidas para trabalho de parto no HSM e respectivos recém-nascidos. Os dados foram submetidos a análise estatística bi-variada pelo teste do qui-quadrado, com um nível de significância de 5% (p<0,05). Resultados: A prevalência da colonização nas grávidas rastreadas na região de Braga foi de 34,9 % [intervalo de confiança a 95% (IC95%), 31,5-38,3%]. No HSM o diagnóstico de infecção neonatal precoce por SGB ocorreu em 9:1000 recém-nascidos. O risco relativo de ocorrência de infecção perinatal entre os recém-nascidos dos grupos de mães rastreadas e não rastreadas foi de 0,3 [IC95% 0,2,7-0,32]. Conclusão: O rastreio bacteriológico positivo para colonização materna por SGB associado à adequada profilaxia intra-parto reduziu significativamente a infecção neonatal precoce, em relação ao grupo de gestantes não rastreadas (p=0,014). Consideramos que é recomendável a instituição do rastreio universal das grávidas e a profilaxia adequada quando indicada.