O objetivo do presente trabalho foi identificar por meio de uma revisão sistemática a influência do sobrepeso e da obesidade gestacional sobre o desenvolvimento de complicações maternas e neonatais, bem como, demonstrar as principais complicações apresentadas pelas gestantes com sobrepeso ou obesas. A revisão foi conduzida de acordo com critérios presentes no PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Para manejo dos artigos, foi utilizado o Mendeley Desktop como software de gestão de referência dos artigos que abordavam ensaios clínicos não randomizados ou randomizados controlados, estudos de coorte, caso controle, transversal e observacional; estudos com seres humanos, gestantes com sobrepeso e obesidade, e que abordassem as complicações maternas e neonatais. Foram considerados artigos em inglês e português publicados no período entre 2000 e 2020. Foram selecionados 98 artigos, destes 31 artigos demonstravam os impactos do sobrepeso e/ou obesidade sobre o desenvolvimento de diabetes mellitus gestacional, 48 relataram a associação entre sobrepeso e/ou obesidade com a hipertensão gestacional e pré-eclâmpsia, 3 associaram com tromboembolismo venoso e 45 com a indução de trabalho de parto e cesarianas. Ainda, 26 artigos associaram o sobrepeso e/ou obesidade com a prematuridade e 49 com a macrossomia. Assim, pode-se observar que a obesidade associada ao período gestacional aumenta significativamente o risco de complicações para a gestante e para o recém-nascido, podendo comprometer a vida destes a longo prazo.
BACKGROUNDChikungunya is a viral illness caused by chikungunya virus (CHIKV) and has become a relevant public health problem, as half of the cases tend to evolve into chronic, persistent and disabling arthritis. The signs and symptoms are clinically similar to those of dengue, such as sudden onset high fever, headache and skin rashes. The main clinical manifestation that differentiates them is the severe bilateral joint pain that occurs in chikungunya, with or without edema and may persist for months to years. It should be noted that the data in the literature regarding therapeutic treatment in the various stages of arthropathy caused by CHIKV are limited, but biological therapy has shown promise in cases in which joint inflammatory activity is maintained even after the use of corticosteroids, hydroxychloroquine and methotrexate. CASE REPORTMale patient, 63 years old, reported inflammatory arthralgia and morning stiffness in wrists, ankles and fourth and fifth interphalangeal joints bilaterally, thirty days after presenting fever with myalgia and diffuse rash, with positive serology for chikungunya. After the diagnosis of arthritis secondary to chikungunya, therapy with hydroxychloroquine 400 mg/day and corticosteroid therapy with prednisone were established. After 2 months, the patient returned with worsening of the arthralgic condition after initial improvement and opted for replacing hydroxychloroquine by methotrexate 15 mg/week. Reassessed after 60 days, the patient presented a slight improvement of the condition and remained with high inflammatory tests, thus opting to increase the dose of methotrexate to 20 mg/week and maintenance of prednisone. After reassessment and finding that the previous pain persisted, biological therapy with adalimumab 40 mg 14/14 days was associated with treatment, resulting in complete improvement of the joint condition and decrease in inflammatory tests after 2 months of treatment.
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