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Objective: To identify the main recommendations found in systematic reviews regarding exclusive breastfeeding protective factors.Data source: Integrative review based on the guiding question: What evidence is found in literature regarding the protective factors of exclusive breastfeeding during the intrahospital period? A search was conducted in the Cochrane Library, PubMed/MEDLINE and LILACS database using the keyword “Breast Feeding” and the word “Breastfeeding”. Systematic reviews published from 2007 to 2016 that answered the guiding question were included in the study, whereas systematic reviews that analyzed breastfeeding of preterm infants and breastfeeding of children with orofacial malformation were excluded. The sample included eight systematic reviews. Data synthesis: The recommendations related to the protective factors for exclusive in-hospital breastfeeding found in the systematic reviews were: early skin-to-skin contact, rooming-in care, intervention for treating painful nipples during breastfeeding, restriction of infant supplementation, baby-led breastfeeding and educational interventions and support for mothers during hospital stay. The proposed measures included the six practices presented as protective factors. Conclusions: The review enabled the identification of evidence to support the recommended measures from delivery room to hospital discharge, with the aim of encouraging breastfeeding and preventing intrahospital weaning,

OBJETIVO: Determinar a prevalência das deformidades congênitas da parede torácica anterior em escolares de 11 a 14 anos. MÉTODOS: Participaram do estudo escolares da rede estadual de ensino da cidade de Manaus (AM). Para a composição de uma amostra estatisticamente significativa, com precisão de 1% e IC95%, foram incluídos 1.332 escolares. A deformidade pectus foi identificada através de exame físico do tórax, e os indivíduos com esta deformidade responderam a um questionário com questões sobre hereditariedade e sintomatologia decorrente da anomalia torácica. RESULTADOS: A idade média dos participantes foi de 11,7 anos. A prevalência da deformidade pectus foi de 1,95% (pectus excavatum: 1,275%; pectus carinatum: 0,675%). Dos 26 escolares com deformidades pectus, 17 (65,4%) tinham pectus excavatum, e 18 (69,2%) eram do sexo masculino. Houve associação com a escoliose em 3 casos (11,5%). História familiar de pectus foi relatada por 17 escolares (65,4%), e 17 (65,4%) relataram dor torácica, dispneia ou palpitações. CONCLUSÕES: A prevalência das deformidades pectus encontrada neste estudo (1,95%) foi inferior àquela de trabalhos em outras regiões do país (3,6-4,9%), porém, superior àquela relatada na literatura (média, 1%).

Objective: To analyze the characteristics of patients with lung cancer. Methods: A retrospective descriptive study of patients receiving a histopathological diagnosis of lung cancer between 1995 and 2002 in the city of Manaus, Brazil. Data were collected from the medical archives of three hospitals. Statistical analyses were carried out, and survival curves were generated by means of an actuarial estimator. Results: Of the 352 patients selected, 262 (74.4%) were male and 90 (25.6%) were female. The mean age was 62 years. The following histological types were identified: squamous cell carcinoma, 62.8%; adenocarcinoma, 24.7%; small cell carcinoma, 9.1%; and large cell carcinoma, 3.4%. The most common stages were stages IIIB and IV, in 45% and 21.5%, respectively. Of the total sample, 73.4% were submitted to treatment. Of these, 51.4% underwent radiotherapy; 16.6%, surgery; 15.8%, chemotherapy; and 16.2%, radiotherapy in association with chemotherapy. Cumulative survival rates were low: three-year survival was 6.5%, and five-year survival was 3.5%. Conclusions: In this group of patients with lung cancer, survival rates were considerably lower than those reported in the literature. This might be attributable to the limited access to the specialized health care system and the advanced stage of the disease at diagnosis.Keywords: Lung neoplasms; Neoplasm staging; Survival. ResumoObjetivo: Analisar as características de pacientes com câncer de pulmão. Métodos: Estudo retrospectivo e descritivo dos pacientes com diagnóstico histopatológico de câncer de pulmão entre 1995 e 2002 em Manaus (AM). Os dados dos pacientes foram coletados nos arquivos médicos de três hospitais. As análises estatísticas foram realizadas, e as curvas de sobrevida geradas a partir do estimador atuarial. Resultados: Dos 352 pacientes selecionados, 262 (74,4%) eram do sexo masculino e 90 (25,6%) do feminino. A média de idade foi de 62 anos. Os seguintes tipos histológicos foram encontrados: carcinoma de células escamosas, 62,8%; adenocarcinoma, 24,7%; carcinoma de pequenas células, 9,1%; e carcinoma de grandes células, 3,4%. Os estádios IIIB e IV foram os mais comuns, com uma frequência de 45% e 21,5%, respectivamente. Da amostra total, 73,4% foram submetidos a tratamento. Desses, 51,4% foram submetidos à radioterapia; 16,6%, à cirurgia; 15,8%, à quimioterapia; e 16,2%, à radioterapia associada à quimioterapia. Os níveis de sobrevida acumulada foram baixos: a sobrevida em três anos foi de 6,5% e a sobrevida em cinco anos foi de 3,5%. Conclusões: Este grupo de pacientes com câncer de pulmão apresentou uma sobrevida muito pequena, divergindo dos resultados encontrados na literatura. Isto é provavelmente decorrente da dificuldade de acesso ao sistema de saúde especializado e do estágio avançado do diagnóstico.Descritores: Neoplasias pulmonares; Estadiamento de neoplasias; Sobrevivência.* Study carried out at the Federal University of Amazonas, Manaus, Brazil.

Methods Methods Methods Methods: We performed a retrospective study through analyzed records in the two main reference hospitals for trauma adults in this city during a period of 5 years. We considered for this study the epidemiological data, causal agent, type of incision, anatomical classification score of trauma, prognostic factors and mortality. Results Results ResultsResults Results: We analyzed 124 patients who underwent thoracotomy with a mean age of 28 years. Stab wounds were the most common casual agent (68%). The main indication for thoracotomy was massive hemothorax with 50.7% of cases, followed by cardiogenic or hypovolemic shock with 48.4%. There were 28 deaths (20.6%). Patients with vena cava injuries (5 patients) and aorta lesions (2 patients) had 100% mortality rate. There was a higher mortality in patients with major index of trauma (p = 0004), and largest quantity of blood transfused (p = 0090). Conclusion Conclusion Conclusion Conclusion Conclusion: Thoracic trauma patients submitted to exploratory thoracotomy were young, males and victims of stab wound trauma. The most contributing death factors were the lethal anatomical score, more than 15 points, and the association with major vascular lesions, as the aorta and vena cava.

Pulmonary sequestration is defined as a mass of lung tissue separated from the tracheobronchial tree and irrigated by an anomalous systemic artery. It is rarely seen in conjunction with lung neoplasms. We report the case of a 39-year-old female patient diagnosed with a carcinoid tumor, located in the intermediate bronchus and accompanied by bronchiectasis in the right lower lobe. The patient underwent thoracotomy for the resection of the affected area. During surgery, she presented with significant hemorrhage resulting from the transection of the anomalous artery that irrigated an intralobar pulmonary sequestration, which was located in right lower lobe and had not been identified in pre-operative examinations.Keywords: Bronchopulmonary sequestration; Hemorrhage; Carcinoid tumor. ResumoO sequestro pulmonar é definido como uma massa de tecido pulmonar separada da árvore traqueobrônquica e irrigada por uma artéria sistêmica anômala. Sua associação com neoplasias pulmonares é rara. Relatamos o caso de uma paciente de 39 anos com o diagnóstico de tumor carcinoide localizado no brônquio intermediário, associado a alterações caracterizadas como bronquiectasias em lobo inferior direito. A paciente foi submetida à toracotomia para ressecção da área acometida e, durante a cirurgia, apresentou hemorragia importante decorrente da transecção da artéria anômala que nutria o sequestro pulmonar intralobar localizado em lobo inferior direito, não identificado nos exames pré-operatórios. Depending on its pleural covering, PS is classically divided into intralobar and extralobar. An intralobar PS (ILPS) share the pleural covering with the rest of the lung, whereas an extralobar PS (ELPS) is completely covered by its own visceral pleura. Descritores(5) Although the extralobar form is well defined as a congenital abnormality, the intralobar form has a controversial pathogenesis, with some evidence indicating that, in many cases, it is an acquired disease. (6,7) Accounting for approximately 75% of all cases of PS, ILPS is more common in the lower lobes and on the left, involving the posterior basal segment. (5,8) Its arterial supply is nearly always derived from the aorta or from one of its branches, typically one of a large diameter. Venous drainage is via the pulmonary veins into the left atrium, creating a left-to-left shunt. In a minority of cases, drainage is via the inferior vena cava or via the azygos system. (9) In the case presented here, the PS was located in the right lower lobe and the blood supply came from an anomalous branch derived from the thoracic aorta.Cases of ILPS typically occur in adolescents and young adults with a history of recurrent infections of the respiratory tract, hemoptysis, and dyspnea. Some ILPS patients develop cardiac symptoms, which are a consequence of the lefthemoptysis. In the preoperative investigation, a CT scan of the chest revealed a lesion in the intermediate bronchus (Figure 1), as well as cystic bronchiectasis in the right lower lobe (Figure 2). Fiberoptic bronchoscopy confirme...

Confl itos de interesse: Apesar de ser um editor associado à Acta Paulista de Enfermagem, Francisco AA não esteve envolvido na avaliação do manuscrito ResumoObjetivo: Analisar os efeitos do banho quente, de exercícios perineais com bola suíça ou de ambos durante o trabalho de parto em parâmetros maternos e perinatais.Métodos: Ensaio clínico randomizado controlado incluindo 101 gestantes de baixo risco admitidas em dois centros obstétricos entre junho de 2013 e fevereiro de 2014 com idade mínima de 18 anos, gestação a termo, feto único em apresentação cefálica, dilatação cervical entre 3 e 8 cm, escala de dor ≥5, sem patologias clínicas ou obstétricas ou doença mental, não usuárias de drogas psicoativas ou de corticosteroides naturais ou sintéticos, e que não fi zeram uso de produtos de tabaco, cafeína e analgésicos duas, quatro e seis horas antes de serem incluídas no estudo. Os arâmetros maternos e perinatais foram avaliados antes e 30 minutos após as intervenções, incluindo: pressão arterial materna, frequência cardíaca e respiratória, contratilidade uterina, dilatação cervical, frequência cardíaca fetal, linha de base, variabilidade, acelerações e desacelerações usando cardiotocografi a e escala de Apgar (no 1º e 5º minutos após o nascimento). Os participantes foram alocados aleatoriamente em três grupos: A) banho quente (33); B) bola suíça ( 35); e C) intervenções combinadas (33).

Objective: to create a multidisciplinary conducts manual for tracheostomies in adult and pediatric patients in the Amazonas State Oncology Control Center Foundation. Methods: we developed a protocol using the modified Delphi method, which consisted in the application of two series of questionnaires to 20 professionals of the unit. Results: thirteen professionals completed the two steps. In the first stage, there was consensus in 53 out of 92 questions (57.6%). The questions that obtained consensus formed the text of the second stage, divided into eight chapters and evaluated by marking the answers offered on a Linkert scale. All the chapters presented in the second stage obtained consensus, meaning that the sum of the answers "agree" and "fully agree" were above 70%. Conclusion: using the data obtained in the consensus, we elaborated a tracheostomy conduct protocol and a care guidelines manual for the patients and their caregivers.Keywords: Clinical Protocols. Tracheostomy. Medical Oncology. Hospitals. University. Head and Neck Surgery Service, Manaus, AM, A B S T R A C T -Amazonas Oncology Control Center Foundation (FCECON),