Lábio leporino é a anomalia congênita mais comum da cabeça e pescoço. É o desenvolvimento incompleto do lábio e/ou do palato (céu da boca) visto que eles se desenvolvem separadamente, durante a oitava e a décima segunda semana. A classificação mais utilizada por profissionais é a de Spina baseada no forame incisivo do palato: Grupo I- fissuras pré-forame (lábio e lábio-gengival), Grupo II- fissuras transforame (labiopalatal), Grupo III fissuras pós- forame ( palatal ) e Grupo IV- fissuras raras da face (fissuras faciais). Esse tipo de anomalia ainda não tem as causas bem definidas, provavelmente ocorre por uma combinação de fatores ambientais e genéticos. O objetivo deste estudo foi capacitar os profissionais da saúde sobre a fissura labiopalatinas e suas implicações. Tratou-se de um estudo de revisão integrativa fissura labiopalatinas em busca ativa em banco de dados da scielo, BIREME, Pubmed, para elaboração de um curso de capacitação multiprofissional e um e-book com principais orientações sobre os cuidados ao paciente relacionadas a amamentação, distúrbios de fala, odontológicos, auditivos e as etapas de reabilitação propostas pelos diferentes centros de atendimento e como os pais lidam com esta nova situação.
Objective Data regarding the use and effect of hormonal contraceptives on bone mass acquisition during adolescence are contradictory. The present study was designed to evaluate bone metabolism in two groups of healthy adolescents using combined oral contraceptives (COC). Methods A total of 168 adolescents were recruited from 2014 to 2020 in a non-randomized clinical trial and divided into three groups. The COC1 group used 20 μg Ethinylestradiol (EE)/150 μg Desogestrel and the COC2 group used 30 μg EE/3 mg Drospirenone over a period of two years. These groups were compared to a control group of adolescent non-COC users. The adolescents were submitted to bone densitometry by dual-energy X-ray absorptiometry and measurement of bone biomarkers, bone alkaline phosphatase (BAP), and osteocalcin (OC) at baseline and 24 months after inclusion in the study. The three groups studied were compared at the different time points by ANOVA, followed by Bonferroni’s multiple comparison test. Results Incorporation of bone mass was greater in non-users at all sites analyzed (4.85 g in lumbar Bone mineral content (BMC)) when compared to adolescents of the COC1 and COC2 groups, with a respective increase of 2.15 g and loss of 0.43g in lumbar BMC (P = 0.001). When comparing subtotal BMC, the control increased 100.83 g, COC 1 increased 21.46 g, and COC 2 presented a reduction of 1.47 g (P = 0.005). The values of bone markers after 24 months are similar for BAP, being 30.51 U/L (± 11.6) for the control group, 34.95 U/L (± 10.8) for COC1, and 30.29 U/L for COC 2 (± 11.5) (P = 0.377). However, when we analyzed OC, we observed for control, COC 1, and COC 2 groups, respectively, 13.59 ng/mL (± 7.3), 6.44 ng/mL (± 4.6), and 9.48 ng/mL (± 5.9), with P = 0.003. Despite loss to follow-up occurring in the three groups, there were no significant differences between the variables in adolescents at baseline who remained in the study during the 24-month follow-up and those who were excluded or lost to follow-up. Conclusion Bone mass acquisition was compromised in healthy adolescents using combined hormonal contraceptives when compared to controls. This negative impact seems to be more pronounced in the group that used contraceptives containing 30 μg EE. Clinical trial registration http://www.ensaiosclinicos.gov.br, RBR-5h9b3c. “Low-dose combined oral contraceptive use is associated with lower bone mass in adolescents”.
Introduction: Most contraceptive combinations can interfere with the processes of bone formation and resorption. Aim: The aim of this study was to evaluate the effect of 2 combinations of low-dose oral hormonal contraceptives (20 µg ethinyl estradiol [EE]/150 mg desogestrel [COC1] or 30 µg EE/3 mg drospirenone [COC2]) on bone mass acquisition in adolescents over 2 years by means of bone densitometry and measurement of biomarkers of bone remodeling. Methods: Parallel-group, non-randomized controlled clinical trial of 127 adolescents divided into a control group and 2 groups receiving either COC1 or COC2. The participants were submitted to anthropometric assessment and evaluation of secondary sexual characteristics (Tanner criteria) and bone age. Bone densitometry by dual-energy X-ray absorptiometry and measurement of bone biomarkers (bone alkaline phosphatase, osteocalcin, and C-terminal telopeptide) were performed at baseline and after 24 months. Results: No significant differences in the variables analyzed were observed between COC1 or COC2 users and the control group at baseline. After 24 months, non-users had incorporated more bone mass (content and density) than either group of contraceptive users. This negative impact was more pronounced in the COC2 group than in the COC1 group. A significant reduction in the percentage values of bone alkaline phosphatase and osteocalcin was observed in users of oral contraceptives. Conclusion: Bone mass acquisition was compromised in adolescent users of combined hormonal contraceptives. The negative impact was more pronounced in adolescents using contraceptives that contain 30 µg EE/3 mg drospirenone.
Prenatal care reduces many of the negative effects of pregnancy, such as prematurity, low birth weight and detection of abnormalities with the mother and child, serving as a learning moment for the woman and her family. However, the Covid-19 scenario brought an adaptation in this monitoring, bringing a more suitable prenatal care for the moment with fewer face-toface visits. This work was a cross-sectional retrospective study with a quantitative approach, with the purpose of evaluating the behavior of pregnant women in the face of the impact of the COVID19 pandemic on adherence to prenatal consultations, in the period 2019-2020 through a search carried out in the secondary database available on the Department of Informatics of the Unified Health System (DATASUS). The databases included in this study were obtained from the DATASUS electronic portal, TABNET table of all monthly prenatal consultations in the 2019-2020 period of the Regional Health Care Networks (RRAS 10). It is important to highlight the work of health professionals who are directly involved in facing this pandemic as they had to deal with the risk group, their fears and insecurities in the context of COVID19. It is concluded that there was no significant impact on the number of prenatal consultations in the central west region of são paulo (SP) during the pandemic period, and it may have been favored by the high HDI (0.05) of the region as well as the efficiency of the strategies adopted by the Health units facing the challenge.
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