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Este trabalho tem por objetivo analisar a situação epidemiológica da doença meningocócica (DM) no estado do Paraná. Foi realizado um estudo retrospectivo dos casos confirmados de DM disponibilizados no DATASUS, no estado do Paraná, no período de 2010 até 2019. As variáveis analisadas foram macrorregião/município de residência, sexo, raça e faixa etária do paciente, forma clínica e evolução, sorogrupo do agente etiológico e critérios para o diagnóstico. Foram consideradas diferenças estatisticamente significativas quando p

COVID-19 pandemic has deeply affected medical practice, and conducts o minimize the overload of healthcare services were necessary. The objective of this study is to evaluate the impact of the pandemic in the practice of surgical procedures in Brazil. This is a descriptive study with data about hospitalizations for surgical procedures in Brazil from 2016 to 2020, collected from the Department of Informatics of Brazil’s Unified Health System (DATASUS). Primary analysis describes the variations in the number of elective, urgent and other types of surgical procedures performed during this period, by comparing the mean number of hospitalizations from 2016 to 2019 with the absolute number from 2020. Secondary analysis describe the variations in hospitalizations for surgical procedures during this period in each of Brazil’s geographical regions, and variations in different surgical procedure subgroups. There was a decrease of 14.88% [95% CI: 14,82-14,93] in hospitalizations for surgical procedures in 2020, when comparing to the mean between 2016-2019. Decrease rates were 34.82% [95% CI: 34,73-34,90] for elective procedures and 1.11% [95% CI: 1.07-1.13] for urgent procedures. Surgical procedure subgroups with highest decrease rates were endocrine gland surgery, breast surgery, oral-maxillofacial surgery and surgery of upper airways, face, head and neck. The overload of healthcare facilities demanded reductions in non-urgent activities to prevent services’ collapse. Further studies are needed to evaluate the social and clinical impact of such reductions and support the development of precise criteria defining which procedures should be prioritized.

Limited abdominal space in congenital diaphragmatic hernia (CDH) might result in abdominal compartment syndrome (ACS) and require delayed abdominal closure (DAC). This study reviewed outcomes in pediatric ACS/DAC after CDH repair. Medline/PubMed, Scopus, Web of Science, Ovid and Lilacs databases were reviewed. Data from studies published in English/Spanish/Portuguese between 1990–2020 was collected. Results are presented as descriptive statistics. Sixteen reports offered 118 children, 112 (94.9%) being neonates. There were six ACS (5.1%) and 112 DAC (94.9%). Regarding ACS, the diagnosis was made clinically (n = 4; 66.7%), using Doppler scans (n = 1; 16.7%) or bladder pressure measurement (n = 1; 16.7%). There was one (16.7%) lethal outcome. The rationale to perform DAC was not clearly stated, and measurement of abdominal pressure was not mentioned in all reports. Silo was the preferred approach in 36 children (32.1%), followed by skin closure only (n = 16; 14.3%), vacuum (n = 10; 8.9%), fascia patch and skin closure (n = 5; 4.5%), fascia patch and vacuum dressing (n = 1; 0.9%), fasciotomy (n = 1; 0.9%); with no DAC technique reported in 43 patients (38.4%). Complications after DAC were reported in nine children (8.1%). One DAC using vacuum dressing that was clinically diagnosed with ACS required silo placement. There were 19 (17%) lethal outcomes. ACS/DAC after CDH repair are reported more frequently in neonates (112/118; 94.9%). There is no clear rationale stated behind the decision to perform DAC, with the silo being the preferred approach. Criteria need to be worked for DAC in CDH with large herniated content and small volume abdomen to prevent ACS.

Introduction Given the propensity of severe acute respiratory syndrome coronavirus 2 to spread, it is imperative that those continuing to perform surgery take precautions to limit the potential generation of contaminated aerosols in smoke from energy-based instruments. The aim of this study was to report current data regarding insufflators with desufflation mode and similar options to safely remove CO2 in minimal access surgery. Methods A non-systematic review of the scientific literature was conducted using the PubMed database, and the main companies that provide surgical devices were contacted for information. Results Most commercially available smoke evacuators use a combination of suction and mechanical filtering. There are also electrostatic precipitators that charge surgical smoke and retain the particles via electrostatic attraction. The search identified three insufflators with desufflation mode, four modular smoke evacuators using mechanical filtration, and only one device using electrostatic precipitation. However, none of these devices has been tested with viruses. Conclusion This review identified commercially available equipment that employs mechanical filtering and electrostatic attraction principles that can be used for pneumoperitoneum evacuation during the present coronavirus disease 2019 pandemic. This pandemic should assist in raising awareness regarding protection measures and the risk of occupational exposure in surgery.

This study reviewed outcomes on laparoscopic management of hiatus hernia (HH) in the pediatric age group. MEDLINE/PubMed was reviewed. Studies in patients ≤ 17 years and published in English/Portuguese/Spanish were included, and selected by two reviewers. Data was collected for previous surgery, neurological impairment, type of HH, associated fundoplication, surgical technique, conversions, recurrence, follow-up and mortality. Results are presented as percentages and means. Fisher’s Exact Test was used to evaluate categorical variables, and statistical difference was considered when p ≤ 0.05. Ten articles with n = 171 met the inclusion criteria. Mean age were 66.1 months (range newborn—17 years) with male predominance (n = 110, 64.3%). Neurological impairment was reported in 10/35 children, but the information was not available for the majority of cases (n = 136; 79.5%). Type-I HH was reported in 15 children, type-II in seven, type-III in eight, and it was not specified in n = 141 (82.5%). Surgical correction was associated with fundoplication in n = 170 (99.4%; n = 99 Nissen, n = 68 Thal, n = 3 not specified). Patch was not used in the majority of cases (n = 167, 97.7%). There were seven conversions (4.1%), five recurrences (2.9%) and no mortality. Complications were reported in n = 27 (15.8%), esophageal stenosis being the most common (n = 24; only five required treatment). Mean follow-up was 19.7 months (range 1–138 months). Pediatric reporting on laparoscopic HH management is scarce, and important information is frequently omitted (e.g., neurological impairment, type of HH). The preferred approach is associated with Nissen/Thal fundoplication without patch. Recurrence occurred in less than 3% of the cases, and complications are minor, without mortality.

Background: Patients with congenital diaphragmatic hernia (CDH) have a short postnatal period of ventilatory stability called the honeymoon period, after which changes in pulmonary vascular reactivity result in pulmonary hypertension. However, the mechanisms involved are still unknown. The aim of this study was to evaluate mechanical ventilation's effect in the honeymoon period on VEGF, VEGFR-1/2 and eNOS expression on experimental CDH in rats.Materials and Methods: Neonates whose mothers were not exposed to nitrofen formed the control groups (C) and neonates with left-sided defects formed the CDH groups (CDH). Both were subdivided into non-ventilated and ventilated for 30, 60, and 90 min (n = 7 each). The left lungs (n = 4) were evaluated by immunohistochemistry of the pulmonary vasculature (media wall thickness), VEGF, VEGFR-1/2 and eNOS. Western blotting (n = 3) was performed to quantify the expression of VEGF, VEGFR-1/2 and eNOS.Results: CDH had lower biometric parameters than C. Regarding the pulmonary vasculature, C showed a reduction in media wall thickness with ventilation, while CDH presented reduction with 30 min and an increase with the progression of the ventilatory time (honeymoon period). CDH and C groups showed different patterns of VEGF, VEGFR-1/2 and eNOS expressions. The receptors and eNOS findings were significant by immunohistochemistry but not by western blotting, while VEGF was significant by western blotting but not by immunohistochemistry.Conclusion: VEGF, its receptors and eNOS were altered in CDH after mechanical ventilation. These results suggest that the VEGF-NO pathway plays an important role in the honeymoon period of experimental CDH.

Superior mesenteric artery syndrome (SMAS) refers to the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery, and usually results from weight loss or alteration in spine anatomy. This study reviewed laparoscopic options regarding SMA S in children. MEDLINE/PubMed was reviewed. Studies in patients under 16 years of age and published in English/Spanish were included, and selected by two independent reviewers. Data were collected for age, gender, weight/body mass index, comorbidities, symptoms, surgical technique, complications, conversions, recurrence and mortality. Descriptive statistics were used to analyze the quantitative portion of the study, with results presented as percentages, means and medians. Twelve papers with n = 16 patients were included. Mean/median age were 10.7 and 13 years, respectively, with female predominance (n = 11, 68.75%). Emesis (n = 15, 93.75%) and abdominal pain (n = 11, 68.75%) were the most common symptoms. Anorexia nervosa was present in n = 1, and n = 1 patient had recent history of spinal fusion for idiopathic scoliosis. Regarding surgical technique, eleven cases consisted of duodenojejunostomy with side-to-side anastomosis (one associated with feeding jejunostomy); two Strong’s procedures; and three Ladd’s procedures. There were no conversions, and n = 2 (12.5%) minor complications (self-limited upper gastrointestinal bleed and persistence of vomiting for 48 h post-operatory). There was no mortality. Mean and median follow-up were 44.5 and 48 weeks, respectively, with no recurrences. SMAS is uncommon in children. The preferred laparoscopic approach is duodenojejunostomy, which can provide definitive relief of the obstruction with minor complications and low recurrence.

Biliary cirrhosis is associated with hepatopulmonary syndrome (HPS), which is related to increased posttransplant morbidity and mortality. This study aims to analyze the pathophysiology of biliary cirrhosis and the onset of HPS. Twenty-one-day-old Wistar rats were subjected to common bile duct ligation and were allocated to two groups: group A (killed 2, 3, 4, 5, or 6 weeks after biliary obstruction) and group B (subjected to biliodigestive anastomosis 2, 3, 4, 5, or 6 weeks after the first procedure and killed 3 weeks later). At the killing, arterial blood was collected for the analyses, and samples from the liver and lungs were collected for histologic and molecular analyses. The gasometric parameters as well as the expression levels of ET-1, eNOS, and NOS genes in the lung tissue were evaluated. From a total of 42 blood samples, 15 showed hypoxemia (pO2 18 mmHg]. The liver histology revealed increased ductular proliferation after common bile duct ligation, and reconstruction of bile flow promoted decreased ductular proliferation 5 and 6 weeks post-common bile duct ligation. Pulmonary alterations consisted of decreased parenchymal airspace and increased medial wall thickness. Biliary desobstruction promoted transitory improvements 5 weeks after biliary obstruction (increased parenchymal airspace and decreased MWT—p = 0.003 and p = 0.004, respectively) as well as increased endothelin expression levels (p = 0.009). The present model showed lung tissue alterations promoted by biliary obstruction. The biliodigestive anastomosis had no clear direct effects on these alterations.

Gastric volvulus (GV) in children is a rare condition. This study reviewed management and outcomes of GV in the pediatric population. MEDLINE/PubMed, Embase, and Google Scholar databases were searched for studies in English regarding GV in patients

Fetal lung underdevelopment, also known as pulmonary hypoplasia, is characterized by decreased lung growth and maturation. The most common birth defect found in babies with pulmonary hypoplasia is congenital diaphragmatic hernia (CDH). Despite research and clinical advances, babies with CDH still have high morbidity and mortality rates, which are directly related to the severity of lung underdevelopment. To date, there is no effective treatment that promotes fetal lung growth and maturation. Here, we describe a stem cell-based approach in rodents that enhances fetal lung development via the administration of extracellular vesicles (EVs) derived from amniotic fluid stem cells (AFSCs). Using fetal rodent models of pulmonary hypoplasia (primary epithelial cells, organoids, explants, and in vivo), we demonstrated that AFSC-EV administration promoted branching morphogenesis and alveolarization, rescued tissue homeostasis, and stimulated epithelial cell and fibroblast differentiation. We confirmed this regenerative ability in in vitro models of lung injury using human material, where human AFSC-EVs obtained following good manufacturing practices restored pulmonary epithelial homeostasis. Investigating EV mechanism of action, we found that AFSC-EV beneficial effects were exerted via the release of RNA cargo. MicroRNAs regulating the expression of genes involved in lung development, such as the miR17-92 cluster and its paralogs, were highly enriched in AFSC-EVs and were increased in AFSC-EV-treated primary lung epithelial cells compared to untreated cells. Our findings suggest that AFSC-EVs hold regenerative ability for underdeveloped fetal lungs, demonstrating potential for therapeutic application in patients with pulmonary hypoplasia.

Introdução: A hérnia diafragmática congênita (HDC) consiste em um defeito na formação do diafragma que resulta na passagem de vísceras abdominais para a cavidade torácica. A incidência é de 1:2500-4000 nascidos vivos e sua elevada morbimortalidade está relacionada à hipoplasia e à hipertensão arterial pulmonar, cujos mecanismos ainda são pouco compreendidos e tornam o cuidado neonatal um grande desafio. Portadores de HDC apresentam um curto período de estabilidade ventilatória pós-natal, com oxigenação sistêmica adequada, chamado de período de lua de mel (honeymoon). Em seguida, há deterioração progressiva da oxigenação com piora da hipertensão pulmonar. Acredita-se que alterações da sinalização mediadas pelo VEGF, VEGFR-1/2 e pela eNOS levam à adaptação errática da circulação pulmonar neonatal e resultam em alterações da reatividade vascular, com consequente hipertensão pulmonar. Objetivo: Avaliar o efeito da ventilação mecânica durante o período de lua de mel na morfometria e na expressão de VEGF, VEGFR-1/2 e eNOS na HDC experimental em ratos. Material e Métodos: Filhotes de ratas Sprague Dawley foram separados em cinco grupos: controle (C), controle respirando (CR), controle ventilado (CV), hérnia diafragmática congênita (HDC) e hérnia diafragmática congênita ventilado (HDCV). Para os grupos com HDC, as ratas prenhes foram expostas a 100 mg de nitrofen no dia gestacional (DG) 9,5. Os grupos CR, CV e HDCV foram subdivididos em tempos ventilatórios de 30, 60 e 90 minutos (n=7-8 cada). No DG 21,5, os neonatos foram coletados e, após a ventilação (grupos ventilados) e a pesagem (grupos não ventilados), foram sacrificados. Os pulmões de n=4 neonatos de cada grupo foram submetidos à análise do parênquima (fração de espaço aéreo) e da vasculatura pulmonar (espessura da camada média), além da avaliação imuno-histoquímica (IHQ) (n=4) e por western blotting (WB) (n=3-4) da expressão de VEGF, VEGFR-1/2 e eNOS. A análise estatística foi realizada com diferenças significativas para p

Background Laparoscopic approach for malrotation has become more popular for neonates and in cases with volvulus, but its safety and efficacy remains controversial. This study reviewed laparoscopy outcomes in neonate/infant malrotation. Methods Medline/PubMed and Lilacs databases were reviewed. Data from studies published in English/Spanish between 1995 and 2019 were collected. Results are presented as percentages and means/medians; logistic regression was used to study possible associations. Results Nineteen papers offered 99 neonates/infants with median age and weight of 10.5 days and 3.5 kg, respectively. Ladd’s procedure was performed in 95 (96%) patients and bands’ division in 4 (4%); appendectomy was not included in 16 (16.2%) patients, and cecopexy was not performed in all cases. Volvulus was reported in 39 (39.4%) patients. There were 11 conversions (11.1%) and 10 recurrences of symptoms (10.1%) that required reintervention. An association was found between volvulus and recurrence ( P = .05) and the need for conversion ( P < .01). There were 10 (10.1%) minor complications and no mortality. The median follow-up was 10 months. Discussion Laparoscopic approach to malrotation is feasible and safe in hemodynamically stable neonates/infants without intestinal necrosis and is associated with 11% conversion rate and 10% reinterventions. The presence of volvulus is associated with recurrence and conversion. Laparoscopic Ladd’s procedure with appendectomy and without cecopexy is the commonly practiced approach that is associated with minor complications.

Incomplete lung development, also known as pulmonary hypoplasia, is a recognized cause of neonatal death and poor outcome for survivors. To date, there is no effective treatment that promotes fetal lung growth and maturation. Herein, we describe a novel stem cell-based approach that enhances fetal lung development via the administration of extracellular vesicles (EVs) derived from amniotic fluid stem cells (AFSCs). In experimental models of pulmonary hypoplasia, administration of AFSC-EVs promoted lung branching morphogenesis and alveolarization, and stimulated pulmonary epithelial cell and fibroblast differentiation. This regenerative ability was confirmed in two models of injured human lung cells, where human AFSC-EVs obtained following good manufacturing practices restored pulmonary epithelial homeostasis. AFSC-EV beneficial effects were exerted via the release of RNA cargo, primarily miRNAs, that regulate the expression of genes involved in fetal lung development. Our findings suggest that AFSC-EVs hold regenerative ability for underdeveloped fetal lungs, demonstrating potential for therapeutic application.One Sentence SummaryFetal lung regeneration via administration of extracellular vesicles derived from amniotic fluid stem cells

Laparoscopic cholecystectomy (LC) is the gold standard for surgical management in symptomatic children, but it is not without complications, bile duct injury being among the most feared. This study reviewed the complications of LC in children. MEDLINE/PubMed, CENTRAL and Lilacs were reviewed for LC. Studies in patients ≤ 18 years of age published in English, Portuguese or Spanish were selected by two independent reviewers. Data were collected for patients’ characteristics, surgical information, complications, mortality and follow-up. Twenty-four papers were identified and offered 2783 patients. Mean age was 11 years (3 months–18 years). In the 93/2783 (3.3%) complications, single-port procedures were associated with seven (7.5%), 3/4-port with 81 (87.1%) and the number of ports were not specified in five. Routine cholangiography was not part of the protocol in any of the reports. Complications included wound issues (n = 24), perforation (n = 14), bleeds (n = 13), biliary tree complications (n = 9), sickle cell crisis (n = 8), fever (n = 6), leaks (n = 4), pain (n = 3), nausea/emesis (n = 3) and others (n = 9). Two of these patients had a history of obesity and cholecystitis and only two biliary tree lesions were diagnosed intra-operatively. Seventeen cases (18.3%) required re-intervention: 15 surgical and two endoscopic. Issues related to biliary tree included: common bile duct lesion (n = 6), biliary fistula (n = 3), clip dislocation from cystic duct (n = 1), cholangitis (n = 1) and calculus (n = 1). There was no mortality, and the mean follow-up period was 10.3 months (1 month–5 years). LC is safe in children and, although most complications are minor, almost 1/5 complications require interventions, mostly due to bleeding and biliary tree complications. Mortality has not been reported in pediatric LC.

Postoperative chylothorax occurs due to trauma to lymphatic vessels and can occur after any thoracic procedure. This study reviewed recent literature to evaluate the management and outcomes of surgical chylothorax in neonates. PubMed database was searched for articles in English, Portuguese and Spanish from 2000 to 2016. Data were collected for surgery, chylothorax management, complications, mortality and length of hospital stay (LOS). Twenty studies offered 107 neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac malformations (n = 25, 23.4%), esophageal atresia (n = 5, 4.7%) and CDH + extralobar sequestration (n = 1, 0.9%). Medium-chain triglycerides (MCT) was the initial treatment in 52 neonates (48.6%), prednisolone + MCT in one (0.9%), total parenteral nutrition in 51 patients (47.7%), and three patients (2.8%) did not require any treatment. Octreotide and somatostatin were used as second or third line treatment in 25 neonates (23.4%), and 15 neonates (14%) underwent 17 surgeries, including thoracic duct ligation (TDL) (n = 9); pleurodesis (n = 3) (2 patients required TDL); TDL + pleurodesis (n = 2), and TDL + placement of hemostat (n = 1). Complications due to the chylothorax were reported in 27 neonates (25.2%): hypoalbuminemia + hyponatremia (n = 18), hypoalbuminemia (n = 4), hypoalbuminemia with cutaneous flushing as colateral effect of somatostatin (n = 1), loose stool after somatostatin use (n = 1), pneumonia (n = 1), congestive heart failure + hypernatremia (n = 1), and hyponatremia (n = 1). There were 21 deaths (19.6%) and median LOS was 53.4 days (30–93.1 days). Conservative management is appropriate as initial treatment for neonatal postsurgical chylothorax. Octreotide and somatostatin are safe in neonates and surgical approach should be considered in prolonged leaks.

To review the literature for justification of thoracoscopic management of blebs in children. PubMed database was reviewed for articles in English, Portuguese and Spanish using the key words “thoracoscopy”, “bleb” and “child”. Data was collected for age, gender, type of surgery performed, operating time, conversions, complications, recurrences, follow-up and mortality. Eleven studies with total 266 patients were included (27 bilateral cases; n = 293 surgeries). Median age was 15.7 y (range 11–18 y), 225 were male (87.9%) and 31 were female (12.1%) patients. Endo GIA™ was used in 10 cases, Endoloop® in 11 surgeries, unspecified stapler devices in 150 procedures and, in 122 surgeries, instruments were not mentioned. Pleurodesis was performed in 213 (72.7%) cases. There were 5 (1.7%) conversions (adhesions n = 3, bleeding n = 1, camera failure n = 1). Complications were documented in 8 (2.7%): pneumothorax after chest tube removal 4 (drain reinsertion n = 3, reoperation n = 1); prolonged air leak 3, all submitted to che pleurodesis; bleeding requiring reoperation 1. Recurrence occurred in 25 (8.5%): 10 re-operation, 7 conservative management, 2 chemical pleurodesis, 2 chest tube reinsertions and in 4 the management was not specified. The median follow-up was 46.1 mo (range 3 mo-11 y). There were no lethal outcomes. Although data is scarce on specific instruments used, pleurodesis is performed in 70% of cases. Irrespective of this, thoracoscopic resection of blebs can be safely offered as it has a low complication and conversion rates and no mortality.

The survival rate of newborns with gastroschisis (GS) has been increasing in the past decades; however, the morbidity continues to be high, mainly related to the length of hospitalization due to disturbances of motility, absorption, and risk of intestinal infections. The development of basic research with the creation of experimental models has provided enormous advances in the understanding of the pathophysiology of the disease. These models allowed the study of the target genes involved in the embryology of the defect, the influence of the amniotic fluid, and the use of drugs and fetal therapies in an attempt to reduce the intestinal damage and to provide a rapid return of intestinal motility. Our aim was to describe the main GS models and the translational, historical impact of these research advances on the disease.

Neonatal asphyxia occurs due to reduction in oxygen supply to vital organs in the newborn. Rapid restoration of oxygen to the lungs after a long period of asphyxia can cause lung injury and decline of respiratory function, which result from the activity of molecules that induce vascular changes in the lung such as nitric oxide (NO) and vascular endothelial growth factors (VEGF). In this study, we evaluated the pulmonary and vascular morphometry of rats submitted to the model of neonatal asphyxia and mechanical ventilation, their expression of pulmonary VEGF, VEGF receptors (VEGFR-1/VEGFR-2), and endothelial NO synthase (eNOS). Neonate Sprague-Dawley rats (CEUA #043/2011) were divided into four groups (n=8 each): control (C), control submitted to ventilation (CV), hypoxia (H), and hypoxia submitted to ventilation (HV). The fetuses were harvested at 21.5 days of gestation. The morphometric variables measured were body weight (BW), total lung weight (TLW), left lung weight (LLW), and TLW/BW ratio. Pulmonary vascular measurements, VEGFR-1, VEGFR-2, VEGF, and eNOS immunohistochemistry were performed. The morphometric analysis showed decreased TLW and TLW/BW ratio in HV compared to C and H (P

Aim Appendiceal volvulus (AV) and cecal volvulus (CV) are rare conditions and there is no consensus regarding the best surgical approach. This study reviewed CV and AV management and outcomes in children. Methods PubMed was reviewed from 1990 to 2018 for AV and CV in children and studies published in English were selected by two independent reviewers. This identified 24 papers that provided case reports on 29 children (72% male) with a median age of 10 years. Results Abdominal distension and abdominal pain were the most common symptoms and seven children had Cornelia de Lange syndrome. The initial treatment was surgical in 27 cases and endoscopic in 2. In 23 children, variants of cecopexy were performed. There was no mortality. Complications occurred in seven cases: five with sepsis and two with enterocutaneous fistulas. There were three CV recurrences and these were all in cases where cecopexy was not performed. Conclusion AV and CV are rare paediatric pathologies. Since a quarter of the patients had Cornelia de Lange syndrome, it is paramount to consider CV when abdominal symptoms occur. Complications were minor with prompt management. In order to reduce recurrence, cecopexy is recommended in CV cases and appendectomy in AV cases.