Artigos e Materiais de Revistas Científicas - HC/ICHC

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  • article
    Update of the Brazilian consensus recommendations on Duchenne muscular dystrophy
    (2023) ARAUJO, Alexandra Prufer de Queiroz Campos; SAUTE, Jonas Alex Morales; FORTES, Clarisse Pereira Dias Drumond; JR, Marcondes Cavalcante Franca; PEREIRA, Jaqueline Almeida; ALBUQUERQUE, Marco Antonio Veloso de; CARVALHO, Alzira Alves de Siqueira; CAVALCANTI, Eduardo Boiteux Uchoa; COVALESKI, Anna Paula Paranhos Miranda; FAGONDES, Simone Chaves; GURGEL-GIANNETTI, Juliana; GONCALVES, Marcus Vinicius Magno; MARTINEZ, Alberto Rolim Muro; NEVES, Flavio Reis; NUCCI, Anamarli; NUCERA, Ana Paula Cassetta dos Santos; PESSOA, Andre Luis Santos; REBEL, Marcos Ferreira; SANTOS, Flavia Nardes dos; SCOLA, Rosana Herminia; SOBREIRA, Claudia Ferreira da Rosa
    In the last few decades, there have been considerable improvements in the diagnosis and care of Duchenne muscular dystrophy (DMD), the most common childhood muscular dystrophy. International guidelines have been published and recently reviewed. A group of Brazilian experts has developed a standard of care based on a literature review with evidence-based graded recommendations in a two-part publication. Implementing best practice management has helped change the natural history of this chronic progressive disorder, in which the life expectancy for children of the male sex in the past used to be very limited. Since the previous publication, diagnosis, steroid treatment, rehabilitation, and systemic care have gained more significant insights with new original work in certain fields. Furthermore, the development of new drugs is ongoing, and some interventions have been approved for use in certain countries. Therefore, we have identified the need to review the previous care recommendations for Brazilian patients with DMD. Our objective was to create an evidence-based document that is an update on our previous consensus on those topics.
  • article 0 Citação(ões) na Scopus
    Improving perioperative care in low-resource settings with goal-directed therapy: a narrative review
    (2024) LOBO, Suzana Margareth; SILVA, Joao Manoel da; MALBOUISSON, Luiz Marcelo
    Perioperative Goal-Directed Therapy (PGDT) has significantly showed to decrease complications and risk of death in high-risk patients according to numerous meta-analyses. The main goal of PGDT is to individualize the therapy with fluids, inotropes, and vasopressors, during and after surgery, according to patients' needs in order to prevent organic dysfunction development. In this opinion paper we aimed to focus a discussion on possible alternatives to invasive hemodynamic monitoring in low resource settings. (c) 2023 Sociedade Brasileira de Anestesiologia.
  • article 3 Citação(ões) na Scopus
    Hybrid laparoscopic versus fully robot-assisted minimally invasive esophagectomy: an international propensity-score matched analysis of perioperative outcome
    (2023) JUNG, Jin-On; GROOT, Eline M. de; KINGMA, B. Feike; BABIC, Benjamin; RUURDA, Jelle P.; GRIMMINGER, Peter P.; HOELZEN, Jens P.; CHAO, Yin-Kai; HAVEMAN, Jan W.; DET, Marc J. van; ROUANET, Philippe; BENEDIX, Frank; LI, Hecheng; SARKARIA, Inderpal; HENEGOUWEN, Mark van Berge I.; BOXEL, Gijs I. van; CHIU, Philip; EGBERTS, Jan-Hendrik; SALLUM, Rubens; IMMANUEL, Arul; TURNER, Paul; LOW, Donald E.; HUBKA, Michal; PEREZ, Daniel; STRIGNANO, Paolo; BIEBL, Matthias; CHAUDRY, M. Asif; BRUNS, Christiane J.; HILLEGERSBERG, Richard van; FUCHS, Hans F.
    BackgroundCurrently, little is known regarding the optimal technique for the abdominal phase of RAMIE. The aim of this study was to investigate the outcome of robot-assisted minimally invasive esophagectomy (RAMIE) in both the abdominal and thoracic phase (full RAMIE) compared to laparoscopy during the abdominal phase (hybrid laparoscopic RAMIE).MethodsThis retrospective propensity-score matched analysis of the International Upper Gastrointestinal International Robotic Association (UGIRA) database included 807 RAMIE procedures with intrathoracic anastomosis between 2017 and 2021 from 23 centers.ResultsAfter propensity-score matching, 296 hybrid laparoscopic RAMIE patients were compared to 296 full RAMIE patients. Both groups were equal regarding intraoperative blood loss (median 200 ml versus 197 ml, p = 0.6967), operational time (mean 430.3 min versus 417.7 min, p = 0.1032), conversion rate during abdominal phase (2.4% versus 1.7%, p = 0.560), radical resection (R0) rate (95.6% versus 96.3%, p = 0.8526) and total lymph node yield (mean 30.4 versus 29.5, p = 0.3834). The hybrid laparoscopic RAMIE group showed higher rates of anastomotic leakage (28.0% versus 16.6%, p = 0.001) and Clavien Dindo grade 3a or higher (45.3% versus 26.0%, p < 0.001). The length of stay on intensive care unit (median 3 days versus 2 days, p = 0.0005) and in-hospital (median 15 days versus 12 days, p < 0.0001) were longer for the hybrid laparoscopic RAMIE group.ConclusionsHybrid laparoscopic RAMIE and full RAMIE were oncologically equivalent with a potential decrease of postoperative complications and shorter (intensive care) stay after full RAMIE.
  • article 0 Citação(ões) na Scopus
    Pharmacokinetics and Therapeutic Target Attainment of Meropenem in Pediatric Post-Liver Transplant Patients: Extended vs Intermittent Infusion
    (2023) MORALES JUNIOR, Ronaldo; JUODINIS, Vanessa D'amaro; TELLES, Joao Paulo; ROMANO, Paschoalina; DUARTE, Nilo Jose Coelho; SOUZA, Daniela Carla De; SANTOS, Silvia Regina Cavani Jorge
    Purpose. The aim of this study is to characterize the concentration-time profile, pharmacokinetics parameters, and therapeutic target attainment of meropenem in pediatric post-liver transplant patients according to the duration of infusion. Methods. This is a prospective cohort of pediatric transplant recipients with preserved renal function receiving meropenem 40 mg/kg every 8 hours. The patients were stratified into 2 groups based on infusion duration: G1 (15 minutes of intermittent infusion) and G1 (3 hours of extended infusion). Two blood samples per child were collected during the same interval within 48 hours of starting the antimicrobial. Meropenem concentrations were determined by high-performance liquid chromatography with tandem mass spectrometry. Pharmacokinetic parameters were assessed using a noncompartmental analysis. The therapeutic target was defined as 100% of the time above the minimum inhibitory concentration.Findings. Fourteen patients with 28 measured meropenem concentrations were included. Lower values of volume of distribution and meropenem clearance compared with other critically ill pediatric populations were found. All patients achieved the therapeutic target against gram-negative pathogens with a minimum inhibitory concentration of <= 8 mg/L. Patients receiving a 15-minute infusion had higher values of peak and trough concentrations, resulting in unnecessary increased total drug exposure when compared to patients receiving a 3-hour infusion (P < .05).Conclusions. Meropenem at 120 mg/kg/d attained the therapeutic target against sensitive microorganisms in pediatric liver transplant recipients. The extended infusion should be preferred for patient safety. Because of the pharmacokinetic changes resulting from liver transplantation, individualized meropenem dosing regimens may be necessary.
  • article 3 Citação(ões) na Scopus
    Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer
    (2023) TOBIAS-MACHADO, Marcos; ORNELLAS, Antonio A.; HIDAKA, Alexandre K.; MEDINA, Luis G.; MATTOS, Pablo A. L.; BESIO, Ruben S.; ABREU, Diego; CASTRO, Pedro R.; NISHIMOTO, Ricardo H.; ASTIGUETA, Juan; DOURADO, Aurus; MACHADO, Roberto D.; MAGNABOSCO, Wesley J.; CORONA-MONTES, Victor; VILLOLDO, Gustavo M.; ZAMPOLLI, Hamilton C.; TAHA, Anis; AUAD, Pericles R.; FARIA, Eliney F.; ARANTES, Paulo B. O.; TAVARES, Alessandro; NASCIMENTO, Francisco S. M. S.; BRAZAO JR., Eder S.; ROCHA, Mauricio M.; COSTA, Walter H.; PANICO, Vinicius; REIS, Leonardo O.; ALMEIDA-CARRERA, Roberto J.; SILVA, Rafael C.; ZEQUI, Stenio C.; CALIXTO, Jose R. R.; SOTELO, Rene
    Objective: To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). Materials and Methods: Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. Results: From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. Conclusion: VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of nonbulky lymph nodes in penile cancer.
  • article 0 Citação(ões) na Scopus
    Accuracy of the 10 μg desmopressin test for differential diagnosis of Cushing syndrome: a systematic review and meta-analysis
    (2024) GIAMPIETRO, Rodrigo Rosa; CABRAL, Marcos Vinicius Gama; PEREIRA, Elizandra Gomes; MACHADO, Marcio Carlos; VILAR, Lucio; NUNES-NOGUEIRA, Vania dos Santos
    We evaluated the accuracy of the 10 mu g desmopressin test in differentiating Cushing disease (CD) from non-neoplastic hypercortisolism (NNH) and ectopic ACTH syndrome (EAS). A systematic review of studies on diagnostic test accuracy in patients with CD, NNH, or EAS subjected to the desmopressin test obtained from LILACS, PubMed, EMBASE, and CENTRAL databases was performed. Two reviewers independently selected the studies, assessed the risk of bias, and extracted the data. Hierarchical and bivariate models on Stata software were used for meta-analytical summaries. The certainty of evidence was measured using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation Working Group) approach. In total, 14 studies were included: 3 studies on differentiated CD versus NNH and 11 studies on differentiated CD versus EAS. Considering Delta ACTH in 8 studies involving 429 patients, the pooled sensitivity for distinguishing CD from EAS was 0.85 (95% confidence interval [CI]: 0.80-0.89, I2 = 17.6%) and specificity was 0.64 (95% CI: 0.49-0.76, I2 = 9.46%). Regarding Delta cortisol in 6 studies involving 233 participants, the sensitivity for distinguishing CD from EAS was 0.81 (95% CI: 0.74-0.87, I2 = 7.98%) and specificity was 0.80 (95% CI: 0.61-0.91, I2 = 12.89%). The sensitivity and specificity of the combination of Delta ACTH > 35% and Delta cortisol > 20% in 5 studies involving 511 participants were 0.88 (95% CI: 0.79-0.93, I2 = 35%) and 0.74 (95% CI: 0.55-0.87, I2 = 27%), respectively. The pooled sensitivity for distinguishing CD from NNH in 3 studies involving 170 participants was 0.88 (95% CI: 0.79-0.93) and the specificity was 0.94 (95% CI: 0.86-0.97). Based on the desmopressin test for differentiating CD from EAS, considering Delta ACTH, Delta cortisol, or both percent increments, 15%, 19%, or 20% of patients with CD, respectively, would be incorrectly classified as having EAS. For CD versus NNH, 11% of patients with CD would be falsely diagnosed as having NNH, whereas 7% of patients with NNH would be falsely diagnosed as having CD. However, in all hierarchical plots, the prediction intervals were considerably wider than the confidence intervals. This indicates low confidence in the estimated accuracy, and the true accuracy is likely to be different. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=85634, identifier CRD42018085634; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68317, identifier CRD42017068317.
  • article 0 Citação(ões) na Scopus
    To be or not to B27 positive: implications for the phenotypes of axial spondyloarthritis outcomes. Data from a large multiracial cohort from the Brazilian Registry of Spondyloarthritis
    (2024) RESENDE, Gustavo Gomes; SAAD, Carla Goncalves Schahin; MARQUES, Claudia Diniz Lopes; RIBEIRO, Sandra Lucia Euzebio; GAVI, Maria Bernadete Renoldi de Oliveira; YAZBEK, Michel Alexandre; MARINHO, Adriana de Oliveira; MENIN, Rita de Cassia; OCHTROP, Manuella Lima Gomes; SOARES, Andressa Miozzo; CAVALCANTI, Nara Gualberto; CARNEIRO, Jamille Nascimento; CASTRO, Glaucio Ricardo Werner de; FERNANDES, Jose Mauro Carneiro; SOUZA, Elziane; ALVARENGA, Corina Quental de Menezes; VIEIRA, Rejane Maria Rodrigues de Abreu; MACHADO, Natalia Pereira; XIMENES, Antonio Carlos; GAZZETA, Morgana Ohira; ALBUQUERQUE, Cleandro Pires de; SKARE, Thelma Larocca; KEISERMAN, Mauro Waldemar; KOHEM, Charles Lubianca; BENACON, Gabriel Sarkis; ROCHA, Vitor Florencio Santos; LAGE, Ricardo da Cruz; MALHEIRO, Olivio Brito; GOLEBIOVSKI, Rywka Tenenbaum Medeiros; OLIVEIRA, Thauana Luiza; DUQUE, Ruben Horst; LONDE, Ana Carolina; PINHEIRO, Marcelo de Medeiros; SAMPAIO-BARROS, Percival Degrava
    Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE).Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age >= 18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical.Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (+/- 13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility.Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population.
  • article 0 Citação(ões) na Scopus
    COVID-19 Vaccination in Patients with Inborn Errors of Immunity Reduces Hospitalization and Critical Care Needs Related to COVID-19: a USIDNET Report
    (2024) MCDONNELL, John; COUSINS, Kimberley; YOUNGER, M. Elizabeth M.; LANE, Adam; ABOLHASSANI, Hassan; ABRAHAM, Roshini S.; AL-TAMEMI, Salem; ALDAVE-BECERRA, Juan Carlos; AL-FARIS, Eman Hesham; ALFARO-MURILLO, Alberto; ALKHATER, Suzan A.; ALSAATI, Nouf; DOSS, Alexa Michelle Altman; ANDERSON, Melissa; ANGAROLA, Ernestina; ARIUE, Barbara; ARNOLD, Danielle E.; ASSA'AD, Amal H.; AYTEKIN, Caner; BANK, Meaghan; BERGERSON, Jenna R. E.; BLEESING, Jack; BOESING, John; BOUSO, Carolina; BRODSZKI, Nicholas; CABANILLAS, Diana; CADY, Carol; CALLAHAN, Meghan A.; CAORSI, Roberta; CARBONE, Javier; CARRABBA, Maria; CASTAGNOLI, Riccardo; CATANZARO, Jason R.; CHAN, Samantha; CHANDRA, Sharat; CHAPDELAINE, Hugo; CHAVOSHZADEH, Zahra; CHONG, Hey Jin; CONNORS, Lori; CONSONNI, Filippo; CORREA-JIMENEZ, Oscar; CUNNINGHAM-RUNDLES, Charlotte; D'ASTOUS-GAUTHIER, Katherine; DELMONTE, Ottavia Maria; DEMIRDAG, Yesim Yilmaz; DESHPANDE, Deepti R.; DIAZ-CABRERA, Natalie M.; DIMITRIADES, Victoria R.; EL-OWAIDY, Rasha; ELGHAZALI, Gehad; AL-HAMMADI, Suleiman; FABIO, Giovanna; FAURE, Astrid Schellnast; FENG, Jin; FERNANDEZ, James M.; FILL, Lauren; FRANCO, Guacira R.; FRENCK, Robert W.; FULEIHAN, Ramsay L.; GIARDINO, Giuliana; GALANT-SWAFFORD, Jessica; GAMBINERI, Eleonora; GARABEDIAN, Elizabeth K.; GEERLINKS, Ashley V.; GOUDOURIS, Ekaterini; GRECCO, Octavio; PAN-HAMMARSTROM, Qiang; KHANI, Hedieh Haji Khodaverdi; HAMMARSTROM, Lennart; HARTOG, Nicholas L.; HEIMALL, Jennifer; HERNANDEZ-MOLINA, Gabriela; HORNER, Caroline C.; HOSTOFFER, Robert W.; HRISTOVA, Nataliya; HSIAO, Kuang-Chih; IVANKOVICH-ESCOTO, Gabriela; JABER, Faris; JALIL, Maaz; JAMEE, Mahnaz; JEAN, Tiffany; JEONG, Stephanie; JHAVERI, Devi; JORDAN, Michael B.; JOSHI, Avni Y.; KALKAT, Amanpreet; KANAREK, Henry J.; KELLNER, Erinn S.; KHOJAH, Amer; KHOURY, Ruby; KOKRON, Cristina M.; KUMAR, Ashish; LECERF, Kelsey; LEHMAN, Heather K.; LEIDING, Jennifer W.; LESMANA, Harry; LIM, Xin Rong; LOPES, Joao Pedro; LOPEZ, Ana Laura; TARQUINI, Lucia; LUNDGREN, Ingrid S.; MAGNUSSON, Julieann; MARINHO, Ana Karolina B. B.; MARSEGLIA, Gian Luigi; MARTONE, Giulia M.; MECHTLER, Annamaria G.; MENDONCA, Leonardo; MILNER, Joshua D.; MUSTILLO, Peter J.; NADERI, Asal Gharib; NAVIGLIO, Samuele; NELL, Jeremy; NIEBUR, Hana B.; NOTARANGELO, Luigi; OLEASTRO, Matias; ORTEGA-LOPEZ, Maria Claudia; PATEL, Neil R.; PETROVIC, Gordana; PIGNATA, Claudio; PORRAS, Oscar; PRINCE, Benjamin T.; PUCK, Jennifer M.; QAMAR, Nashmia; RABUSIN, Marco; RAJE, Nikita; REGAIRAZ, Lorena; RISMA, Kimberly A.; RISTAGNO, Elizabeth H.; ROUTES, John; ROXO-JUNIOR, Persio; SALEMI, Negin; SCALCHUNES, Christopher; SCHUVAL, Susan J.; SENEVIRATNE, Suranjith L.; SHANKAR, Ashwin; SHERKAT, Roya; SHIN, Junghee Jenny; SIDDIQI, Abeer; SIGNA, Sara; SOBH, Ali; LIMA, Fabiana Mascarenhas Souza; STENEHJEM, Kristen K.; TAM, Jonathan S.; TANG, Monica; BARROS, Myrthes Toledo; VERBSKY, James; VERGADI, Eleni; VOELKER, Dayne H.; VOLPI, Stefano; WALL, Luke A.; WANG, Christine; WILLIAMS, Kelli W.; WU, Eveline Y.; WU, Shan Shan; ZHOU, Jessie J.; COOK, Alexandria; SULLIVAN, Kathleen E.; MARSH, Rebecca
    Background The CDC and ACIP recommend COVID-19 vaccination for patients with inborn errors of immunity (IEI). Not much is known about vaccine safety in IEI, and whether vaccination attenuates infection severity in IEI. Objective To estimate COVID-19 vaccination safety and examine effect on outcomes in patients with IEI. Methods We built a secure registry database in conjunction with the US Immunodeficiency Network to examine vaccination frequency and indicators of safety and effectiveness in IEI patients. The registry opened on January 1, 2022, and closed on August 19, 2022. Results Physicians entered data on 1245 patients from 24 countries. The most common diagnoses were antibody deficiencies (63.7%). At least one COVID-19 vaccine was administered to 806 patients (64.7%), and 216 patients received vaccination prior to the development of COVID-19. The most common vaccines administered were mRNA-based (84.0%). Seventeen patients were reported to seek outpatient clinic or emergency room care for a vaccine-related complication, and one patient was hospitalized for symptomatic anemia. Eight hundred twenty-three patients (66.1%) experienced COVID-19 infection. Of these, 156 patients required hospitalization (19.0%), 47 required ICU care (5.7%), and 28 died (3.4%). Rates of hospitalization (9.3% versus 24.4%, p < 0.001), ICU admission (2.8% versus 7.6%, p = 0.013), and death (2.3% versus 4.3%, p = 0.202) in patients who had COVID-19 were lower in patients who received vaccination prior to infection. In adjusted logistic regression analysis, not having at least one COVID-19 vaccine significantly increased the odds of hospitalization and ICU admission. Conclusion Vaccination for COVID-19 in the IEI population appears safe and attenuates COVID-19 severity.
  • article 0 Citação(ões) na Scopus
    Machine learning algorithms using national registry data to predict loss to follow-up during tuberculosis treatment
    (2024) RODRIGUES, Moreno M. S.; BARRETO-DUARTE, Beatriz; VINHAES, Caian L.; ARAUJO-PEREIRA, Mariana; FUKUTANI, Eduardo R.; BERGAMASCHI, Keityane Bone; KRISTKI, Afranio; CORDEIRO-SANTOS, Marcelo; ROLLA, Valeria C.; STERLING, Timothy R.; QUEIROZ, Artur T. L.; ANDRADE, Bruno B.
    Background Identifying patients at increased risk of loss to follow-up (LTFU) is key to developing strategies to optimize the clinical management of tuberculosis (TB). The use of national registry data in prediction models may be a useful tool to inform healthcare workers about risk of LTFU. Here we developed a score to predict the risk of LTFU during anti-TB treatment (ATT) in a nationwide cohort of cases using clinical data reported to the Brazilian Notifiable Disease Information System (SINAN). Methods We performed a retrospective study of all TB cases reported to SINAN between 2015 and 2022; excluding children (< 18 years-old), vulnerable groups or drug-resistant TB. For the score, data before treatment initiation were used. We trained and internally validated three different prediction scoring systems, based on Logistic Regression, Random Forest, and Light Gradient Boosting. Before applying our models we splitted our data into training (similar to 80% data) and test (similar to 20%) sets, and then compared the model metrics using the test data set. Results Of the 243,726 cases included, 41,373 experienced LTFU whereas 202,353 were successfully treated. The groups were different with regards to several clinical and sociodemographic characteristics. The directly observed treatment (DOT) was unbalanced between the groups with lower prevalence in those who were LTFU. Three models were developed to predict LTFU using 8 features (prior TB, drug use, age, sex, HIV infection and schooling level) with different score composition approaches. Those prediction scoring systems exhibited an area under the curve (AUC) ranging between 0.71 and 0.72. The Light Gradient Boosting technique resulted in the best prediction performance, weighting specificity and sensitivity. A user-friendly web calculator app was developed (https://tbprediction.herokuapp.com/) to facilitate implementation. Conclusions Our nationwide risk score predicts the risk of LTFU during ATT in Brazilian adults prior to treatment commencement utilizing schooling level, sex, age, prior TB status, and substance use (drug, alcohol, and/or tobacco). This is a potential tool to assist in decision-making strategies to guide resource allocation, DOT indications, and improve TB treatment adherence.
  • article 4 Citação(ões) na Scopus
    The trajectory of very old critically ill patients
    (2024) GUIDET, Bertrand; VALLET, Helene; FLAATTEN, Hans; JOYNT, Gavin; BAGSHAW, Sean M.; LEAVER, Susannah K.; BEIL, Michael; DU, Bin; FORTE, Daniel N.; ANGUS, Derek C.; SVIRI, Sigal; LANGE, Dylan de; HERRIDGE, Margaret S.; JUNG, Christian
    The demographic shift, together with financial constraint, justify a re-evaluation of the trajectory of care of very old critically ill patients (VIP), defined as older than 80 years. We must avoid over- as well as under-utilisation of critical care interventions in this patient group and ensure the inclusion of health care professionals, the patient and their caregivers in the decision process. This new integrative approach mobilises expertise at each step of the process beginning prior to intensive care unit (ICU) admission and extending to long-term follow-up. In this review, several international experts have contributed to provide recommendations that can be universally applied. Our aim is to define a minimum core dataset of information to be shared and discussed prior to ICU admission and to facilitate the shared-decision-making process with the patient and their caregivers, throughout the patient journey. Documentation of uncertainty may contribute to a tailored level of care and ultimately to discussions around possible limitations of life sustaining treatments. The goal of ICU care is not only to avoid death, but more importantly to maintain an acceptable quality of life and functional autonomy after hospital discharge. Societal consideration is important to highlight, together with alternatives to ICU admission. We discuss challenges for the future and potential areas of research. In summary, this review provides a state-of-the-art current overview and aims to outline future directions to address the challenges in the treatment of VIP.
  • article
    Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic
    (2024) CZEPIEL, Diana; MCCORMACK, Clare; SILVA, Andrea T. C. da; SEBLOVA, Dominika; MORO, Maria F.; RESTREPO-HENAO, Alexandra; MARTINEZ, Adriana M.; AFOLABI, Oyeyemi; ALNASSER, Lubna; ALVARADO, Ruben; ASAOKA, Hiroki; AYINDE, Olatunde; BALALIAN, Arin; BALLESTER, Dinarte; BARATHIE, Josleen A. l.; BASAGOITIA, Armando; BASIC, Djordje; BURRONE, Maria S.; CARTA, Mauro G.; DURAND-ARIAS, Sol; ESKIN, Mehmet; FERNANDEZ-JIMENEZ, Eduardo; FREY, Marcela I. F.; GUREJE, Oye; ISAHAKYAN, Anna; JALDO, Rodrigo; KARAM, Elie G.; KHATTECH, Dorra; LINDERT, Jutta; MARTINEZ-ALES, Gonzalo; MASCAYANO, Franco; MEDIAVILLA, Roberto; GONZALEZ, Javier A. Narvaez; NASSER-KARAM, Aimee; NISHI, Daisuke; OLAOPA, Olusegun; OUALI, Uta; PUAC-POLANCO, Victor; RAMIREZ, Dorian E.; RAMIREZ, Jorge; RIVERA-SEGARRA, Eliut; RUTTEN, Bart P. F.; SANTAELLA-TENORIO, Julian; SAPAG, Jaime C.; SEBLOVA, Jana; SOTO, Maria T. S.; TAVARES-CAVALCANTI, Maria; VALERI, Linda; SIJBRANDIJ, Marit; SUSSER, Ezra S.; HOEK, Hans W.; VEN, Els van der
    Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.
  • article 0 Citação(ões) na Scopus
    Fertility Potential and Gonadal Function in Survivors of Reduced-Intensity Hematopoietic Stem Cell Transplantation
    (2024) ROTZ, Seth J.; HAMILTON, Betty K.; WEI, Wei; AHMED, Ibrahim; WINSTON, Sameeya Ahmed; BALLARD, Sherri; BERNARD, Robyn J.; CARPENTER, Paul; FARHADFAR, Nosha; FERRARO, Christina; FRIEND, Brian D.; GLOUDE, Nicholas J.; HAYASHI, Robert J.; HOYLE, Kerry; JENSSEN, Kari; KOO, Jane; LEE, Catherine J.; MARIANO, Livia; NAWABIT, Rawan; NGWUBE, Alexander; LALEFAR, Nahal; PHELAN, Rachel; PERKINS, Laynie; RAO, Anandini; RAYES, Ahmad; SANDHEINRICH, Taryn; STAFFORD, Lauren; TOMLINSON, Kathryn; WHITESIDE, Stacy; WIEDL, Christina; MYERS, Kasiani
    The use of reduced -intensity conditioning (RIC) regimens has increased in an effort to minimize hematopoietic stem cell transplantation (HCT) end -organ toxicity, including gonadal toxicity. We aimed to describe the incidence of fertility potential and gonadal function impairment in adolescent and young adult survivors of HCT and to identify risk factors (including conditioning intensity) for impairment. We performed a multi -institutional, international retrospective cohort study of patients age 10 to 40 years who underwent first allogeneic HCT before December 1, 2019, and who were alive, in remission, and available for follow-up at 1 to 2 years post-HCT. For females, an AMH level of >.5 ng/mL defined preserved fertility potential; an AMH level of >.03 ng/mL was considered detectable. Gonadal failure was defined for females as an elevated follicle -stimulating hormone (FSH) level >30 mIU/mL with an estradiol (E2) level <17 pg/mL or current use of hormone replacement therapy (regardless of specific indication or intent). For males, gonadal failure was defined as an FSH level >10.4 mIU/mL or current use of hormone replacement therapy. A total of 326 patients (147 females) were available for analysis from 17 programs (13 pediatric, 4 adult). At 1 to 2 years post-HCT, 114 females (77.6%) had available FSH and E2 levels and 71 (48.3%) had available AMH levels. FSH levels were reported for 125 males (69.8%). Nearly all female HCT recipients had very low levels of AMH. One of 45 (2.2%) recipients of myeloablative conditioning (MAC) and four of 26 (15.4%) recipients of reduced -intensity conditioning (RIC) ( P = .06) had an AMH >.5 ng/m, and 8 of 45 MAC recipients (17.8%) and 12 of 26 RIC recipients (46.2%) ( P = .015) had a detectable AMH level. Total body irradiation (TBI) dose and cyclophosphamide equivalent dose (CED) were not associated with detectable AMH. The incidence of female gonadal hormone failure was 55.3%. In univariate analysis, older age at HCT was associated with greater likelihood of gonadal failure (median age, 17.6 versus 13.9; P < .0001), whereas conditioning intensity (RIC versus MAC), TBI, chronic graft -versushost disease requiring systemic therapy, and CED were not significantly associated with gonadal function. In multivariable analysis, age remained statistically significant (odds ratio [OR]. 1.11; 95% confidence interval [CI], 1.03 to 1.22) for each year increase; P = .012), Forty-four percent of the males had gonadal failure. In univariate analysis, older age (median, 16.2 years versus 14.4 years; P = .0005) and TBI dose ( P = .002) were both associated with gonadal failure, whereas conditioning intensity (RIC versus MAC; P = .06) and CED ( P = .07) were not statistically significant. In multivariable analysis, age (OR, 1.16; 95% CI, 1.06-1.27 for each year increase; P = .0016) and TBI >600 cGy (OR, 6.23; 95% CI, 2.21 to 19.15; P = .0008) remained significantly associated with gonadal failure. Our data indicate that RIC does not significantly mitigate the risk for gonadal failure in females or males. Age at HCT and (specifically in males) TBI use seem to be independent predictors of post -transplantation gonadal function and fertility status. All patients should receive pre-HCT infertility counseling and be offered appropriate fertility preservation options and be screened post-HCT for gonadal failure.
  • article 0 Citação(ões) na Scopus
    Papillary glioneuronal tumor: a case report of the cerebral aqueduct and review of literature
    (2024) HOSHINO, Hillary Sayuri Ramires; SANTOS, Bruna Grazielle Silva dos; NOGUEIRA, Adriano Barreto; GUIMARAES, Antonio Celso Alvarenga
    Papillary glioneuronal tumour is an entity described as grade I neuronal-glial tumour by the World Health Organization. Headaches, seizures, vomiting, language or visual disturbances, and hemiparesis are the most common clinical findings. This tumour typically presents as cystic with enhancing mural nodule in the cerebral hemisphere. In this paper, we reported a case of a papillary glioneuronal tumour in a young adult whose magnetic resonance imaging revealed a solid tumour in the cerebral aqueduct. The tumour was totally resected surgically 13 years ago. The histological and immunohistochemical examination determined the diagnosis. No further therapy was necessary. Currently, the patient presents no neurologic signs or symptoms and there is no radiologic evidence of tumour relapse. The case of papillary glioneuronal tumour reported here displayed unusual location and radiologic features. The long duration of follow-up of this case with no tumour relapse enhances that the preferred management for this type of tumour is its total surgical resection.
  • article 0 Citação(ões) na Scopus
    Transcranial Doppler and Color-Coded Doppler Use for Brain Death Determination in Adult Patients: A Pictorial Essay
    (2024) DEANA, Cristian; BIASUCCI, Daniele G.; ASPIDE, Raffaele; BRASIL, Sergio; VERGANO, Marco; LEONARDIS, Francesca; RICA, Ermal; CAMMAROTA, Gianmaria; DAURI, Mario; VETRUGNO, Giuseppe; LONGHINI, Federico; MAGGIORE, Salvatore Maurizio; RASULO, Frank; VETRUGNO, Luigi
    Transcranial Doppler (TCD) is a repeatable, at-the-bedside, helpful tool for confirming cerebral circulatory arrest (CCA). Despite its variable accuracy, TCD is increasingly used during brain death determination, and it is considered among the optional ancillary tests in several countries. Among its limitations, the need for skilled operators with appropriate knowledge of typical CCA patterns and the lack of adequate acoustic bone windows for intracranial arteries assessment are critical. The purpose of this review is to describe how to evaluate cerebral circulatory arrest in the intensive care unit with TCD and transcranial duplex color-coded doppler (TCCD).
  • article 0 Citação(ões) na Scopus
    Gerstmann-Sträussler-Scheinker Disease Presenting as Late-Onset Slowly Progressive Spinocerebellar Ataxia, and Comparative Case Series with Neuropathology
    (2024) STEPHEN, Christopher D.; GUSMAO, Claudio Melo de; SRINIVASAN, Sharan R.; OLSEN, Abby; FREUA, Fernando; KOK, Fernando; BARBOSA, Renata Montes Garcia; CHEN, Jin Yun (Helen); APPLEBY, Brian S.; PRIOR, Thomas; FROSCH, Matthew P.; SCHMAHMANN, Jeremy D.
    Background Genetic prion diseases, including Gerstmann-Straussler-Scheinker disease (GSS), are extremely rare, fatal neurodegenerative disorders, often associated with progressive ataxia and cognitive/neuropsychiatric symptoms. GSS typically presents as a rapidly progressive cerebellar ataxia, associated with cognitive decline. Late-onset cases are rare.Objective To compare a novel GSS phenotype with six other cases and present pathological findings from a single case.Methods Case series of seven GSS patients, one proceeding to autopsy.Results Case 1 developed slowly progressive gait difficulties at age 71, mimicking a spinocerebellar ataxia, with a family history of balance problems in old age. Genome sequencing revealed a heterozygous c.392G > A (p.G131E) pathogenic variant and a c.395A > G resulting in p.129 M/V polymorphism in the PRNP gene. Probability analyses considering family history, phenotype, and a similar previously reported point mutation (p.G131V) suggest p.G131E as a new pathogenic variant. Clinical features and imaging of this case are compared with those six additional cases harboring p.P102L mutations. Autopsy findings of a case are described and were consistent with the prion pathology of GSS.Conclusions We describe a patient with GSS with a novel p.G131E mutation in the PRNP gene, presenting with a late-onset, slowly progressive phenotype, mimicking a spinocerebellar ataxia, and six additional cases with the typical P102L mutation.
  • article 0 Citação(ões) na Scopus
    The role of ESAT-6 in tuberculosis immunopathology
    (2024) PASSOS, Beatriz B. S.; ARAUJO-PEREIRA, Mariana; VINHAES, Caian L.; AMARAL, Eduardo P.; ANDRADE, Bruno B.
    Despite major global efforts to eliminate tuberculosis, which is caused by Mycobacterium tuberculosis (Mtb), this disease remains as a major plague of humanity. Several factors associated with the host and Mtb interaction favor the infection establishment and/or determine disease progression. The Early Secreted Antigenic Target 6 kDa (ESAT-6) is one of the most important and well-studied mycobacterial virulence factors. This molecule has been described to play an important role in the development of tuberculosis-associated pathology by subverting crucial components of the host immune responses. This review highlights the main effector mechanisms by which ESAT-6 modulates the immune system, directly impacting cell fate and disease progression.
  • article 0 Citação(ões) na Scopus
    Consensus on pharmacological treatment of obesity in Latin America
    (2024) CAPPELLETTI, Ana Maria; MONTERO, Alex Valenzuela; CERCATO, Cintia; OSSMAN, John Jairo Duque; VASQUEZ, Pablo Enrique Fletcher; GARCIA, Juan Eduardo Garcia; MANCILLAS-ADAME, Leonardo Guadalupe; MANRIQUE, Herald Andres; MONTERROSO, Flor de Maria Ranchos; SEGARRA, Pablo; NAVAS, Trina
    A panel of 10 experts in obesity from various Latin American countries held a Zoom meeting intending to reach a consensus on the use of anti-obesity medicines and make updated recommendations suitable for the Latin American population based on the available evidence. A questionnaire with 16 questions was developed using the Patient, Intervention, Comparison, Outcome (Result) methodology, which was iterated according to the modified Delphi methodology, and a consensus was reached with 80% or higher agreement. Failure to reach a consensus led to a second round of analysis with a rephrased question and the same rules for agreement. The recommendations were drafted based on the guidelines of the American College of Cardiology Foundation/American Heart Association Task Force on Practice. This panel of experts recommends drug therapy in patients with a body mass index of >= 30 or >= 27 kg/m2 plus at least one comorbidity, when lifestyle changes are not enough to achieve the weight loss objective; alternatively, lifestyle changes could be maintained while considering individual parameters. Algorithms for the use of long-term medications are suggested based on drugs that increase or decrease body weight, results, contraindications, and medications that are not recommended. The authors concluded that anti-obesity treatments should be individualized and multidisciplinary.
  • article 7 Citação(ões) na Scopus
    Goodbye to the term 'ankylosing spondylitis', hello 'axial spondyloarthritis': time to embrace the ASAS-defined nomenclature
    (2024) HEIJDE, Desiree van der; MOLTO, Anna; RAMIRO, Sofia; BRAUN, Juergen; DOUGADOS, Maxime; GAALEN, Floris A. van; GENSLER, Lianne S.; INMAN, Robert D.; LANDEWE, Robert B. M.; MARZO-ORTEGA, Helena; NAVARRO-COMPAN, Victoria; PHOKA, Andri; PODDUBNYY, Denis; PROTOPOPOV, Mikhail; REVEILLE, John; RUDWALEIT, Martin; SAMPAIO-BARROS, Percival; SEPRIANO, Alexandre; SIEPER, Joachim; BOSCH, Filip E. Van den; HORST-BRUINSMA, Irene van der; MACHADO, Pedro M.; BARALIAKOS, Xenofon
    Ankylosing spondylitis (AS) is the historic term used for decades for the HLA-B27-associated inflammatory disease affecting mainly the sacroiliac joints (SIJ) and spine. Classification criteria for AS have radiographic sacroiliitis as a dominant characteristic. However, with the availability of MRI of SIJ, it could be demonstrated that the disease starts long before definite SIJ changes become visible on radiographs. The Assessment of SpondyloArthritis international Society, representing a worldwide group of experts reached consensus on changes in the nomenclature pertaining to axial spondyloarthritis (axSpA), such as the terminology of diagnosis and of assessment of disease activity tools. These are important changes in the field, as experts in axSpA are now in agreement that the term axSpA is the overall term for the disease. A further differentiation, of which radiographic versus non-radiographic is only one aspect, may be relevant for research purposes. Another important decision was that the terms AS and radiographic axSpA (r-axSpA) can be used interchangeably, but that the preferred term is r-axSpA. Based on the decision that axSpA is the correct terminology, a proposal was made to officially change the meaning of the ASDAS acronym to 'Axial Spondyloarthritis Disease Activity Score'. In addition, for simplification it was proposed that the term ASDAS (instead of ASDAS-CRP) should be preferred and applied to the ASDAS calculated with C reactive protein (CRP). It is hoped that these changes will be used consequently for education, in textbooks, manuscripts and presentations.
  • article 1 Citação(ões) na Scopus
    A systematic review of progranulin concentrations in biofluids in over 7,000 people-assessing the pathogenicity of GRN mutations and other influencing factors
    (2024) SWIFT, Imogen J.; RADEMAKERS, Rosa; FINCH, Nicole; BAKER, Matt; GHIDONI, Roberta; BENUSSI, Luisa; BINETTI, Giuliano; ROSSI, Giacomina; SYNOFZIK, Matthis; WILKE, Carlo; MENGEL, David; GRAFF, Caroline; TAKADA, Leonel T.; SANCHEZ-VALLE, Raquel; ANTONELL, Anna; GALIMBERTI, Daniela; FENOGLIO, Chiara; SERPENTE, Maria; ARCARO, Marina; SCHREIBER, Stefanie; VIELHABER, Stefan; ARNDT, Philipp; SANTANA, Isabel; ALMEIDA, Maria Rosario; MORENO, Fermin; BARANDIARAN, Myriam; GABILONDO, Alazne; STUBERT, Johannes; GOMEZ-TORTOSA, Estrella; AGUEERO, Pablo; SAINZ, M. Jose; GOHDA, Tomohito; MURAKOSHI, Maki; KAMEI, Nozomu; KITTEL-SCHNEIDER, Sarah; REIF, Andreas; WEIGL, Johannes; JIAN, Jinlong; LIU, Chuanju; SERRERO, Ginette; GREITHER, Thomas; THEIL, Gerit; LOHMANN, Ebba; GAZZINA, Stefano; BAGNOLI, Silvia; COPPOLA, Giovanni; BRUNI, Amalia; QUANTE, Mirja; KIESS, Wieland; HIEMISCH, Andreas; JURKUTAT, Anne; BLOCK, Matthew S.; CARLSON, Aaron M.; BRATHEN, Geir; SANDO, Sigrid Botne; GRONTVEDT, Goril Rolfseng; LAURIDSEN, Camilla; HESLEGRAVE, Amanda; HELLER, Carolin; ABEL, Emily; GOMEZ-NUNEZ, Alba; PUEY, Roger; ARIGHI, Andrea; ROTONDO, Enmanuela; JISKOOT, Lize C.; MEETER, Lieke H. H.; DURAES, Joao; LIMA, Marisa; TABUAS-PEREIRA, Miguel; LEMOS, Joao; BOEVE, Bradley; PETERSEN, Ronald C.; DICKSON, Dennis W.; GRAFF-RADFORD, Neill R.; LEBER, Isabelle; SELLAMI, Leila; LAMARI, Foudil; CLOT, Fabienne; BORRONI, Barbara; CANTONI, Valentina; RIVOLTA, Jasmine; LLEO, Alberto; FORTEA, Juan; ALCOLEA, Daniel; ILLAN-GALA, Ignacio; ANDRES-CEREZO, Lucie; DAMME, Philip Van; CLARIMON, Jordi; STEINACKER, Petra; FENEBERG, Emily; OTTO, Markus; ENDE, Emma L. van der; SWIETEN, John C. van; SEELAAR, Harro; ZETTERBERG, Henrik; SOGORB-ESTEVE, Aitana; ROHRER, Jonathan D.
    Background Pathogenic heterozygous mutations in the progranulin gene (GRN) are a key cause of frontotemporal dementia (FTD), leading to significantly reduced biofluid concentrations of the progranulin protein (PGRN). This has led to a number of ongoing therapeutic trials aiming to treat this form of FTD by increasing PGRN levels in mutation carriers. However, we currently lack a complete understanding of factors that affect PGRN levels and potential variation in measurement methods. Here, we aimed to address this gap in knowledge by systematically reviewing published literature on biofluid PGRN concentrations. Methods Published data including biofluid PGRN concentration, age, sex, diagnosis and GRN mutation were collected for 7071 individuals from 75 publications. The majority of analyses (72%) had focused on plasma PGRN concentrations, with many of these (56%) measured with a single assay type (Adipogen) and so the influence of mutation type, age at onset, sex, and diagnosis were investigated in this subset of the data. Results We established a plasma PGRN concentration cut-off between pathogenic mutation carriers and non-carriers of 74.8 ng/mL using the Adipogen assay based on 3301 individuals, with a CSF concentration cut-off of 3.43 ng/mL. Plasma PGRN concentration varied by GRN mutation type as well as by clinical diagnosis in those without a GRN mutation. Plasma PGRN concentration was significantly higher in women than men in GRN mutation carriers (p = 0.007) with a trend in non-carriers (p = 0.062), and there was a significant but weak positive correlation with age in both GRN mutation carriers and non-carriers. No significant association was seen with weight or with TMEM106B rs1990622 genotype. However, higher plasma PGRN levels were seen in those with the GRN rs5848 CC genotype in both GRN mutation carriers and non-carriers. Conclusions These results further support the usefulness of PGRN concentration for the identification of the large majority of pathogenic mutations in the GRN gene. Furthermore, these results highlight the importance of considering additional factors, such as mutation type, sex and age when interpreting PGRN concentrations. This will be particularly important as we enter the era of trials for progranulin-associated FTD.
  • article 0 Citação(ões) na Scopus
    Alcohol consumption during pregnancy by women from southern Brazil: a cross-sectional study
    (2024) ZOTTIS, Laira Francielle Ferreira; SOUZA, Mateus Arenhardt de; HARTMANN, Jessica Karine; GAMA, Thiago Kenji Kurogi; RIZENTAL, Lais Borges; MACIEL, Anita Machado; GRESELE, Merialine; ROSA, Ernani Bohrer da; NUNES, Mauricio Rouvel; ROCHA, Juliana Trevisan da; TELLES, Jorge Alberto Bianchi; CUNHA, Andre Campos da; ZEN, Paulo Ricardo Gazzola; ROSA, Rafael Fabiano Machado
    BACKGROUND: Some maternal characteristics are related to alcohol intake during pregnancy, which irreversibly compromises the maternal -fetal binomial integrity. OBJECTIVES: To identify the frequency, impact, and factors associated with alcohol consumption during pregnancy. DESIGN AND SETTING: A cross-sectional study was performed at the Hospital Materno Infantil Presidente Vargas (HMIPV) in Porto Alegre/RS between March and December 2016. METHODS: A structured questionnaire was administered along with a medical records review. They refer to the maternal sociodemographic and gestational status, alcohol consumption patterns, and characteristics of the fetus/newborn. In the statistical analysis, P values < 0.05 were considered significant. RESULTS: The frequency of alcohol intake was 37.3%; this was characterized by the consumption of fermented beverages (89.3%), especially during the first trimester (79.6%). Risky consumption (high and/ or early) occurred for 30.2% of participants. Risk factors associated with maternal alcohol consumption during pregnancy were tobacco use (P < 0.001) and abortion attempt (P = 0.023). Living with a partner (P = 0.002) and planning pregnancy (P = 0.009) were protective factors. Risky consumption was related to all of the aforementioned variables as well as threatened abortion (P = 0.023). CONCLUSIONS: Alcohol intake during pregnancy is common and affects nearly one-third of pregnant women. Knowledge of the population at risk and protective factors is essential for the development of campaigns that seek to reduce consumption and, therefore, its consequences for the mother and fetus.