Vacina, desmopressina, infeções urinárias e aniversário do cirurgião

1. Vacina
O artigo com os resultados do ensaio clínico da vacina Moderna em adolescentes foi o ‘must-read’ deste Verão. Foi publicado no NEJM: Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents. A total of 3732 participants were randomly assigned to receive mRNA-1273 (2489 participants) or placebo (1243 participants). In the mRNA-1273 group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 93.1% and 92.4%, respectively), headache (in 44.6% and 70.2%, respectively), and fatigue (in 47.9% and 67.8%, respectively); in the placebo group, the most common solicited adverse reactions after the first or second injections were injection-site pain (in 34.8% or 30.3%, respectively), headache (in 38.5% and 30.2%, respectively), and fatigue (in 36.6% and 28.9%, respectively). No serious adverse events related to mRNA-1273 or placebo were noted. The geometric mean titer ratio of pseudovirus neutralizing antibody titers in adolescents relative to young adults was 1.08 (95% confidence interval [CI], 0.94 to 1.24), and the absolute difference in serologic response was 0.2 percentage points (95% CI, −1.8 to 2.4), which met the noninferiority criterion. No cases of Covid-19 with an onset of 14 days after the second injection were reported in the mRNA-1273 group, and four cases occurred in the placebo group.

2. Desmopressina
Este segundo artigo contesta o uso indiscriminado da desmopressina na enurese noctura e é uma pequena aula de fisiologia do aparelho excretor. Under physiological conditions, a normal person produces urine within a circadian rhythm with urine production reducing during night-time sleep accompanied by a fall in night-time blood pressure (BP). Currently, a fall of 10% in night time values for BP is accepted as normal and is called the dipping phenomenon. The lack of this normally expected fall and even small changes in BP can cause significant variations in urine amounts (pressure diuresis). A pergunta que dá nome ao artigo é: Non-dipping phenomenon effects in monosymptomatic nocturnal enuresis treatment?  The response to desmopressin treatment was found to be significantly low in the patients who were non-dippers on 24 h ABPM before treatment compared to those with normal ABPM results (P < 0.05). Similarly, the waking problems in the non-dipper group were found to be high by a significant degree (P < 0.05). In the non-dipper group, the systolic non-dipping rate was higher. Conclusions: Before desmopressin use, assessment of patients with a 24 h ABPM may be beneficial to select the method to be used for treatment.

3. Infeções urinárias
Já saíram no início do ano, mas por alguma razão escaparam-me. São as as guidelines atualizadas da Sociedade Europeia de Urologia Pediátrica sobre diagnóstico, estudo e profilaxia das infeções urinárias. Update of the EAU/ESPU guidelines on urinary tract infections in children. This publication is a summary of the updated 2021 European Association of Urology guidelines on Pediatric Urology. A previous summary of these guidelines was published in 2015 [1]. The most important updates include the incorporation of additional risk factors for anatomic abnormalities in the diagnostic evaluation and an updated flowchart. Furthermore, alternative preventative measures for recurrent UTIs are highlighted.

4. Aniversário do cirurgião
Termino com esta notícia do Medscape: Patient Mortality Higher When Surgeons Operate on Their Birthdays. Patients who undergo procedures on their surgeon’s birthday are more likely to die within a month than those who have surgery on other days of the year, a new study suggests. In the analysis of nearly one million procedures, 2,064 performed on a surgeon’s birthday, the adjusted 30-day mortality for patients who had a procedure on the surgeon’s birthday was 6.9%, as compared to 5.6% when the surgery was on a different day, according to the report published in The BMJ.

Por João Moreira Pinto, MD PhD, Cirurgião Pediátrico
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Cirurgia Pediátrica, Centro Hospitalar Universitário do Porto | Hospital da Luz Arrábida/Guimarães | Hospital-Escola Fernando Pessoa

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