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Search Results: 1 - 10 of 77042 matches for " Torloni Maria Regina "
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Design and level of evidence of studies published in two Brazilian medical journals recently indexed in the ISI Web of Science database
Torloni, Maria Regina;Riera, Rachel;
Sao Paulo Medical Journal , 2010, DOI: 10.1590/S1516-31802010000400005
Abstract: context and objectives: the level of evidence and methodological quality of articles published in medical journals are important aids for clinicians in decision-making and also affect journals' impact factor. although systematic reviews (sr) are considered to represent the highest level of evidence, their methodological quality is not homogeneous and they need to be as carefully assessed as other types of study. this study aimed to assess the design and level of evidence of articles published in 2007, in two recently indexed brazilian journals (clinics and revista da associa??o médica brasileira), and to evaluate the methodological quality of the srs. design and setting: descriptive study developed in the brazilian cochrane center, universidade federal de s?o paulo. methods: all 289 published articles were classified according to types of study design and level of evidence. the srs were critically appraised by two evaluators using the amstar tool. results: the most frequent design types were cross-sectional studies (39.9%), case reports (15.8%), experimental studies (10.8%) and narrative reviews (7.4%). according to the oxford criteria, 25.6% of the articles were classified as level 4 or 5 evidence, while 2.8% were level 1. srs represented only 2% of the published articles and their methodological quality scores were low. conclusions: the main design types among the published papers were observational and experimental studies and narrative reviews. srs accounted for a small proportion of the articles and had low methodological scores. brazilian medical journals need to encourage publication of greater numbers of clinically relevant papers of high methodological quality.
Placenta Prévia: Fatores de risco para o Acretismo
Torloni, Maria Regina;Moron, Antonio Fernandes;Camano, Luiz;
Revista Brasileira de Ginecologia e Obstetrícia , 2001, DOI: 10.1590/S0100-72032001000700002
Abstract: purpose: to investigate risk factors associated with accretion in placenta previa (pp) patients. methods: this was a retrospective case-control study of all the records of patients who delivered between 1986-1998 at maternidade escola de vila nova cachoeirinha (s?o paulo) with a diagnosis of placenta previa. the groups with and without accretion were compared regarding age, parity, previous history of miscarriage, curettage and cesarean section, type of pp and predominant area of placental attachment. possible associations between the dependent (accretion) and independent (maternal and placental characteristics) variables were evaluated using the c2 test, univariate and multivariate analyses. results: reviewing 245 cases of pp, two risk factors were significantly associated with accretion: central placenta previa (odds ratio (or): 2.93) and two or more previous cesarean sections(or: 2.54). based on these data, a predictive model was constructed, according to which a patient with central pp and two more previous cesarean sections has a 44.4% risk for accretion. conclusions: results of the current study may help obstetricians in the classification of their patients with pp in different risk categories for accretion. this could be useful in preparing for possible delivery complications in those patients considered at a higher risk for accretion.
Gaucher's disease with myocardial involvement in pregnancy
Torloni, Maria Regina;Franco, Kátia;Sass, Nelson;
Sao Paulo Medical Journal , 2002, DOI: 10.1590/S1516-31802002000300008
Abstract: context: described originally in 1882, gaucher's disease is the most prevalent of storage disorders. this autosomal recessive disease is caused by a defective gene responsible for coding the beta-glucosidase enzyme, essential in the hydrolysis of glucosylceramide in glucose and ceramide. the accumulation of glucosylceramide in the lysosomes of the reticuloendothelial system produces a heterogeneous clinical picture with neurological involvement, liver and spleen enlargement, hematological disorders and bone lesions. case report: two pregnancies of a patient with gaucher's disease are presented. the patient, who had been asymptomatic following earlier splenectomy, developed congestive heart failure due to myocardial involvement at the beginning of her first pregnancy, and responded to conservative treatment. in spite of this complication and also chronic anemia, hepatomegaly and ascites due to portal hypertension, the patient had two successful pregnancies with good perinatal results. no hemorrhagic complications were observed.
Placenta Prévia: Fatores de risco para o Acretismo
Torloni Maria Regina,Moron Antonio Fernandes,Camano Luiz
Revista Brasileira de Ginecologia e Obstetrícia , 2001,
Abstract: Objetivo: investiga o dos fatores de risco associados ao acretismo em pacientes com placenta prévia (PP). Métodos: foi realizada uma análise retrospectiva caso-controle de todos os prontuários de pacientes com diagnóstico de PP que tiveram seus partos na Maternidade Escola Vila Nova Cachoeirinha (S o Paulo) entre 1986 e 1998. O grupo com acretismo foi comparado ao grupo sem acretismo quanto à idade, paridade, antecedentes de abortamentos, curetagens e cesarianas, o tipo de PP e a área predominante de inser o placentária. Para avaliar a associa o entre a variável dependente (acretismo placentário) e as variáveis independentes (características maternas e placentária) foram utilizados o teste do chi2, análise univariada e multivariada, considerando-se significantes os valores de p < 0,05. Resultados: o levantamento de 245 casos de PP evidenciou que os fatores de risco, significativamente associados ao acretismo, foram o tipo de PP centro-total (odds ratio (OR): 2,93) e o antecedente de duas ou mais cesarianas (OR: 2,54). Utilizando estes resultados foi possível construir um modelo preditivo para a probabilidade de ter acretismo, segundo o qual uma paciente com PP centro-total e duas ou mais cesáreas teria uma probabilidade de 44,4% de apresentar acretismo placentário. Conclus es: os resultados deste estudo podem ajudar o obstetra a classificar suas gestantes com PP em diferentes categorias de risco para o acretismo, o que possibilita a ado o de medidas apropriadas para lidar com possíveis complica es no parto daquelas pacientes com maior risco de acretismo.
Gesta??o Trigemelar Espontanea: Complica??es Maternas e Resultados Perinatais
Torloni, Maria Regina;Kikuti, Márcia Akemi;Costa, Márcia Maria Marques da;
Revista Brasileira de Ginecologia e Obstetrícia , 2000, DOI: 10.1590/S0100-72032000000700003
Abstract: purpose: to analyze maternal complications and perinatal results of triplet pregnancies. method: retrospective study of maternal and perinatal data on all triplets weighing >500 g delivered in a period of 8 years at maternidade escola de vila nova cachoeirinha. results: between 1990-1998, 18 women gave birth to triplets, representing 1 in every 2,060 deliveries. the main complications were preterm delivery (94.4%) and preeclampsia (44.4%) and 83.3% of these patients needed hospitalization before delivery, for 1-50 days, most in order to inhibit preterm labor. cesarean section was performed in 88.9%, the mean gestational age at birth was 34.2 weeks (+ 1.8), mean weight 1,827 g (+ 421), 20.4% weighed <1,500 g and 75.9% weighed 1,500-2,499 g. birth weight discrepancy (> 25%) occurred in 38.9% of these pregnancies and 35.2% of the 54 fetuses were small for gestational age. eighty-six percent of live-born infants had neonatal morbidity and 3.7% had evident congenital anomalies. perinatal mortality was 16.7%, 7.4% due to intrauterine demise and 9.3% due to neonatal death. the mean duration of hospitalization in the neonatal ward was 18.5 days; late neonatal sepsis was the main cause of death. conclusion: triplet pregnancies had high a incidence of obstetric complications, demanded prolonged maternal hospitalization and ended almost always in surgical delivery. intrauterine and neonatal death rates were high, neonatal morbidity was detected in almost all live-born infants and their hospitalization was long, exposing these prematures to infection, their main cause of death. triplet pregnancies carry high maternal and fetal risks and should be managed at tertiary facilities.
Gesta o Trigemelar Espontanea: Complica es Maternas e Resultados Perinatais
Torloni Maria Regina,Kikuti Márcia Akemi,Costa Márcia Maria Marques da
Revista Brasileira de Ginecologia e Obstetrícia , 2000,
Abstract: Objetivo: avaliar as complica es maternas e os resultados perinatais de gesta es trigemelares. Métodos: estudo retrospectivo analisando variáveis maternas e perinatais de todas gesta es trigemelares com peso fetal > 500 g ocorridas em 8 anos na Maternidade Escola de Vila Nova Cachoeirinha. Resultados: entre 1990-1998, 18 gestantes deram à luz trigemelares, representando 1:2.060 partos. As principais complica es foram a prematuridade (94,4%) e pré-eclampsia (44,4%) e 83,3% das pacientes precisaram ser internadas antes do parto por 1-50 dias, a maioria para inibi o de trabalho de parto prematuro. O parto foi cesáreo em 88,9%, a IG média ao nascer foi 34,2 semanas (+ 1,8), o peso médio foi 1.827 g (+ 421), com 20,4% <1.500 g e 75,9% pesando entre 1.500-2.499 g. Houve discordancia de peso (>25%) em 38,9% das gesta es e 35,2% dos 54 conceptos eram pequenos para idade gestacional. A morbidade neonatal acometeu 86% dos nativivos e 3,7% tiveram malforma es evidentes. A mortalidade perinatal foi de 16,7%: 7,4% natimortos e 9,3% neomortos. A permanência média no ber ário foi 18,5 dias e a principal causa de neomortalidade foi a sepse tardia. Conclus o: as gesta es trigemelares tiveram elevada incidência de complica es obstétricas, exigiram interna es maternas prolongadas e terminaram quase todas em parto operatório. A nati e neomortalidade foram elevadas, a morbidade neonatal acometeu praticamente todos os neonatos e a permanência no ber ário foi prolongada, expondo esses prematuros à infec o, principal causa de mortalidade neonatal. A gesta o trigemelar é de alto risco materno e fetal e exige atendimento em centros terciários.
Does sodium nitroprusside kill babies? A systematic review
Sass, Nelson;Itamoto, Caroline Harumi;Silva, Marina Pereira;Torloni, Maria Regina;Atallah, álvaro Nagib;
Sao Paulo Medical Journal , 2007, DOI: 10.1590/S1516-31802007000200008
Abstract: objective: to determine whether sodium nitroprusside causes fetal death in pregnancies complicated with hypertension. data sources: medical literature analysis and retrieval system online (medline; 1996 to 2003), excerpta medica (embase; 1970 to 2003), web of science/institute for scientific information (isi; 1945 to 2003), literatura latino-americana e do caribe em ciências da saúde (lilacs; 1982 to 2003) and the cochrane library. review methods: the medical subject headings used were "nitroprusside and pregnancy", "hypertension or eclampsia or preeclampsia" and "nitroprusside and pregnancy and hypertensive emergencies". the search was limited to humans and female gender, in all fields, publication types, languages and subsets. articles were also identified by reviewing the references of articles and textbooks on hypertension and pregnancy. results: the search located nine studies. the sum of all the publications yielded a total of 22 patients and 24 exposed fetuses (two pairs of twins). there were no randomized clinical trials and no prospective cohorts. all of the studies were observational in nature. conclusions: at present, there is insufficient evidence for definitive conclusions about any direct association between sodium nitroprusside use and fetal demise.
Continuing medical education in Brazil: what about obstetricians and gynecologists?
Sass, Nelson;Torloni, Maria Regina;Soares, Bernardo Garcia de Oliveira;Atallah, álvaro Nagib;
Sao Paulo Medical Journal , 2005, DOI: 10.1590/S1516-31802005000100002
Abstract: context: in brazil, obstetricians and gynecologists are not required to submit to periodical evaluations to ascertain their professional competence in dealing with new concepts and therapies. objectives: to evaluate the performance of a group of obstetricians and gynecologists on a written evidence-based obstetrics test and determine their opinions and use of systematic reviews. type of study: prospective cohort. setting: brazilian obstetrics and gynecology congress 2001. methods: 230 doctors agreed to participate in the study during a national obstetrics and gynecology congress. participants took an individual anonymous written multiple-choice test with seven questions on clinical obstetrics, one question on the interpretation of a meta-analysis graph and two questions on their opinions and actual use of systematic reviews. scores were analyzed and compared after grouping the participants according to year of graduation, residence training, doctoral program and faculty status. results: the general average score was 49.2 ± 17.4. the scores tended to decline as the years since graduation advanced. doctors who graduated in the last five years had higher scores than those who graduated over 25 years ago (52.2 versus 42.9). the performance did not vary according to medical residence, postgraduate program or teaching status. while 98.2% considered systematic reviews relevant, only 54.9% said that they routinely used this source of information. discussion: the participants' average score was low, even though they were highly qualified and trained. despite the limitations of the study, the results are worrisome. if motivated physicians participating in a national congress obtained such low scores, we can speculate that the results might be even worse among other doctors that do not attend these events. conclusions: these findings suggest that brazilian obstetricians and gynecologists could benefit from continuing medical education and raise questions about the recycling me
A Systematic Review of the Robson Classification for Caesarean Section: What Works, Doesn't Work and How to Improve It
Ana Pilar Betrán, Nadia Vindevoghel, Joao Paulo Souza, A. Metin Gülmezoglu, Maria Regina Torloni
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0097769
Abstract: Background Caesarean sections (CS) rates continue to increase worldwide without a clear understanding of the main drivers and consequences. The lack of a standardized internationally-accepted classification system to monitor and compare CS rates is one of the barriers to a better understanding of this trend. The Robson's 10-group classification is based on simple obstetrical parameters (parity, previous CS, gestational age, onset of labour, fetal presentation and number of fetuses) and does not involve the indication for CS. This classification has become very popular over the last years in many countries. We conducted a systematic review to synthesize the experience of users on the implementation of this classification and proposed adaptations. Methods Four electronic databases were searched. A three-step thematic synthesis approach and a qualitative metasummary method were used. Results 232 unique reports were identified, 97 were selected for full-text evaluation and 73 were included. These publications reported on the use of Robson's classification in over 33 million women from 31 countries. According to users, the main strengths of the classification are its simplicity, robustness, reliability and flexibility. However, missing data, misclassification of women and lack of definition or consensus on core variables of the classification are challenges. To improve the classification for local use and to decrease heterogeneity within groups, several subdivisions in each of the 10 groups have been proposed. Group 5 (women with previous CS) received the largest number of suggestions. Conclusions The use of the Robson classification is increasing rapidly and spontaneously worldwide. Despite some limitations, this classification is easy to implement and interpret. Several suggested modifications could be useful to help facilities and countries as they work towards its implementation.
Classifications for Cesarean Section: A Systematic Review
Maria Regina Torloni,Ana Pilar Betran,Joao Paulo Souza,Mariana Widmer,Tomas Allen,Metin Gulmezoglu,Mario Merialdi
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014566
Abstract: Rising cesarean section (CS) rates are a major public health concern and cause worldwide debates. To propose and implement effective measures to reduce or increase CS rates where necessary requires an appropriate classification. Despite several existing CS classifications, there has not yet been a systematic review of these. This study aimed to 1) identify the main CS classifications used worldwide, 2) analyze advantages and deficiencies of each system.
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