Equations based on anthropometry to predict body fat measured by absorptiometry in schoolchildren and adolescents

OBJECTIVE

To develop and validate equations to estimate the percentage of body fat of children and adolescents from Mexico using anthropometric measurements.

METHODS

A cross-sectional study was carried out with 601 children and adolescents from Mexico aged 5-19 years. The participants were randomly divided into the following two groups: the development sample (n=398) and the validation sample (n=203). The validity of previously published equations (e.g., Slaughter) was also assessed. The percentage of body fat was estimated by dual-energy X-ray absorptiometry. The anthropometric measurements included height, sitting height, weight, waist and arm circumferences, skinfolds (triceps, biceps, subscapular, supra-iliac, and calf), and elbow and bitrochanteric breadth. Linear regression models were estimated with the percentage of body fat as the dependent variable and the anthropometric measurements as the independent variables.

RESULTS

Equations were created based on combinations of six to nine anthropometric variables and had coefficients of determination (r²) equal to or higher than 92.4% for boys and 85.8% for girls. In the validation sample, the developed equations had high r² values (≥85.6% in boys and ≥78.1% in girls) in all age groups, low standard errors (SE≤3.05% in boys and ≤3.52% in girls), and the intercepts were not different from the origin (p>0.050). Using the previously published equations, the coefficients of determination were lower, and/or the intercepts were different from the origin.

CONCLUSIONS

The equations developed in this study can be used to assess the percentage of body fat of Mexican schoolchildren and adolescents, as they demonstrate greater validity and lower error compared with previously published equations.

Comparison of body composition and adipokine levels between thin and normal-weight prepubertal children

OBJECTIVE

Thinness can have substantial consequences for child development and health. Adipokines, including leptin and adiponectin, play a significant role in the regulation of important metabolic functions. The aim of this study was to investigate associations between body composition and serum leptin and adiponectin levels in thin and normal-weight children.

METHODS

The authors examined 100 healthy prepubertal children, who were divided into two subgroups: thin (n=50) and normal-weight children (n=50). Body composition was assessed by dual-energy X-ray absorptiometry. Serum concentrations of adipokines were determined by immunoenzymatic assays.

RESULTS

Thin children had a similar body height but significantly lower (p<0.0001) body weight, body mass index, fat mass, lean mass, and bone mineral content compared with normal-weight children. Serum concentrations of leptin were about 2-fold lower (p<0.0001) in thin vs. normal-weight subjects. Serum levels of total adiponectin, adiponectin multimers, and soluble leptin receptor (sOB-R) were similar in both groups. The leptin/soluble leptin receptor ratio and leptin/adiponectin ratios were lower (p<0.0001) in thin vs. normal-weight children. In both groups of children, it was found that body composition parameters were positively related with leptin but not with adiponectin levels. Additionally, bone mineral content was positively related with body mass index, fat mass, lean mass, and leptin level in thin and normal-weight children.

CONCLUSIONS

Prepubertal thin children have disturbances in body composition and adipokine profile. Early recognition of thinness and determination of body composition parameters and adipokine levels can be useful in medical and nutritional care of thin children for the optimization of bone mineral accrual.

Acute viral bronchiolitis and risk of asthma in schoolchildren: analysis of a Brazilian newborn cohort

OBJECTIVE

To verify whether the occurrence of acute viral bronchiolitis in the first year of life constitutes a risk factor for asthma at age 6 considering a parental history of asthma.

METHODS

Cross-sectional study in a cohort of live births. A standardized questionnaire of the International Study of Asthma and Allergies in Childhood was applied to the mothers to identify asthma in children at the age of 6 years. Acute viral bronchiolitis diagnosis was performed by maternal report of a medical diagnosis and/or presence of symptoms of coryza accompanied by cough, tachypnea, and dyspnea when participants were 3, 6, 9, and 12 months. Socioeconomic, environmental data, parental history of asthma, and data related to pregnancy were collected in the first 72h of life of the newborn and in prospective home visits by trained interviewers. The association between acute viral bronchiolitis and asthma was evaluated by logistic regression analysis and potential modifier effect of parental history was verified by introducing an interaction term into the adjusted logistic regression model.

RESULTS

Prevalence of acute viral bronchiolitis in the first year of life was 68.6% (461). The occurrence of acute viral bronchiolitis was a risk factor for asthma at 6 years of age in children with parental history of asthma OR: 2.66, 95% CI (1.10-6.40), modifier effect p=0.002. Parental history of asthma OR: 2.07, 95% CI (1.29-3.30) and male gender OR: 1.69, 95% CI, (1.06-2.69) were other identified risk factors for asthma.

CONCLUSION

Acute viral bronchiolitis in the first year of life is a risk factor for asthma in children with parental history of asthma.

Association between dietary pattern and cardiometabolic risk in children and adolescents: a systematic review

OBJECTIVE

To evaluate the association between dietary patterns and cardiometabolic risk factors in children and adolescents.

DATA SOURCE

This article followed the recommendations of PRISMA, which aims to guide review publications in the health area. The article search strategy included searches in the electronic databases MEDLINE via PubMed, Scopus, and LILACS. There was no date limitation for publications. The descriptors were used in English according to MeSH and in Portuguese according to DeCS. Only articles on dietary patterns extracted by the a posteriori methodology were included. The question to be answered was: how much can an "unhealthy" dietary pattern influence biochemical and inflammatory markers in this population?

DATA SYNTHESIS

The studies showed an association between dietary patterns and cardiometabolic alterations. The patterns were characterized as unhealthy when associated to the consumption of ultraprocessed products, poor in fiber and rich in sodium, fat, and refined carbohydrates. Despite the associations, in several studies, the strength of this association for some risk markers was reduced or lost after adjusting for confounding variables.

CONCLUSION

There was a positive association between "unhealthy" dietary patterns and cardiometabolic alterations in children and adolescents. Some unconfirmed associations may be related to the difficulty of assessing food consumption. Nevertheless, studies involving dietary patterns and their association with risk factors should be performed in children and adolescents, aiming at interventions and early changes in dietary habits considered to be inadequate.

Diabetic ketoacidosis in a pediatric intensive care unit

OBJECTIVE

To describe the characteristics of children aged 0-14 years diagnosed with diabetic ketoacidosis and compare the following outcomes between children with prior diagnosis of type 1 diabetes mellitus and children without prior diagnosis of type 1 diabetes mellitus length of hospital stay, severity on admission, insulin dosage, time of continuous insulin use, volume of fluids infused during treatment, and complications.

METHODS

A retrospective descriptive study with review of medical records of patients admitted to the pediatric intensive care unit of a referral hospital from June 2013 to July 2015. The following data regarding 52 admissions were analyzed: age, sex, weight, body surface area, signs, symptoms and severity on admission, blood gas, blood glucose, glycated hemoglobin, serum osmolarity, and index of mortality. The insulin dosage, time of continuous insulin use, volume administered in the expansion phase and in the first 24h, length of stay, and complications such as electrolyte disturbances, hypoglycemia, cerebral edema, and death were compared between the two groups.

RESULTS

Patients without a previous diagnosis of DM1 were younger at admission, with mean age of 8.4 years (p<0.01), reported more nausea or vomiting, polydipsia and polyuria, and showed more weight loss (p<0.01). This study also observed a higher prevalence of hypokalemia (p<0.01) and longer hospital stay in this group.

CONCLUSIONS

No differences in severity between groups were observed. The study showed that children without prior diagnosis of type 1 diabetes mellitus were younger at admission, had more hypokalemia during the course of treatment, and had greater length of hospital stay.

Sleep disorders in children with moderate to severe persistent allergic rhinitis

Introduction

Allergic rhinitis is associated with several complications, including sleep disorders. The Children's Sleep Habits Questionnaire has been recently translated and validated in Portuguese for the evaluation of sleep disorders in children.

Objective

To assess sleep disorders in children with moderate to severe persistent allergic rhinitis and to correlate the findings with disease severity markers.

Methods

We evaluated 167 children (4–10 years), 112 with allergic rhinitis and 55 controls. Parents/guardians of the children answered the Children's Sleep Habits Questionnaire, consisting of 33 questions divided into eight subscales, which refers to the previous week. Patients with rhinitis were also evaluated regarding the score of nasal and extra-nasal symptoms related to the previous week and the peak nasal inspiratory flow.

Results

There were no significant differences between groups of different age. All patients with rhinitis were being treated with nasal topical corticosteroids. The total Children's Sleep Habits Questionnaire score was significantly higher among children with rhinitis than in controls (median 48 vs. 43, p < 0.001). Significantly higher values were also observed for the parasomnia (9 vs. 8), respiratory disorders (4 vs. 3) and daytime sleepiness (14 vs. 12) subscales. Among the patients with rhinitis, no significant correlation was observed between the total Children's Sleep Habits Questionnaire score and disease activity variables, but moderate correlations were observed for the respiratory distress subscale vs. nasal symptom score (r = 0.32) and vs. extra-nasal symptom score (r = 0.32).

Conclusion

Children with moderate to severe persistent allergic rhinitis, even when submitted to regular treatment, have a higher frequency of sleep disorders than controls, particularly concerning nocturnal breathing disorders, daytime sleepiness, and parasomnias. The intensity of sleep disorders found in some subscales was correlated with objective markers of allergic rhinitis severity.

Clinical and genetic diagnosis of familial hypertrophic cardiomyopathy: Results in pediatric cardiology

INTRODUCTION

Hypertrophic cardiomyopathy (HCM) is most often of autosomal dominant inheritance with incomplete penetrance and variable expression. The main purpose of family screening is to identify relatives with unrecognized HCM and to monitor those at risk for disease, in order to minimize complications and to assess risk of sudden cardiac death. The ESC and ACCF/AHA guidelines on the diagnosis and management of HCM recommend the screening of child relatives from the age of 10-12 years.

OBJECTIVES

We studied the outcome of clinical screening and genetic testing of child probands and relatives (<18 years of age) from families with HCM and assessed the age-related penetrance of HCM during the follow-up of these young relatives.

METHODS AND RESULTS

Twenty patients from ten families were included between 2004 and 2013, consisting of three probands and 17 first-degree relatives (80% male; median age 10 years). Fourteen child relatives were mutation carriers (70%; median age eight years). Seven (50%) of the 14 mutation carriers were diagnosed with HCM at initial assessment. At-risk child relatives were defined as those with a positive mutation but a negative phenotype at enrollment. After 3.5±0.8 years of follow-up, two of the phenotype-negative mutation carriers developed HCM at 10 and 15 years of age (28% penetrance rate).

CONCLUSIONS

The penetrance of HCM in phenotype-negative child relatives was 28% after 3.5 years of follow-up. This underlines the need for long-term monitoring of mutation carriers irrespective of the presence of a positive phenotype.

Nutritional quality of dietary patterns of children: are there differences inside and outside school?

OBJECTIVES

To describe the dietary patterns of children inside and outside school and investigate their associations with sociodemographic factors and nutritional status.

METHODS

This was a multicenter cross-sectional study in which children of both sexes, aged 1-6 years, attending private and public daycare centers and preschools in Brazil, were evaluated (n=2979). Demographic, socioeconomic and dietary data (weighed food records and estimated food records) were collected. Dietary patterns were derived by factor analysis from 36 food groups.

RESULTS

Four dietary patterns were identified inside school, and three outside. Inside school, the "traditional" pattern was associated to low income and presented high nutritional quality. The "dual" pattern was associated with low income and with high intake of added sugar and glycemic load. The "snack" pattern was associated with children enrolled at private schools and with high intake of added sugar and glycemic load. The "bread and butter" pattern was associated with high intake of added sugar and trans fat. Outside school, the "traditional" pattern was associated with high intake of saturated fat, trans fats, sodium, and total fiber. The "bread and butter" pattern was associated with high intake of trans fats and glycemic load, whereas the "snack" pattern was associated with overweight, private schools, high income, and high intake of trans fats, sodium, and total fiber.

CONCLUSION

There are differences in the nutritional quality of dietary patterns inside and outside school, and heterogeneity in adherence to these patterns were observed across regions and socioeconomic classes.

[Anthropometric indices among schoolchildren from a municipality in Southern Brazil: a descriptive analysis using the LMS method]

OBJECTIVE:

To describe the percentile values for body mass index (BMI), waist circumference (WC) and waist-to-height (WHtR) of children from Colombo, Brazil, and compare them with data of children from other countries.

METHODS:

This was a cross-sectional study with a random sample of 2,035 children aged 6-11 years. Age- and sex-specific smoothed percentiles curves for BMI, WC and WHtR were created using the LMS method. Values of 10^th, 50^th and 90^th percentiles from Brazilian children were compared with data from other countries.

RESULTS:

There was a trend of increasing BMI and WC with age in both sexes. WHtR remained constant with advancing age in boys and girls. Comparison of the growth pattern among countries showed clear differences. Southern Brazil boys and girls had elevated 90^th percentile values for BMI, which was similar to German children and higher than the North American and World Health Organization percentile values. However, children from this study had intermediate values for WC and WHtR in comparison to children from other countries.

CONCLUSIONS:

Elevated BMI values were observed among southern Brazilian children, but WC and WHtR percentile values were lower in southern Brazilian children than in children from other countries. Interventions at different levels should be made to avoid a probable increase of nutritional disorders (especially general obesity) in the next years.

Impact of extrinsic factors on fine motor performance of children attending day care

OBJECTIVE

To assess the impact of extrinsic factors on fine motor performance of children aged two years old.

METHODS

73 children attending public and 21 private day care centers were assessed. Day care environment was evaluated using the Infant/Toddler Environment Rating Scale - Revised Edition (ITERS-R), fine motor performance was assessed through the Bayley Scales of Infant and Toddler Development - III (BSITD-III), socioeconomic data, maternal education and time of start at the day care were collected through interviews. Spearman's correlation coefficient was calculated to assess the association between the studied variables.

RESULTS

The time at the day care was positively correlated with the children's performance in some fine motor tasks of the BSITD-III, showing that the activities developed in day care centers were important for the refinement of specific motor skills, while the overall fine motor performance by the scale was associated with maternal education and the ITERS-R scale sub-item "language and understanding".

CONCLUSIONS

Extrinsic factors such as higher maternal education and quality of day care centers are associated with fine motor performance in children attending day care.

Acute kidney injury in HIV-infected children: comparison of patients according to the use of highly active antiretroviral therapy

OBJECTIVE

To assess clinical and laboratory data, and acute kidney injury (AKI) in HIV-infected children using and not using highly active antiretroviral therapy (HAART) prior to admission.

METHODS

A retrospective study was conducted with HIV-infected pediatric patients (<16 years). Children who were using and not using HAART prior to admission were compared.

RESULTS

Sixty-three patients were included. Mean age was 5.3±4.27 years; 55.6% were females. AKI was observed in 33 (52.3%) children. Patients on HAART presented lower levels of potassium (3.9±0.8 vs. 4.5±0.7mEq/L, p=0.019) and bicarbonate (19.1±4.9 vs. 23.5±2.2mEq/L, p=0.013) and had a higher estimated glomerular filtration rate (102.2±36.7 vs. 77.0±32.8mL/min/1.73m², p=0.011) than those not on HAART. In the multivariate analysis, the use of HAART prior to the admission was a protective factor for AKI (p=0.036; OR=0.30; 95% CI=0.097-0.926).

CONCLUSION

AKI is a common complication of pediatric HIV infection. Use of HAART prior to the admission preserved glomerular filtration and was a protective factor for AKI, but increased medication side effects, such as hypokalemia and renal metabolic acidosis.

Effects of the use of growth hormone in children and adolescents with juvenile idiopathic arthritis: a systematic review

INTRODUCTION

Children with juvenile idiopathic arthritis (JIA) often have impaired growth and short stature. There is evidence that the therapeutic use of growth hormone (GH) is useful and safe in these patients.

OBJECTIVE

To analyze the effects of GH use in patients with JIA.

METHOD

A systematic review of the literature over the last 18 years in Medline and Embase databases. The criteria were analyzed independently by the researchers. We used the following keywords: "growth hormone", "arthritis, juvenile", "arthritis, rheumatoid", "child" and "adolescent".

RESULTS

Among the 192 identified articles, 20 corresponded to the inclusion criteria. Seventeen longitudinal studies and 3 case reports were found. Most studies analyzed observed increased growth, muscle mass and bone mass using GH. Adverse effects observed were glucose intolerance, diabetes, bone deformities, osteonecrosis, reactivation of the disease and low final height.

CONCLUSION

The majority of studies reported positive effects after the therapeutic use of GH, but some variability in response to treatment was observed. The combination of growth hormone with other drugs seems to be a good option.

Waist circumference as a mediator of biological maturation effect on the motor coordination in children

OBJECTIVE

The present study aimed to: 1) examine the association of biological maturation effect on children's performance at a motor coordination battery and 2) to assess whether the association between biological maturation and scores obtained in motor coordination tests is mediated by some anthropometric measurement.

METHODS

The convenience sample consisted of 73 male children aged 8 years old. Anthropometric data considered the height, body mass, sitting height, waist circumference, body mass index, fat mass and fat-free mass estimates. Biological maturation was assessed by the percentage of the predicted mature stature. Motor coordination was tested by the Körperkoordinationstest für Kinder. A partial correlation between anthropometric measurements, z-score of maturation and the motor coordination tests were performed, controlling for chronological age. Finally, causal mediation analysis was performed.

RESULTS

Height, body mass, waist circumference and fat mass showed a slight to moderate inverse correlation with motor coordination. Biological maturation was significantly associated with the balance test with backward walking (r=-0.34). Total mediation of the waist circumference was identified in the association between biological maturation and balance test with backward walking (77%).

CONCLUSIONS

We identified an association between biological maturation and KTK test performance in male children and also verified that there is mediation of waist circumference. It is recommended that studies be carried out with female individuals and at other age ranges.

Clinical and laboratory signs associated to serious dengue disease in hospitalized children

OBJECTIVE

To evaluate the validity of clinical and laboratory signs to serious dengue disease in hospitalized children.

METHODS

Retrospective cohort of children (<18 years) hospitalized with dengue diagnosis (2007-2008). Serious dengue disease was defined as death or use of advanced life support therapy. Accuracy measures and area under the receiver operating characteristic curve were calculated.

RESULTS

Of the total (n=145), 53.1% were female, 69% aged 2-11 years, and 15.9% evolved to the worse outcome. Lethargy had the best accuracy (positive likelihood ratio >19 and negative likelihood ratio <0.6). Pleural effusion and abdominal distension had higher sensitivity (82.6%). History of bleeding (epistaxis, gingival or gastrointestinal bleeding) and severe hemorrhage (pulmonary or gastrointestinal bleeding) in physical examination were more frequent in serious dengue disease (p<0.01), but with poor accuracy (positive likelihood ratio=1.89 and 3.89; negative likelihood ratio=0.53 and 0.60, respectively). Serum albumin was lower in serious dengue forms (p<0.01). Despite statistical significance (p<0.05), both groups presented thrombocytopenia. Platelets count, hematocrit, and hemoglobin parameters had area under the curve <0.5.

CONCLUSIONS

Lethargy, abdominal distension, pleural effusion, and hypoalbuminemia were the best clinical and laboratorial markers of serious dengue disease in hospitalized children, while bleeding, severe hemorrhage, hemoconcentration and thrombocytopenia did not reach adequate diagnostic accuracy. In pediatric referral hospitals, the absence of hemoconcentration does not imply absence of plasma leakage, particularly in children with previous fluid replacement. These findings may contribute to the clinical management of dengue in children at referral hospitals.

Influence of the Bolsa Família program on nutritional status and food frequency of schoolchildren

OBJECTIVE

To evaluate the food frequency and nutritional status among students according to participation in the Bolsa Família program funded by the government.

METHODS

Cross-sectional study carried out with students from the fourth grade of elementary school in the municipal capital of the southeastern region of Brazil. Food consumption and anthropometry were investigated by a questionnaire administered in school, while participation in the Bolsa Família program and other socio-economic information was obtained through a protocol applied to mothers/guardians. Statistical analysis included the Mann-Whitney test, the chi-squared test, and Poisson regression with robust variance, and the 5% significance level was adopted.

RESULTS

There were 319 children evaluated; 56.4% were male, with a median of 9.4 (8.6-11.9) years, and 37.0% were beneficiaries of Bolsa Família program. Between the two groups, there was high prevalence of regular soda consumption (34.3%), artificial juice (49.5%), and sweets (40.3%), while only 54.3% and 51.7% consumed fruits and vegetables regularly, respectively. Among participants of Bolsa Família program, a prevalence 1.24 times higher in the regular consumption of soft drinks (95% CI: 1.10-1.39) was identified compared to non-beneficiaries. The prevalence of overweight was higher in the sample (32.9%), with no difference according to participation in the program.

CONCLUSION

The study found increased consumption of soft drinks among BFP participants. The high rate of overweight and poor eating habits denote the need to develop actions to promote healthy eating, especially for the beneficiaries of the Bolsa Família program, to promote improvements in nutritional status and prevent chronic diseases throughout life.

Coparenting after marital dissolution and children's mental health: a systematic review

OBJECTIVE

Research has shown that coparenting is a vital family mechanism in predicting mental health in children and adolescents. Considering the increasing prevalence of marital dissolution in Western societies, the objective of this systematic review was to summarize the key results of empirical studies that tested the association between mental health of children and coparenting after marital dissolution.

DATA SOURCE

The studies were obtained from three databases (PsycInfo, PubMed, and Web of Knowledge), published between January 2000 and October 2014. The titles, abstracts, and key words of the generated citations were independently reviewed by two investigators to consensually select the articles that met the inclusion criteria. Articles that used psychometrically valid tools to measure at least one mental health indicator and at least one dimension of coparenting in samples with divorced parents were included in the review.

DATA SYNTHESIS

Of the 933 screened articles, 11 met the inclusion criteria. Significant positive associations were found between coparental conflict and behavioral problems and symptoms of anxiety, depression, and somatization. Significant positive associations were also found between other specific dimensions of coparenting (coparental support, cooperation, and agreement), overall mental health, self-esteem, and academic performance.

CONCLUSIONS

The integrated analysis of these studies suggests that coparenting is a key mechanism within the family system for the prediction of child mental health after marital dissolution, and thus, it is recommended that pediatricians, psychologists, and other health professionals consider coparenting as a psychosocial variable for children's mental health assessment and diagnosis.

Can procalcitonin be a diagnostic marker for catheter-related blood stream infection in children?

OBJECTIVE

The potential role of procalcitonin (PCT) in the diagnosis of catheter-related bloodstream infection (CRBSIs) is still unclear and requires further research. The diagnostic value of serum PCT for the diagnosis of CRBSI in children is evaluated here.

METHOD

This study was conducted between October 2013 and November 2014, and included patients with suspected CRBSI from 1 month to 18 years of age who were febrile, with no focus of infection, and had a central venous catheter. Levels of PCT and other serum markers were measured, and their utility as CRBSI markers was assessed. Additionally, the clinical performance of a new, automated, rapid, and quantitative assay for the detection of PCT was tested.

RESULTS

Among the 49 patients, 24 were diagnosed with CRBSI. The PCT-Kryptor and PCT-RTA values were significantly higher in proven CRBSI compared to those in unproven CRBSI (p=0.03 and p=0.03, respectively). There were no differences in white blood cell count and C-reactive protein (CRP) levels between proven CRBSI and unproven CRBSI. Among the 24 patients with CRBSI, CRP was significantly higher among those with Gram-negative bacterial infection than in those with Gram-positive bacterial infections. PCT-Kryptor was also significantly higher among patients with Gram-negative bacterial infection than in those with Gram-positive bacterial infections (p=0.01 and p=0.02, respectively).

CONCLUSIONS

The authors suggest that PCT could be a helpful rapid diagnostic marker in children with suspected CRBSIs.

Erythrocyte oxidative stress markers in children with sickle cell disease

OBJECTIVE

To determine eight parameters of oxidative stress markers in erythrocytes from children with sickle cell disease and compare with the same parameters in erythrocytes from healthy children, since oxidative stress plays an important role in the pathophysiology of sickle cell disease and because this disease is a serious public health problem in many countries.

METHODS

Blood samples were obtained from 45 children with sickle cell disease (21 males and 24 females with a mean age of 9 years; range: 3-13 years) and 280 blood samples were obtained from children without hemoglobinopathies (137 males and 143 females with a mean age of 10 years; range: 8-11 years), as a control group. All blood samples were analyzed for methemoglobin, reduced glutathione, thiobarbituric acid reactive substances, percentage of hemolysis, reactive oxygen species, and activity of the enzymes glucose 6-phosphate dehydrogenase, superoxide dismutase, and catalase. Data were analyzed using Student's t-test and were expressed as the mean±standard deviation. A p-value of <0.05 was considered significant.

RESULTS

Significant differences were observed between children with sickle cell disease and the control group for the parameters methemoglobin, thiobarbituric acid reactive substances, hemolysis, glucose 6-phosphate dehydrogenase activity, and reactive oxygen species, with higher levels in the patients than in the controls.

CONCLUSIONS

Oxidative stress parameters in children's erythrocytes were determined using simple laboratory methods with small volumes of blood; these biomarkers can be useful to evaluate disease progression and outcomes in patients.

[Characterization of anthropometric assessment studies of Brazilian children attending daycare centers]

OBJECTIVE

To obatin an overview of available information on the anthropometric assessment of Brazilian children attending daycare centers.

DATA SOURCE

A literature search was carried out in the PubMed, LILACS and SciELO databases of studies published from 1990 to 2013 in Portuguese and English languages. The following search strategy was used: (nutritional status OR anthropometrics OR malnutrition OR overweight) AND daycare centers, as well as the equivalent terms in Portuguese. In the case of MEDLINE search, the descriptor Brazil was also used.

DATA SYNTHESIS

It was verified that the 33 studies included in the review were comparable from a methodological point of view. The studies, in general, were characterized by their restrictive nature, geographical concentration and dispersion of results in relation to time. Considering the studies published from 2010 onwards, low prevalence of acute malnutrition and significant rates of stunting and overweight were observed.

CONCLUSIONS

Despite the limitations, considering the most recent studies that used the WHO growth curves (2006), it is suggested that the anthropometric profile of Brazilian children attending daycare centers is characterized by a nutritional transition process, with significant prevalence of overweight and short stature. We emphasize the need to develop a multicenter survey that will more accurately define the current anthropometric nutritional status of Brazilian children attending daycare centers.

[Scientific Evidence on Preventive Interventions in Childhood Obesity]

INTRODUCTION

The increasing prevalence of obesity or overweight at all ages, their associated morbidity and mortality associated, and the increased perception of the problem by the society have generated several hypotheses in response to the scientific and the international community.

OBJECTIVE

Investigate the preventive interventions in childhood obesity so far.

METHODS

Integrative review during the study period from April 2013 to November 2014. The MEDLINE international database was used, including PubMed, the Cochrane Library (Issue 4 2002), the national database Isooc (CSIC) national database, as well as the Internet. The review included health articles published in Spanish and English between 1990 and 2014 that focused on or included education, prevention, diagnostic, and treatment of obesity interventions.

RESULTS

Of the 726 articles identified, 34 of most relevant (peer reviewed) were selected. It was noted that there is limited generisable evidence on interventions that could be implemented in Primary Care or referral services available, although numerous studies suggest that improvements in the overweight are possible.

CONCLUSIONS

Despite the abundant literature and that many institutions place childhood obesity as one of the priorities of Public Health, we face the paradox that the evidence on cost-effectiveness of prevention interventions is sparse. Knowing these gaps in knowledge should lead to filling them with rigorous and well-designed studies.

Obesogenic environment - intervention opportunities

OBJECTIVES

To evaluate environmental obesogenic-related factors, such as physical activity in neighborhoods and schools, nutritional behavior, and intervention programs.

SOURCES

Critical analysis of literature with personal point of view from infant obesity experts and political advisors for public intervention.

DATA SYNTHESIS

Although obesity is a public health problem affecting several age groups, it is among children and adolescents that it plays a more important role, due to treatment complexity, high likelihood of persistence into adulthood, and association with other non-transmissible diseases while still in early age. Environment is a main component of the genesis and outcomes in the near future or long term. Modification of intake with high-density food, meal skipping, and high intake of saturated fat, sugar, and salt, associated to high levels of sedentarism are main causes of obesity.

CONCLUSION

Intervention opportunities are related to modifications in political, environmental, and individual settings. School and physical activities in the educational environment are intertwined with nutrition intervention in continuous education. A critical review of some different scenarios in Latin American countries is presented.

Influence of passive smoking on learning in elementary school

OBJECTIVE

To analyze the association between household smoking and the development of learning in elementary schoolchildren.

METHODS

Cross-sectional study with 785 students from the 2nd to the 5th year of elementary school. Students were evaluated by the School Literacy Screening Protocol to identify the presence of learning disabilities. Mothers/guardians were interviewed at home through a validated questionnaire. Descriptive and bivariate analysis, as well as multivariate Poisson regression, were performed.

RESULTS

In the final model, the variables associated with learning difficulties were current smoking at the household in the presence of the child (PR=6.10, 95% CI: 4.56 to 8.16), maternal passive smoking during pregnancy (PR=1.46, 95% CI: 1.07 to 2.01), students attending the 2nd and 3rd years of Elementary School (PR=1.44, 95% CI: 1.10 to 1.90), and being children of mothers with only elementary level education (PR=1.36, 95% CI: 1.04 to 1.79).

CONCLUSION

The study demonstrated an association between passive exposure to tobacco smoke and learning difficulties at school.

Assessment of Eustachian tube function in patients with tympanic membrane retraction and in normal subjects

Introduction

The diagnosis of Eustachian tube dysfunctions is essential for better understanding of the pathogenesis of chronic otitis media. A series of tests to assess tube function are described in the literature; however, they are methodologically heterogeneous, with differences ranging from application protocols to standardization of tests and their results.

Objective

To evaluate the variation in middle ear pressure in patients with tympanic membrane retraction and in normal patients during tube function tests, as well as to evaluate intra-individual variation between these tests.

Methods

An observational, contemporary, cross-sectional study was conducted, in which the factor under study was the variation in middle ear pressure during tube function tests (Valsalva maneuver, sniff test, Toynbee maneuver) in healthy patients and in patients with mild and moderate/severe tympanic retraction. A total of 38 patients (76 ears) were included in the study. Patients underwent tube function tests at two different time points to determine pressure measurements after each maneuver. Statistical analysis was performed using SPSS software, version 18.0, considering p-values <0.05 as statistically significant.

Results

Mean (standard deviation) age was 11 (2.72) years; 55.3% of patients were male and 44.7% female. The prevalence of type A tympanogram was higher among participants with healthy ears and those with mild retraction, whereas type C tympanograms were more frequent in the moderate/severe retraction group. An increase in middle ear pressure was observed during the Valsalva maneuver at the first time point evaluated in all three groups of ears (p = 0.012). The variation in pressure was not significant either for the sniff test or for the Toynbee maneuver at the two time points evaluated (p ≥ 0.05). Agreement between measurements obtained at the two different time points was weak to moderate for all tests in all three groups of ears, and the variations in discrepancy between measurements were higher in ears with moderate/severe tympanic retraction.

Conclusion

In this study population, the mean pressure in the middle ear showed significant variation only during the Valsalva maneuver at the first time point evaluated in the three groups of ears. Normal ears and those with mild retraction behaved similarly in all tests. The tested maneuvers exhibited weak to moderate intra-individual variation, with the greatest variation occurring in ears with moderate/severe retraction.

Impact of extrinsic factors on fine motor performance of children attending day care

OBJECTIVE

To assess the impact of extrinsic factors on fine motor performance of children aged two years old.

METHODS

73 children attending public and 21 private day care centers were assessed. Day care environment was evaluated using the Infant/Toddler Environment Rating Scale - Revised Edition (ITERS-R), fine motor performance was assessed through the Bayley Scales of Infant and Toddler Development - III (BSITD-III), socioeconomic data, maternal education and time of start at the day care were collected through interviews. Spearman's correlation coefficient was calculated to assess the association between the studied variables.

RESULTS

The time at the day care was positively correlated with the children's performance in some fine motor tasks of the BSITD-III, showing that the activities developed in day care centers were important for the refinement of specific motor skills, while the overall fine motor performance by the scale was associated with maternal education and the ITERS-R scale sub-item "language and understanding".

CONCLUSIONS

Extrinsic factors such as higher maternal education and quality of day care centers are associated with fine motor performance in children attending day care.

Atypical manifestations of Epstein-Barr virus in children: a diagnostic challenge

OBJECTIVE

Clarify the frequency and the pathophysiological mechanisms of the rare manifestations of Epstein-Barr virus infection.

SOURCES

Original research studies published in English between 1985 and 2015 were selected through a computer-assisted literature search (PubMed and Scopus). Computer searches used combinations of key words relating to "EBV infections" and "atypical manifestation."

SUMMARY OF THE FINDINGS

Epstein-Barr virus is a herpes virus responsible for a lifelong latent infection in almost every adult. The primary infection concerns mostly children and presents with the clinical syndrome of infectious mononucleosis. However, Epstein-Barr virus infection may exhibit numerous rare, atypical and threatening manifestations. It may cause secondary infections and various complications of the respiratory, cardiovascular, genitourinary, gastrointestinal, and nervous systems. Epstein-Barr virus also plays a significant role in pathogenesis of autoimmune diseases, allergies, and neoplasms, with Burkitt lymphoma as the main representative of the latter. The mechanisms of these manifestations are still unresolved. Therefore, the main suggestions are direct viral invasion and chronic immune response due to the reactivation of the latent state of the virus, or even various DNA mutations.

CONCLUSIONS

Physicians should be cautious about uncommon presentations of the viral infection and consider EBV as a causative agent when they encounter similar clinical pictures.

Physical activity and nutrition education at the school environment aimed at preventing childhood obesity: evidence from systematic reviews

OBJECTIVE

To organize the main findings and list the most frequent recommendations from systematic reviews of interventions developed at the school environment aimed at reducing overweight in children and adolescents.

DATA SOURCE

Searches for systematic reviews available until December 31, 2014 were conducted in five electronic databases: Cochrane, PubMed, SciELO, SPORTDiscus, and Web of Science. Manual search for cross-references were also performed.

SUMMARY OF THE FINDINGS

Of the initial 2139 references, 33 systematic reviews adequately met the inclusion criteria and were included in the descriptive summary. In this set, interventions with periods of time greater than six months in duration (nine reviews), and parental involvement in the content and/or planned actions (six reviews) were identified as the most frequent and effective recommendations. Additionally, it was observed that boys respond more effectively to structural interventions, whereas girls respond to behavioral interventions. None of the included reviews was able to make inferences about the theoretical basis used in interventions as, apparently, those in charge of the interventions disregarded this component in their preparation.

CONCLUSIONS

Although the summary identified evidence with important applications in terms of public health, there are still gaps to be filled in this field of knowledge, such as the effectiveness of different theoretical models, the identification of the best strategies in relation to gender and age of participants and, finally, the identification of moderating variables to maximize the benefits provided by the interventions.

[Factors associated with abdominal obesity in children]

Objective:

To identify the association of dietary, socioeconomic factors, sedentary behaviors and maternal nutritional status with abdominal obesity in children.

Methods:

A cross-sectional study with household-based survey, in 36 randomly selected census tracts in the city of Santos, SP. 357 families were interviewed and questionnaires and anthropometric measurements were applied in mothers and their 3-10 years-old children. Assessment of abdominal obesity was made by maternal and child's waist circumference measurement; for classification used cut-off points proposed by World Health Organization (1998) and Taylor et al. (2000) were applied. The association between variables was performed by multiple logistic regression analysis.

Results:

30.5% of children had abdominal obesity. Associations with children's and maternal nutritional status and high socioeconomic status were shown in the univariate analysis. In the regression model, children's body mass index for age (OR=93.7; 95%CI 39.3-223.3), female gender (OR=4.1; 95%CI 1.8-9.3) and maternal abdominal obesity (OR=2.7; 95%CI 1.2-6.0) were significantly associated with children's abdominal obesity, regardless of the socioeconomic status.

Conclusions:

Abdominal obesity in children seems to be associated with maternal nutritional status, other indicators of their own nutritional status and female gender. Intervention programs for control of childhood obesity and prevention of metabolic syndrome should consider the interaction of the nutritional status of mothers and their children.

[Clinical evolution and nutritional status in asthmatic children and adolescents enrolled in Primary Health Care]

Objective:

To evaluate the clinical evolution and the association between nutritional status and severity of asthma in children and adolescents enrolled in Primary Health Care.

Methods:

A retrospective cohort study of 219 asthmatic patients (3-17 years old) enrolled in Primary Care Services (PCSs) in Embu das Artes (SP), from 2007 to 2011. Secondary data: gender, age, diagnosis of asthma severity, other atopic diseases, family history of atopy, and body mass index. To evaluate the clinical outcome of asthma, data were collected on number of asthma exacerbations, number of emergency room consultations and doses of inhaled corticosteroids at follow-up visits in the 6th and 12th months. The statistical analysis included chi-square and Kappa agreement index, with 5% set as the significance level.

Results:

50.5% of patients started wheezing before the age of 2 years, 99.5% had allergic rhinitis and 65.2% had a positive family history of atopy. Regarding severity, intermittent asthma was more frequent (51.6%) and, in relation to nutritional status, 65.8% of patients had normal weight. There was no association between nutritional status and asthma severity (p =0.409). After 1 year of follow-up, 25.2% of patients showed reduction in exacerbations and emergency room consultations, and 16.2% reduced the amount of inhaled corticosteroids.

Conclusions:

The monitoring of asthmatic patients in Primary Care Services showed improvement in clinical outcome, with a decreased number of exacerbations, emergency room consultations and doses of inhaled corticosteroids. No association between nutritional status and asthma severity was observed in this study.

[Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and Hirschsprung's disease]

Objective:

Surgical treatment of anorectal malformations (ARMs) and Hirschsprung's disease (HD) leads to alterations in bowel habits and fecal incontinence, with consequent quality of life impairment. The objectives were to create and validate a Questionnaire for the Fecal Incontinence Index (FII) based on the Holschneider score, as well as a Questionnaire for the Assessment of Quality of Life Related to Fecal Incontinence in Children and Adolescents (QQVCFCA), based on the Fecal Incontinence Quality of Life.

Methods:

The questionnaires were applied to 71 children submitted to surgical procedure, in two stages. Validity was tested by comparing the QQVCFCA and a generic quality of life questionnaire (SF-36), and between QQVCFCA and the FII. A group of 59 normal children was used as control.

Results:

At two stages, 45.0% (32/71) and 42.8% (21/49) of the patients had fecal incontinence. It was observed that the QQVCFCA showed a significant correlation with the SF-36 and FII (Pearson's correlation 0.57), showing that the quality of life is directly proportional to improvement in fecal incontinence. Quality of life in patients with fecal incontinence is still globally impaired, when compared with control subjects (p<0.05, Student's t-test). There were also significant differences between the results of children with ARMs and children with HD.

Conclusions:

QQVCFCA and FII are useful tools to assess the quality of life and fecal incontinence in these groups of children. Children with ARMs submitted to surgical procedure and HD have similar quality of life impairment.

Whole-exome sequencing as a diagnostic tool for distal renal tubular acidosis

OBJECTIVE

Distal renal tubular acidosis (dRTA) is characterized by metabolic acidosis due to impaired renal acid excretion. The aim of this study was to demonstrate the genetic diagnosis of four children with dRTA through use of whole-exome sequencing.

METHODS

Two unrelated families were selected; a total of four children with dRTA and their parents, in order to perform whole-exome sequencing. Hearing was preserved in both children from the first family, but not in the second, wherein a twin pair had severe deafness. Whole-exome sequencing was performed in two pooled samples and findings were confirmed with Sanger sequencing method.

RESULTS

Two mutations were identified in the ATP6V0A4 and ATP6V1B1 genes. In the first family, a novel mutation in the exon 13 of the ATP6V0A4 gene with a single nucleotide change GAC → TAC (c.1232G>T) was found, which caused a substitution of aspartic acid to tyrosine in position 411. In the second family, a homozygous recurrent mutation with one base-pair insertion (c.1149_1155insC) in exon 12 of the ATP6V1B1 gene was detected.

CONCLUSION

These results confirm the value of whole-exome sequencing for the study of rare and complex genetic nephropathies, allowing the identification of novel and recurrent mutations. Furthermore, for the first time the application of this molecular method in renal tubular diseases has been clearly demonstrated.

Validation of a subjective global assessment questionnaire

OBJECTIVE

To validate the Subjective Global Nutritional Assessment (SGNA) questionnaire for Brazilian children and adolescents.

METHODS

A cross-sectional study with 242 patients, aged 30 days to 13 years, treated in pediatric units of a tertiary hospital with acute illness and minimum hospitalization of 24h. After permission from the authors of the original study, the following criteria were observed to obtain the validation of SGNA instruments: translation and backtranslation, concurrent validity, predictive validity, and inter-observer reliability. The variables studied were age, sex, weight and length at birth, prematurity, and anthropometry (weight, height, body mass index, upper arm circumference, triceps skinfold, and subscapular skinfold). The primary outcome was considered as the need for admission/readmission within 30 days after hospital discharge. Statistical tests used included ANOVA, Kruskal-Wallis, Mann-Whitney, chi-square, and Kappa coefficient.

RESULTS

According to SGNA score, 80% of patients were considered as well nourished, 14.5% moderately malnourished, and 5.4% severely malnourished. Concurrent validity showed a weak correlation between the SGNA and anthropometric measurements (p<0.001). Regarding predictive power, the main outcome associated with SGNA was length of admission/readmission. Secondary outcomes associated included the following: length of stay at the unit after SGNA, weight and length at birth, and prematurity (p<0.05). The interobserver reliability showed good agreement among examiners (Kappa=0.74).

CONCLUSION

This study validated the SGNA in this group of hospitalized pediatric patients, ensuring its use in the clinical setting and for research purposes in the Brazilian population.

Ultra-processed food consumption in children from a Basic Health Unit

OBJECTIVES

To evaluate the contribution of ultra-processed food (UPF) on the dietary consumption of children treated at a Basic Health Unit and the associated factors.

METHODOLOGY

Cross-sectional study carried out with a convenience sample of 204 children, aged 2-10 years old, in Southern Brazil. Children's food intake was assessed using a 24-h recall questionnaire. Food items were classified as minimally processed, processed for culinary use, and ultra-processed. A semi-structured questionnaire was applied to collect socio-demographic and anthropometric variables. Overweight in children was classified using a Z score >2 for children younger than 5 and Z score >+1 for those aged between 5 and 10 years, using the body mass index for age.

RESULTS

Overweight frequency was 34% (95% CI: 28-41%). Mean energy consumption was 1672.3 kcal/day, with 47% (95% CI: 45-49%) coming from ultra-processed food. In the multiple linear regression model, maternal education (r=0.23; p=0.001) and child age (r=0.40; p<0.001) were factors associated with a greater percentage of UPF in the diet (r=0.42; p<0.001). Additionally, a statistically significant trend for higher UPF consumption was observed when data were stratified by child age and maternal educational level (p<0.001).

CONCLUSIONS

The contribution of UPF is significant in children's diets and age appears to be an important factor for the consumption of such products.

Use of macrolides in lung diseases: recent literature controversies

OBJECTIVE

To review the mechanisms of action of macrolides in pediatric respiratory diseases and their clinical indications.

SOURCES

Review in the PubMed database, comprising the following terms in English: "macrolide and asthma"; "macrolide and cystic fibrosis"; "macrolide bronchiolitis and viral acute"; "macrolide and bronchiolitis obliterans" and "macrolide and non-CF bronchiectasis".

SUMMARY OF THE FINDINGS

The spectrum of action of macrolides includes production of inflammatory mediators, control of mucus hypersecretion, and modulation of host-defense mechanisms. The potential benefit of macrolide antibiotics has been studied in a variety of lung diseases, such as cystic fibrosis (CF), bronchiectasis, asthma, acute bronchiolitis, and non-CF bronchiectasis. Several studies have evaluated the benefits of macrolides in asthma refractory to therapy, but the results are controversial and indications should be limited to specific phenotypes. In viral bronchiolitis, there is no consistent benefit in acute conditions, although recent data have shown an effect in recurrent wheezing prevention. In patients with CF results are also contradictory, but the consensus states there is a small clinical benefit, especially for patients infected with P. aeruginosa. There was also no positive action of macrolides in patients with post-infectious bronchiolitis obliterans. Children with non-CF bronchiectasis seem to have clear benefits regarding the use of macrolides, which showed clinical advantages in parenchyma protection and lung function.

CONCLUSIONS

The long-term use of macrolides should be limited to highly selected situations, especially in patients with bronchiectasis. Careful evaluation of the benefits and potential damage are tools for their indication in specific groups.

Acute diarrhea: evidence-based management

OBJECTIVES

To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease.

DATA SOURCE

PubMed, Scopus, Google Scholar.

DATA SUMMARY

There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis.

CONCLUSIONS

Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.

Association between electronic equipment in the bedroom and sedentary lifestyle, physical activity, and body mass index of children

OBJECTIVE

To describe the association between electronic devices in the bedroom with sedentary time and physical activity, both assessed by accelerometry, in addition to body mass index in children from São Caetano do Sul.

METHODS

The sample consisted of 441 children. The presence of electronic equipment (television, personal computer, and videogames) in the bedroom was assessed by a questionnaire. For seven consecutive days, children used an accelerometer to objectively monitor the sedentary time and moderate-to-vigorous physical activity. Body mass index was categorized as suggested by the World Health Organization.

RESULTS

Overall, 73.9%, 54.2% and 42.8% of children had TV, computer, and videogames in the bedroom, respectively, and spent an average of 500.7 and 59.1 min/day of sedentary time and moderate-to-vigorous physical activity. Of the children, 45.3% were overweight/obese. Girls with a computer in the bedroom (45 min/day) performed less moderate-to-vigorous physical activity than those without it (51.4 min/day). Similar results were observed for body mass index in boys. Moderate-to-vigorous physical activity was higher and body mass index was lower in children that had no electronic equipment in the bedroom. Presence of a computer (β=-4.798) and the combination TV+computer (β=-3.233) were negatively associated with moderate-to-vigorous physical activity. Videogames and the combinations with two or three electronic devices were positively associated with body mass index. Sedentary time was not associated with electronic equipment.

CONCLUSION

Electronic equipment in the children's bedroom can negatively affect moderate-to-vigorous physical activity and body mass index regardless of gender, school, and annual family income, which can contribute to physical inactivity and childhood obesity.

Psychological aspects of juvenile fibromyalgia syndrome: a literature review

Juvenile fibromyalgia syndrome (JFMS) is a non-inflammatory chronic pain condition that occurs mainly in girls aged 9-15 years. JFMS is characterized by constant widespread pain in different parts of the body, poor sleep quality, daytime sleepiness and an altered mood. Concomitant psychological and organic factors result in a diminished capacity to cope with pain. The quality of life of individuals with chronic pain and their caregivers is severely restricted and the occurrence of symptoms of anxiety and depression is common in this population. The aim of the present study was to perform a systematic review of the literature on psychosocial factors related to JFMS. The findings reveal differences in opinion between patients and family members regarding the effect of the condition, as mothers tend to classify JFMS as more severe than the patients themselves. Individuals with JFMS seem to share the same personality traits and there seems to be a type of family environment that is favorable to the occurrence of this condition. Psychological and functional aspects should be treated with methods that can help patients and family members alter their coping strategies regarding day-to-day problems, attenuate the dysfunctional consequences of pain and fatigue and diminish the risk of catastrophizing that individuals submitted to constant pain develop in relation to their surrounding environment.

Variations in peak nasal inspiratory flow among healthy students after using saline solutions

Introduction

Nasal hygiene with saline solutions has been shown to relieve congestion, reduce the thickening of the mucus and keep nasal cavity clean and moist.

Objective

Evaluating whether saline solutions improve nasal inspiratory flow among healthy children.

Methods

Students between 8 and 11 years of age underwent 6 procedures with saline solutions at different concentrations. The peak nasal inspiratory flow was measured before and 30 min after each procedure. Statistical analysis was performed by means of t test, analysis of variance, and Tukey's test, considering p < 0.05.

Results

We evaluated 124 children at all stages. There were differences on the way a same concentration was used. There was no difference between 0.9% saline solution and 3% saline solution by using a syringe.

Conclusion

The 3% saline solution had higher averages of peak nasal inspiratory flow, but it was not significantly higher than the 0.9% saline solution. It is important to offer various options to patients.

Fibrinogen: cardiometabolic risk marker in obese or overweight children and adolescents

OBJECTIVES

To determine the prevalence of increased serum fibrinogen levels and its association with cardiometabolic risk factors in overweight or obese children and adolescents.

METHODS

Cross-sectional study with 138 children and adolescents (overweight or obese) followed at a reference outpatient clinic of the public health care network. Fibrinogen concentration was divided into quartiles, and values above or equal to the third quartile were considered high. The association between high fibrinogen values and cardiometabolic risk factors was assessed using Pearson's chi-squared test or Fisher's exact test, as necessary. Logistic regression was used to adjust variables predictive of fibrinogen levels. Analyses were performed using SPSS version 22.0 and SAS software, considering a confidence interval of 95%.

RESULTS

Serum fibrinogen levels were elevated in 28.3% of individuals, showing association with the presence of high CRP (p=0.003, PR: 2.41, 95% CI: 1.30-4.46) and the presence of four or more risk factors (p=0.042; PR: 1.78, 95% CI: 1.00-3.17). After a logistic regression, only elevated CRP remained associated with altered fibrinogen levels (p=0.024; PR: 1.32; 95% CI: 1.09-5.25).

CONCLUSIONS

Increased fibrinogen was prevalent in the study population and was associated with ultrasensitive C-reactive protein and the presence of four or more cardiovascular risk factors; it should be included in the assessment of individuals at risk.

Probiotics for the treatment of upper and lower respiratory-tract infections in children: systematic review based on randomized clinical trials

OBJECTIVES

Evaluate the effect of probiotics on the symptoms, duration of disease, and the occurrence of new episodes of upper and lower respiratory infections in healthy children.

SOURCES

In order to identify eligible randomized controlled trials, two reviewers accessed four electronic databases [MEDLINE/PubMed, Scopus (Elsevier), Web of Science, and Cochrane (Cochrane VHL)], as well as ClinicalTrials.gov until January 2015. Descriptors were determined by using the Medical Subject Headings tool, following the same search protocol.

SUMMARY OF THE FINDINGS

Studies showed to be heterogeneous regarding strains of probiotics, the mode of administration, the time of use, and outcomes. The present review identified 11 peer-reviewed, randomized clinical trials, which analyzed a total of 2417 children up to 10 incomplete years of age. In the analysis of the studies, reduction in new episodes of disease was a favorable outcome for the use of probiotics in the treatment of respiratory infections in children. It is noteworthy that most of these studies were conducted in developed countries, with basic sanitation, health care, and strict, well-established and well-organized guidelines on the use of probiotics. Adverse effects were rarely reported, demonstrating probiotics to be safe.

CONCLUSIONS

Despite the encouraging results - reducing new episodes of respiratory infections - the authors emphasize the need for further research, especially in developing countries, where rates of respiratory infections in children are higher when compared to the high per capita-income countries identified in this review.

Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting

OBJECTIVE

Two randomized controlled clinical trials have shown that Lactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea.

METHODS

This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1×10(8)CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded.

RESULTS

The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15h, 60.4±24.5h [95% CI: 51.0-69.7h] vs. 74.3±15.3h [95% CI: 68.7-79.9h], p<0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79, p<0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted.

CONCLUSION

L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.

Colonic transit in children and adolescents with chronic constipation

OBJECTIVE

The aim of this study was to assess clinical features and colonic transit patterns in Brazilian children with refractory constipation.

METHODS

From 2010 to 2013, 79 constipated patients received follow-up care in a tertiary hospital. Of these patients, 28 (aged 8-14 years) were refractory to conventional therapy and underwent a simplified visual method of nuclear colonic transit study, by ingestion of a liquid meal containing 9.25 MBq/kg of (99m)Tc-phytate. Abdominal static images were taken immediately and at two, six, 24, 30, and 48h after ingestion for qualitative analysis of the radio marker progression through the colon.

RESULTS

Two patterns of colonic transit were found: slow colonic transit (SCT, n=14), when images at 48h showed a larger part of the tracer remained in proximal and transverse colon, and distal retention (DR, n=14), when after 30h, the radio isotope passed the transverse colon and was retained in the rectosigmoid up to 48h. The SCT and DR group included, respectively, nine and ten males; median ages in the nuclear study of 11 and 10 years, p=0.207; median duration of constipation of seven and six years, p=0.599. Constipation appearing during first year age (p=0.04) and report of soft stools (p=0.02) were more common in SCT patients. Palpable abdominal fecal impaction was found only in DR group. Appendicostomy for antegrade continence enema was successful in 4/12 (30%) of SCT patients (median follow-up: 2.4 years).

CONCLUSION

Nuclear transit study distinguished two colonic dysmotility patterns and was useful for guiding refractory patients to specific therapies.

Television viewing habits and their influence on physical activity and childhood overweight

OBJECTIVES

To assess the prevalence of television (TV) viewing habits and their association with childhood sedentary lifestyle and overweight in 8-year-old children, from a cohort in a city in Southern Brazil.

METHODS

A prospective cohort study with hospital screening of all births that occurred from September of 2002 to May of 2003. This study refers to a cross-sectional analysis of data collected during the cohort's follow-up conducted at 8 years of age. To evaluate the level of physical activity, a physical activity questionnaire for children and adolescents was used (PAQ-C), during the consultation at 8 years of age.

RESULTS

Of the 616 interviewed children, a prevalence of sedentary lifestyle>70% was found, as well as the habit of watching TV for more than two hours a day in 60% of the sample, regardless of gender (p=0.30), income (p=0.57), or family socioeconomic level (p=0.90). The daily time spent watching TV was inversely associated with physical activity (p<0.05) and positively associated with excess weight (p<0.01). Regarding physical activity, running was the most frequently practiced sports modality among the population.

CONCLUSIONS

Considering the high prevalence of sedentary lifestyle and children who watch TV for an excessive period of time, it is necessary to motivate such individuals to perform interactive activities, as well as promote a more active lifestyle, by decreasing the time children spend in front of the TV.

[Dietary patterns of children and socioeconomical, behavioral and maternal determinants]

Objective:

To identify dietary patterns of children and to verify their association with socio-economical, behavioral and maternal determinants.

Methods:

A cross-sectional study with a random sample of 328 children aged 8 and 9 years. Dietary intake was assessed by food records in three nonconsecutive days and measured in grams of food groups and nutrients. Factor analysis and subsequent orthogonal rotation (varimax) were used to determine dietary patterns. Ordinal logistic regression was used to assess associations between dietary patterns and the studied determinants.

Results:

Five dietary patterns were observed: “Traditional,” “Sweetened beverages and snacks,” “Monotonous,” “Healthy” and “Egg-dairy.” A higher maternal level of education was directly associated with “Sweetened beverages and snacks” and “Egg-dairy' standards. Low income children who were submitted to greater food restriction by parents/guardians followed the more “Traditional” standard, represented by the consumption of rice, beans, vegetables, cooked roots and tubers and red meat. The “Monotonous” pattern, represented by a high consumption of milk and chocolate powder, was most followed by children from the middle class. Children living in rural areas consumed more foods from the “Egg-dairy” pattern, when compared to those from the urban area.

Conclusions:

Dietary patterns of children were associated with family socioeconomic status, maternal level of education, practice of food restriction by parents/guardians and location of residence in urban or rural area. Better socioeconomic conditions contributed to a more nutritionally inadequate dietary pattern.

[Usefulness of the WHOQOL-BREF questionnaire in assessing the quality of life of parents of children with asthma]

Objective::

To evaluate the quality of life (QOL) of parents of children with asthma and to analyze the internal consistency of the generic QOL tool World Health Organization Quality of Life, abbreviated version (WHOQOL-BREF).

Methods::

We evaluated the QOL of parents of asthmatic and healthy children aged between 8 and 16, using the generic WHOQOL-BREF questionnaire. We also evaluated the internal consistency using Cronbach's alpha (αC), in order to determine whether the tool had good validity for the target audience.

Results::

The study included 162 individuals with a mean age of 43.8±13.6 years, of which 104 were female (64.2%) and 128 were married (79.0%). When assessing the QOL, the group of parents of healthy children had higher scores than the group of parents of asthmatic children in the four areas evaluated by the questionnaire (Physical, Psychological Health, Social Relationships and Environment), indicating a better quality of life. Regarding the internal consistency of the WHOQOL-BREF, values of ˛C were 0.86 points for the group of parents of asthmatic children, and 0.88 for the group of parents of healthy children.

Conclusions::

Parents of children with asthma have impaired quality of life due to their children's disease. Furthermore, the WHOQOL-BREF, even as a generic tool, showed to be practical and efficient to evaluate the quality of life of parents of asthmatic children. © 2015 Sociedade de Pediatria de São Paulo. Published by Elsevier Editora Ltda. All rights reserved.

Rituximab use in young adults diagnosed with juvenile idiopathic arthritis unresponsive to conventional treatment: report of 6 cases

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. Without an effective therapy, patients may progress quickly to functional disability. Recently, depletion of B cells emerged as a new approach for the treatment of autoimmune diseases, including JIA. We describe six cases of JIA patients followed at a referral center for Rheumatology and Pediatric Rheumatology, submitted to treatment with rituximab (RTX) after refractoriness to three anti-TNF agents. Patients received RTX cycles with two infusions every six months. Response to treatment was assessed by DAS28, HAQ/CHAQ, and an overall assessment by the doctor and the patient. Of our six patients, four were girls (mean age at onset of disease: 6.1 years; mean disease evolution time: 15.1 years; mean age upon receiving RTX: 21.6 years). Four patients belonged to polyarticular subtype (1 rheumatoid factor [RF]-negative, 3 FR-positive), a patient with systemic JIA subtype with a polyarticular course and arthritis related to enthesitis. Of our six patients, five responded to treatment; and during the course of 12 months, the clinical response was maintained, although not sustained. However, discontinuation by infusion reactions caused the withdrawal of RTX in two patients. The use of RTX in JIA is restricted to cases refractory to other biological agents and, even considering that this study was held in a small number of advanced patients, RTX proved to be an effective therapeutic option.

[Metabolic syndrome risk assessment in children: use of a single score]

OBJECTIVE

To calculate a score of metabolic syndrome (MetS) in children and set a cutoff point of this score for the prediction of MetS risk.

METHODS

The study included a random sample of 348 children aged 8 and 9 years of Viçosa, Southeast Brazil. Factor analysis by principal components (PCA) was used to determine, among various risk factors, those with higher degrees of intercorrelation. The chosen variables were: waist circumference (PC), homeostatic model assessment of insulin resistance (HOMA), high density lipoprotein (HDL), triglycerides (TAG) and mean arterial pressure (MAP). Z-scores were created for each one of these parameters and the sum of these z-scores constituted the MetS score. The receiver operating characteristic (ROC) curve was used to identify the cutoff of MetS score, using as gold standard the presence or absence of MetS determined according to criteria age-modified.

RESULTS

The prevalence of MetS in the sample was 8.9% by adopting specific criteria for age, and 24% when considering the cutoff of MetS score. The selected cutoff point of 1.86 was accurate to predict the MetS risk in this sample due to its high sensitivity (96.7%), specificity (82.7%) and AUC of 0.96.

CONCLUSIONS

This original Brazilian study presents the MetS score as a suitable alternative for the study of Metabolic Syndrome in children, given the lack of consensus for the definition of this syndrome in childhood.

[Calcium intake, serum vitamin D and obesity in children: is there an association?]

OBJECTIVE:

To evaluate the association between calcium intake and serum vitamin D levels and childhood obesity by an integrative review.

DATA SOURCE:

The research was conducted in the databases PubMed/medLine, Science Direct and SciELO with 2001 to 2014 publications. We used the combined terms in English: ''children'' and ''calcium'' or ''children'' and ''vitamin D'' associated with the descriptors: ''obesity'', ''adiposity'' or ''body fat'' for all bases. Cross-sectional and cohort studies, as well as clinical trials, were included. Review articles or those that that have not addressed the association of interest were excluded.

DATA SYNTHESIS:

Eight articles were part of this review, five of which were related to calcium and three to vitamin D. Most studies had a longitudinal design. The analyzed studies found an association between calcium intake and obesity, especially when age and sex were considered. Inverse relationship between serum vitamin D and measures of adiposity in children has been observed and this association was influenced by the sex of the patient and by the seasons of the year.

CONCLUSIONS:

The studies reviewed showed an association between calcium and vitamin D with childhood obesity. Considering the possible protective effect of these micronutrients in relation to childhood obesity, preventive public health actions should be designed, with emphasis on nutritional education.

[Disseminated histoplamosis in adolescent mimicking granulomatosis with polyangiitis]

INTRODUCTION

Systemic histoplasmosis is an invasive fungal infection that may mimic primary vasculitis, particularly granulomatosis with polyangiitis (GPA), and was rarely described in adult patients. We reported an immunocompetent patient with disseminated histoplasmosis mimicking GPA who fulfilled European League Against Rheumatism (EULAR)/Pediatric Rheumatology International Trials Organisation (PRINTO)/Pediatric Rheumatology European Society (PRES) validated classification criteria.

CASE REPORT

A 6-year old boy presented acute migratory polyarthritis with spontaneous improvement, sinus inflammation, fever, headache and abdominal pain. Serologic test for hepatitis, cytomegalovirus, human immunodeficiency virus, Epstein-Barr virus, toxoplasmosis, dengue virus and antistreptolysin O were all negative. Magnetic resonance imaging (MRI) showed moderate ascites in pelvis and pansinusitis. Antineutrophil cytoplasmic antibodies (c-ANCA) were positive. He had spontaneous remission of the symptoms including fever. At the age of 11 years and 11 months, he had sinusitis, pneumonia and epididymitis. A month later, he was hospitalized and MRI showed left eye proptosis. Cerebrospinal fluid was normal and indirect tests of fungi were negative. Two months later, he had lumbar pain and computer tomography showed a mass in the right kidney and pulmonary nodule in the right lung. He fulfilled EULAR/PRINTO/PRES criteria for GPA, however the renal biopsy showed a focal granulomatous interstitial nephritis with yeast fungal cells compatible with Histoplasma sp. He was treated with liposomal amphotericin B and itraconazole with improvement of signs and symptoms.

CONCLUSION

We reported a progressive disseminated histoplasmosis case mimicking GPA. Histoplasmosis infection should be considered in immunocompetent subjects with uncommon clinical manifestations, such as arthritis, nephritis and epididymitis.

Chronic polyarthritis as isolated manifestation of toxocariasis

Human toxocariasis is a parasitic zoonosis mainly caused by Toxocara canis or Toxocara cati and is acquired by ingestion of the parasite's embryonated eggs. Arthralgia and/or arthritis were reported in up to 17% of the cases, generally with acute duration (less than 6 weeks). However, to our knowledge, chronic polyarthritis, as the isolated presentation of Toxocara infection, was not reported. One of the 5809 patients that was followed up at our service (0.017%) had chronic polyarthritis as the single manifestation of toxocariasis and was described herein. A 3-year-old girl was referred to our service with severe painful chronic polyarthritis for a period longer than 10 weeks and morning stiffness of 30min. Dog contact exposure history in the recreational areas of neighborhood was reported. Her exams showed high levels of eosinophils in peripheral blood (29%), bone marrow aspirate revealed marked eosinophilia (32%) and Toxocara enzyme-linked immunosorbent assay (Elisa) was positive (1:1280). She was treated with paracetamol (40mg/kg/day) and thiabendazole (25mg/kg/day) for 10 days, and all manifestations reduced. After eight months of follow-up, she was on clinical and laboratorial remission. In conclusion, we described a case of chronic polyarthritis, as isolated manifestation of toxocariasis, mimicking juvenile idiopathic arthritis and leukemia. Importantly, this zoonosis should be considered in patients with arthritis and eosinophilia.

[Physical activity and biological maturation: a systematic review]

OBJECTIVE

To analyze the association between physical activity (PA) and biological maturation in children and adolescents.

DATA SOURCE

We conducted a systematic review in April 2013 in the electronic databases of PubMed/Medline, SportDiscus, Web of Science and Lilacs without time restrictions. A total of 628 articles potentially relevant were identified and 10 met the inclusion criteria for this review: cross-sectional or longitudinal studies, published in Portuguese, English or Spanish, with schoolchildren aged 9-15 year old of both sexes.

DATA SYNTHESIS

Despite the heterogeneity of the studies, there was an inverse association between PA and biological maturation. The PA decreases with increased biological and chronological age in both sexes. Boys tend to be more physically active than girls; however, when controlling for biological age, the sex differences disappear. The association between PA and timing of maturation varies between the sexes. Variation in the timing of biological maturation affects the tracking of PA in early adolescent girls. This review suggests that mediators (BMI, depression, low self-esteem, and concerns about body weight) can explain the association between PA and biological maturation.

CONCLUSIONS

There is a relationship between PA and biological maturation. PA decreases with increasing biological age with no differences between sexes. As for the timing of biological maturation, this relationship varies between sexes.