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Timóteo AT, Cachulo MC, Dinis P, Negrão L, Barreiros-Mota I, Dores H, Gonçalves L. "O meu coração bate saudável" - Results from a pilot project for health education in Portuguese children. Rev Port Cardiol 2023:S0870-2551(23)00469-9. [PMID: 37952926 DOI: 10.1016/j.repc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Childhood offers an excellent window of opportunity to start interventions to promote behavioral changes before unhealthy lifestyles become established, leading to cardiovascular diseases. The goal of this pilot educational project for children is the promotion of healthy lifestyles and cardiovascular health. METHODS This project was implemented in 4th grade children and included teacher-led classroom activities, a lesson given by a cardiologist and a practical lesson with dietitians. The teacher received a manual containing information on the topics to be discussed in class with the pupils and the children received a book that addresses cardiovascular risk factors and prevention. The components included were diet (D), physical activity (PA) and human body and heart awareness (BH). At the beginning and at the end of the schoolyear, a questionnaire was applied to the children to assess knowledge (K), attitudes (A) and habits (H) on these topics. RESULTS A total of 73 children from an urban public school in Lisbon, in a low to medium income area, participated in the project. Following the intervention, there was a 9.5% increase in the overall KAH score, mainly driven by the PA component (14.5%) followed by the BH component (12.3%). No improvement was observed for component D. The benefits were also more significant in children from a lower income area, suggesting that socioeconomic status is a determinant in the response obtained. CONCLUSIONS An educational project for cardiovascular health can be implemented successfully in children aged 9 years, but longer and larger studies are necessary.
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Affiliation(s)
- Ana Teresa Timóteo
- Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal.
| | - Maria Carmo Cachulo
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Fundação Portuguesa de Cardiologia, Portugal
| | - Paulo Dinis
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; Centro de Saúde Militar de Coimbra, Coimbra, Portugal
| | - Luís Negrão
- Fundação Portuguesa de Cardiologia, Portugal
| | - Inês Barreiros-Mota
- CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Nutrition & Metabolism Department, NOVA Medical School, Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Hélder Dores
- NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; CHRC - Comprehensive Health Research Center, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade Nova de Lisboa, Lisbon, Portugal; Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Hospital da Luz, Lisboa, Portugal
| | - Lino Gonçalves
- Sociedade Portuguesa de Cardiologia (Biénio 2021-2023), Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coinbra, Portugal; ICBR, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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Affonseca CDA, Carvalho LFAD, Quinet RDPB, Guimarães MCDC, Cury VF, Rotta AT. Palliative extubation: five-year experience in a pediatric hospital. J Pediatr (Rio J) 2020; 96:652-659. [PMID: 31493370 PMCID: PMC9432159 DOI: 10.1016/j.jped.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To present the characteristics of pediatric patients with chronic and irreversible diseases submitted to palliative extubation. METHOD This is a descriptive analysis of a series of patients admitted to a public pediatric hospital, with chronic and irreversible diseases, permanently dependent on ventilatory support, who underwent palliative extubation between April 2014 and May 2019. The following information was collected from the medical records: demographic data, diagnosis, duration and type of mechanical ventilation; date, time, and place of palliative extubation; medications used; symptoms observed; and hospital outcome. RESULTS A total of 19 patients with a mean age of 2.2 years were submitted to palliative extubation. 68.4% of extubations were performed in the ICU; 11 patients (57.9%) died in the hospital. The time between mechanical ventilation withdrawal and in-hospital death ranged from 15minutes to five days. Thirteen patients used an orotracheal tube and the others used tracheostomy. The main symptoms were dyspnea and pain, and the main drugs used to control symptoms were opioids and benzodiazepines. CONCLUSIONS It was not possible to identify predictors of in-hospital death after ventilatory support withdrawal. Palliative extubation requires specialized care, with the presence and availability of a multidisciplinary team with adequate training in symptom control and palliative care.
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Affiliation(s)
- Carolina de Araújo Affonseca
- Hospital Infantil João Paulo II, Unidade CUIDAR - Cuidado Paliativo e Atenção Domiciliar, Belo Horizonte, MG, Brazil.
| | | | | | | | | | - Alexandre Tellechea Rotta
- Duke University School of Medicine, Division of Pediatric Critical Care Medicine, North Carolina, United States
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Zhong M, Huang Y, Li T, Xiong L, Lin T, Li M, He D. Day-1 PELOD-2 and day-1 "quick" PELOD-2 scores in children with sepsis in the PICU. J Pediatr (Rio J) 2020; 96:660-665. [PMID: 31580846 PMCID: PMC9432166 DOI: 10.1016/j.jped.2019.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/16/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the predictive validity of the day-1 PELOD-2 and day-1 "quick" PELOD-2 (qPELOD-2) scores for in-hospital mortality in children with sepsis in a pediatric intensive care unit (PICU) of a developing country. METHODS The data of 516 children diagnosed as sepsis were retrospectively analyzed. The children were divided into survival group and non-survival group, according to the clinical outcome 28 days after admission. Day-1 PELOD-2, day-1 qPELOD-2, pediatric SOFA (pSOFA), and P-MODS were collected and scored. Receiver operating characteristic (ROC) curves were plotted, and the efficiency of the day-1 PELOD-2, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting death were evaluated by the area under the ROC curve (AUC). RESULTS The day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS in the non-survivor group were significantly higher than those in the survivor group. ROC curve analysis showed that the AUCs of the day-1 PELOD-2 score, day-1 qPELOD-2 score, pSOFA, and P-MODS for predicting the prognosis of children with sepsis in the PICU were 0.916, 0.802, 0.937, and 0.761, respectively (all p < 0.05). CONCLUSIONS Both the day-1 PELOD-2 score and day-1 qPELOD-2 score were effective and able to assess the prognosis of children with sepsis in a PICU of a developing country. Additionally, the day-1 PELOD-2 score was superior to the day-1 qPELOD-2 score. Further studies are needed to verify the usefulness of the day-1 qPELOD-2 score, particularly outside of the PICU.
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Affiliation(s)
- Mianling Zhong
- Children's Medical Center of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuge Huang
- Children's Medical Center of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| | - Tufeng Li
- Children's Medical Center of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lu Xiong
- Children's Medical Center of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ting Lin
- Children's Medical Center of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Miaofen Li
- Children's Medical Center of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongqiang He
- Children's Medical Center of the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Kasar T, Ozturk E, Ayyıldız P, Ergul Y, Guzeltas A. The assessment of patients with situs inversus and corrected transposition of the great arteries. Rev Port Cardiol 2020; 39:391-396. [PMID: 32682571 DOI: 10.1016/j.repc.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/17/2019] [Accepted: 09/22/2019] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart defect. There are different subgroups according to the location of the heart in the thorax, apical position and situs. OBJECTIVES The purpose of this study was to assess pediatric patients with situs inversus (SI) ccTGA (SI-ccTGA), a rare subgroup of this condition, in detail. METHODS The records of patients with SI-ccTGA followed between January 1, 2010 and January 1, 2019 in our clinic were analyzed retrospectively. Demographic features, associated cardiac defects, arrhythmias and follow-up data were recorded. RESULTS Twenty-one out of 120 ccTGA patients had SI. The median age was 30 months (4 days-18 years). There were hemodynamically significant associated lesions in 85.7% (n=18) of the patients. A large ventricular septal defect was found in 16 patients (76.2%), severe pulmonary stenosis in 11 (52.4%), pulmonary atresia in six (28.5%), and severe tricuspid regurgitation in two (9.5%). Eleven out of 21 patients had biventricular physiology and eight had single-ventricle physiology. Bidirectional cavopulmonary anastomosis followed by a hemi-Mustard-Rastelli operation were planned for the remaining two patients. Twelve out of 18 patients with associated defects (66.6%) were operated and surgery was planned for three more patients (16.6%). The remaining three patients were scheduled for clinical follow-up. Arrhythmias developed in two (9.5%) patients on follow-up; ablation was performed in one of them and pacemaker implantation followed by cardiac resynchronization therapy was performed in the other. Two patients died during follow-up, one after a central shunt operation and the other preoperatively due to pneumonia and sepsis. CONCLUSION SI-ccTGA is not a mirror image of situs solitus ccTGA (SS-ccTGA) due to important anatomic and physiologic differences between them. SI-ccTGA patients have a lower risk of tricuspid valve regurgitation than SS-ccTGA patients. The timing of clinical presentation of these patients mainly depends on the type and severity of the associated lesions, as in all subtypes of ccTGA.
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Affiliation(s)
- Taner Kasar
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey.
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey; Department of Pediatric Cardiology & Pediatric Cardiac Intensive Care, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Pelin Ayyıldız
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey; Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey; Department of Pediatric Cardiology & Electrophysiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Rezende IFB, Conceição-Machado MEP, Souza VS, Santos EMD, Silva LR. Sarcopenia in children and adolescents with chronic liver disease. J Pediatr (Rio J) 2020; 96:439-446. [PMID: 31005546 PMCID: PMC9432160 DOI: 10.1016/j.jped.2019.02.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the occurrence of sarcopenia in children and adolescents with chronic liver disease. METHODS A series of cases, with patients aged 6-19 years of both genders, who were treated in Liver Outpatient Clinics. Weight, height, muscle strength (assessed by manual grip strength), and muscle mass (estimated through dual-energy X-ray absorptiometry) were measured. Sarcopenia was diagnosed based on the simultaneous presence of muscle mass and muscle strength déficits, defined as the values below the mean for muscle mass and strength of the studied population, according to gender. A descriptive analysis (mean and standard deviation) was performed, and the difference of means was calculated by Student's t-test. RESULTS A total of 85 patients were studied, mostly females (64.7%), with a mean age of 11.7 (SD=3.4) years. Sarcopenia was identified in 40% of the patients. Muscle strength déficit was found in 54.1% of the subjects, and 50.6% showed muscle mass déficit. The mean muscle mass for males was higher than that for females (6.07; SD=1.22kg/m2vs. 5.42; SD=1.10kg/m2; p=0.016). However, there was no significant difference in sex-related muscle strength (male=0.85; SD=0.52kgf/kgm2 and female=0.68; SD=0.30kgf/kgm2; p=0.113). CONCLUSION The research findings identified that sarcopenia is a condition found in pediatric patients treated at a public referral institution for chronic liver disease.
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Affiliation(s)
- Ionar Figueredo Bonfim Rezende
- Universidade Federal da Bahia (UFBA), Instituto de Ciências da Saúde, Programa de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas, Salvador, BA, Brazil; Centro Universitário Estácio da Bahia, Salvador, BA, Brazil.
| | | | - Viviane Sahade Souza
- Universidade Federal da Bahia (UFBA), Escola de Nutrição, Departamento de Ciência da Nutrição, Salvador, BA, Brazil
| | | | - Luciana R Silva
- Universidade Federal da Bahia (UFBA), Instituto de Ciências da Saúde, Programa de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas, Salvador, BA, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina (Famed), Departamento de Pediatria, Porto Alegre, RS, Brazil; Universidade Federal da Bahia (UFBA), Complexo Hospitalar Universitário Professor Edgard Santos (HUPES), Serviço de Gastroenterologia e Hepatologia Pediátricas, Salvador, BA, Brazil
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Fernandes KP, Teixeira BS, Arnold BJ, Mendonça TMDS, Oliveira SM, Silva CHMD. Cross-cultural adaptation and validation of the universal Portuguese-version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F). J Pediatr (Rio J) 2020; 96:456-463. [PMID: 31034788 PMCID: PMC9432275 DOI: 10.1016/j.jped.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To cross-culturally adapt and validate the universal Portuguese version of the Pediatric Functional Assessment of Chronic Illness Therapy - Fatigue (pedsFACIT-F). METHOD The universal Portuguese version of the pedsFACIT-F was cross-culturally adapted and validated in 323 children and adolescents aged 8-18 years, 173 healthy individuals, and 150 with chronic diseases (cancer, juvenile idiopathic arthritis, and diabetes). Reliability (internal consistency and test-retest reliability) was assessed. Item response theory model assumptions were evaluated using confirmatory and exploratory factor analyses. Items were calibrated using a graded response model. Differential item functioning was assessed regarding age, gender, and clinical condition (healthy vs. chronic diseases). RESULTS No major cultural adaptations were needed. Internal consistency (Cronbach's alpha=0.84) and test-retest reliability (intraclass correlation coefficient=0.92) were good. CFA (CFI=0.92, TLI=0.90, RMSEA=0.097) and CFE analysis confirmed sufficient unidimensionality. The data also fit the GRM and demonstrated good coverage of the fatigue construct (threshold parameters range: -1.42 to 4.56). No items demonstrated significant differential item functioning. CONCLUSION The universal Portuguese version of the pedsFACIT-F provides a reliable, precise, and valid measure after being assessed by robust psychometric properties. Stability of the measurement properties of the pedsFACIT-F scale allows its use to assess fatigue in clinical research in Portuguese-speaking children and adolescents.
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Affiliation(s)
- Karla P Fernandes
- Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde, Uberlândia, MG, Brazil.
| | - Bruno S Teixeira
- Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde, Uberlândia, MG, Brazil
| | | | - Tânia M da S Mendonça
- Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde, Uberlândia, MG, Brazil
| | - Sthela M Oliveira
- Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde, Uberlândia, MG, Brazil
| | - Carlos Henrique M da Silva
- Universidade Federal de Uberlândia, Faculdade de Medicina, Programa de Pós-graduação em Ciências da Saúde, Uberlândia, MG, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil; Universidade Federal de Uberlândia (UFU), Grupo de Pesquisa em Qualidade de Vida Relacionada à Saúde, Uberlândia, MG, Brazil
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Martins G, Siedlikowski M, Coelho AKS, Rauch F, Tsimicalis A. Bladder and bowel symptoms experienced by children with osteogenesis imperfecta. J Pediatr (Rio J) 2020; 96:472-8. [PMID: 30802423 DOI: 10.1016/j.jped.2018.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and presentation of bladder, bowel, and combined bladder and bowel symptoms experienced by children with osteogenesis imperfecta and to describe the socio-demographic and clinical profile of these children. METHOD A descriptive study was conducted with a convenience sample of parent-child pairs of toilet-trained children aged from 3 to 18 years. Pairs were interviewed using three tools: (1) Socio-Demographic and Clinical Questionnaire; (2) Dysfunctional Voiding Scoring System; (3) Rome III Criteria along with the Bristol Stool Scale. Data were stratified by socio-demographic and clinical variables and analyzed using descriptive statistics. RESULTS Thirty-one parent-child pairs participated in the study; 38.7% (n=12) children reported bowel symptoms, 19.4% (n=6) reported a combination of bladder issues (such as holding maneuvers and urgency) and bowel symptoms (such as hard or painful bowel movements and large diameter stools). There were no reports of isolated bladder issues. Among the child participants, 16 (51.7%) identified as female and 20 (64.5%) were 5-14 years old. The most prevalent type of osteogenesis imperfecta was type III (n=12; 38.7%) and eight (25.8%) children reported using a wheelchair. CONCLUSION This is the first study to examine the prevalence and presentation of bladder, bowel, and combined bladder and bowel symptoms in children with osteogenesis imperfecta, offering a preliminary socio-demographic and clinical profile of these children. This research is an important step toward effective screening, detection, and access to care and treatment, especially for clinicians working with this group of very fragile patients.
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Cilsal E. In newly diagnosed hypertensive children, increased arterial stiffness and reduced heart rate variability were associated with a non-dipping blood pressure pattern. Rev Port Cardiol 2020; 39:331-338. [PMID: 32561230 DOI: 10.1016/j.repc.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 10/06/2019] [Accepted: 02/22/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES This study was designed to investigate the differences in pulsatile hemodynamics, echocardiographic findings, 24-h Holter monitoring and heart rate variability parameters of dipper patterns in children with newly diagnosed essential hypertension. METHODS This study included 30 children with newly diagnosed essential hypertension and 30 healthy controls. The essential hypertension cohort was divided into dippers and non-dippers. Physical examinations, 24-hour ambulatory blood pressure monitoring, 24-h Holter monitoring, 24-h heart rate variability, conventional 2-dimensional and Doppler echocardiography, and tissue Doppler imaging were performed. Pulse wave analysis using an oscillometric monitor was conducted to measure augmentation index (AIx) and pulse wave velocity (PWV). RESULTS In patients with essential hypertension, left ventricular (LV) wall thickness and LV mass index were increased. There were no significant differences in LV mass index and LV wall thickness based on the dipping patterns. Time domain values and the standard deviation of all RR intervals (SDNN) were substantially lower in the essential hypertension group. SDNN values were considerably lower in the non-dipper group compared with the dipper group. In terms of frequency domain measures, low frequency measured in daytime values was much lower in the essential hypertension group compared with the control. The dipper patterns revealed that low frequency measured in nighttime values was also substantially lower in the non-dipper group. Pulse wave analysis and AIx values were notably higher in the essential hypertension patient group and those with non-dipper status. CONCLUSION SDNN values, which reflect parasympathetic activity, were markedly lower in children with hypertension and the non-dipper group than healthy controls and the dipper group, respectively. Also, parameters related to arterial stiffness, such as PWV and AIx values were significantly higher in children with hypertension and the non-dipper group.
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Affiliation(s)
- Erman Cilsal
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, University of Health Sciences, Istanbul, Turkey.
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Mota DM, Matijasevich A, Santos IS, Petresco S, Mota LM. Psychiatric disorders in children with enuresis at 6 and 11 years old in a birth cohort. J Pediatr (Rio J) 2020; 96:318-326. [PMID: 30726712 PMCID: PMC9432106 DOI: 10.1016/j.jped.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/03/2018] [Accepted: 11/19/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Enuresis may have a negative impact on the self-image in childhood and adolescence. The objective of this study was to evaluate the association between enuresis and psychiatric disorders at 6 and 11 years of age. METHOD 3,356 children of a birth cohort were evaluated. A standard questionnaire on urinary habits and mental health (Development and Well-Being Assessment [DAWBA]), was used. The prevalence of psychiatric disorders pursuant to the existence of enuresis and its subtypes (monosymptomatic and non-monosymptomatic), stratified by sex, was described. A logistic regression was used for adjusted analysis. RESULTS The prevalence of enuresis at age 6 years was of 10.2% (9% non-monosymptomatic) and, at 11 years old, of 5.4% (4.5% non-monosymptomatic). At age 6 years, boys with non-monosymptomatic enuresis showed more hyperactivity disorders than those without enuresis (6.2% vs. 2.7%, p=0.017). At 11 years old, after adjustment, among the boys with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder, hyperactivity disorders, and oppositional disorders was, respectively, 3.2, 3.4, and 2.6 times higher than in boys without enuresis; and, among the girls with non-monosymptomatic enuresis, the prevalence of any psychiatric disorder and oppositional disorders was, respectively, 4 and 5.5 times higher than among girls without enuresis. CONCLUSION There is a strong association between non-monosymptomatic enuresis and psychiatric disorders at 6 and 11 years old.
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Affiliation(s)
- Denise M Mota
- Universidade Federal de Pelotas (UFPel), Departamento Materno-Infantil, Pelotas, RS, Brazil.
| | - Alicia Matijasevich
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Departamento de Medicina Preventiva, São Paulo, SP, Brazil
| | - Iná S Santos
- Universidade Federal de Pelotas (UFPel), Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brazil
| | - Sandra Petresco
- Psiquiatra da Infância e Adolescência, Porto Alegre, RS, Brazil
| | - Laís Marques Mota
- Universidade Federal do Rio Grande do Sul (UFRGS), Medicina Interna, Porto Alegre, RS, Brazil Received 22 Agust 2018; accepted 6 November 2018
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Filho EM, Riechelmann MB. Propofol use in newborns and children: is it safe? A systematic review. J Pediatr (Rio J) 2020; 96:289-309. [PMID: 31926134 PMCID: PMC9432291 DOI: 10.1016/j.jped.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the main indications and assess the most common adverse events with the administration of hypnotic propofol in most pediatric clinical scenarios. SOURCES A systematic review of PubMed, SciELO, Cochrane, and EMBASE was performed, using filters such as a maximum of five years post-publication, and/or references or articles of importance, with emphasis on clinical trials using propofol. All articles of major relevance were blind-reviewed by both authors according to the PRISMA statement, looking for possible bias and limitations or the quality of the articles. SUMMARY OF THE FINDINGS Through the search criterion applied, 417 articles were found, and their abstracts evaluated. A total of 69 papers were thoroughly studied. Articles about propofol use in children are increasing, including in neonates, with the majority being cohort studies and clinical trials in two main scenarios: upper digestive endoscopy and magnetic resonance imaging. A huge list of adverse events has been published, but most articles considered them of low risk. CONCLUSIONS Propofol is a hypnotic drug with a safe profile of efficacy and adverse events. Indeed, when administered by non-anesthesiologists, quick access to emergency care must be provided, especially in airway events. The use of propofol in other scenarios must be better studied, aiming to reduce the limitations of its administration by general pediatricians.
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Affiliation(s)
- Eduardo Mekitarian Filho
- Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil; Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil; Universidade Cidade de São Paulo (Unicid), Faculdade de Medicina, São Paulo, SP, Brazil; Hospital Santa Catarina, São Paulo, SP, Brazil.
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11
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Benka AU, Pandurov M, Galambos IF, Rakić G, Vrsajkov V, Drašković B. [Effects of caudal block in pediatric surgical patients: a randomized clinical trial]. Rev Bras Anestesiol 2020; 70:97-103. [PMID: 32204919 DOI: 10.1016/j.bjan.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. OBJECTIVES The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. METHODS This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient. RESULTS Children who received a caudal block had significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01) and pain scores 3 hours (p = 0.002) and 6 hours (p = 0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group. CONCLUSIONS The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.
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Affiliation(s)
- Anna Uram Benka
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
| | - Marina Pandurov
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia.
| | - Izabella Fabri Galambos
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
| | - Goran Rakić
- Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia; University of Novi Sad, Medical Faculty, Department of Emergency Medicine, Novi Sad, República da Sérvia
| | - Vladimir Vrsajkov
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Clinical Centre of Vojvodina, Clinic of Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
| | - Biljana Drašković
- University of Novi Sad, Medical Faculty, Department of Anesthesia and Perioperative Medicine, Novi Sad, República da Sérvia; Institute for the Healthcare of Children and Youth of Vojvodina, Clinic of Pediatric surgery, Department for Pediatric Anesthesia, Intensive Care and Pain Therapy, Novi Sad, República da Sérvia
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Alfayate Miguélez S, Garcia-Marcos L. Rational use of antimicrobials in the treatment of upper airway infections. J Pediatr (Rio J) 2020; 96 Suppl 1:111-9. [PMID: 31857096 DOI: 10.1016/j.jped.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To analyze the main cause of the irresponsible use of antibiotics at the pediatric level in a very frequent, usually self-limited, and typically viral condition: upper airway respiratory infections. SOURCES Different databases were searched using specific terms related to resistance to antibiotics, upper airway respiratory infections, and pediatrics patients. SUMMARY OF THE FINDINGS Effectiveness varies depending on the place, the form of intervention, and the resources used. Multiple interventions appear to be more effective. The foundations of treatment are training in technical aspects and in communication skills for the prescribers, and having enough time for each patient; and training through the health clinic and the media for patients/parents. Deferred prescription and the use of rapid diagnostic tests in the primary care setting have been shown to be effective. A fluid relationship based on trust between clinicians and parents/guardians is one of the keystones. CONCLUSIONS Any project that seeks to be totally effective must include a health authority, which in addition to helping implement these measures, has the firm intention of drastically reducing the use of antibiotics in animals and in the environment, as well as favoring research into new antimicrobials.
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Abstract
OBJECTIVES To present the currently available evidence on transmission, clinical, diagnostic methods, treatment, and prevention methods of major arboviruses that occur in childhood. SOURCE OF DATA Non-systematic review carried out in MEDLINE (PubMed), LILACS (VHL), Scopus, Web of Science, Cochrane, CAPES Portal, and Google Scholar databases for the past five years using the search terms arboviruses, dengue, chikungunya, Zika, Mayaro, and West Nile fever, as well as child, newborn, and adolescent. SYNTHESIS OF DATA The main characteristic of arboviruses is the fact that part of their replication cycle occurs inside insect vectors, thus being classically transmitted to humans through the bite of mosquitoes (hematophagous arthropods), although non-vector transmission of these viruses is also possible in specific situations. These diseases remain a major public health challenge, due to the lack of specific antiviral treatment, the co-circulation of different arboviruses in endemic/epidemic regions, the lack of effective and safe immunizations for the vast majority of these viruses, and the great difficulty in vector control, especially in large urban centers. CONCLUSIONS Children are especially vulnerable to this group of diseases due to characteristics that facilitate the development of the most severe forms. More detailed knowledge of this group of diseases allows the pediatrician to diagnose them earlier, implement the correct treatment, monitor warning signs for the most severe forms, and establish effective preventive measures.
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Abstract
OBJECTIVE To collect the most up-to-date information regarding pediatric osteoarticular infections, including the epidemiological and microbiological profiles, diagnosis, and treatment. SOURCE OF DATA A non-systematic review was performed on the search engines PubMed, SciELO, LILACS, and Google Scholar, using the keywords "bone and joint infection", "children", "pediatric", "osteomyelitis", "septic arthritis" and "spondylodiscitis" over the last ten years. The most relevant articles were selected by the authors to constitute the database. SYNTHESIS OF DATA Osteoarticular infections are still a major cause of morbidity in pediatrics. Their main etiology is Staphylococcus aureus, but there has been an increase in the detection of Kingella kingae, especially through molecular methods. Microbiological identification allows treatment direction, while evidence of inflammatory activity assists in treatment follow-up. Imaging tests are especially useful in the initial diagnosis of infections. Empirical treatment should include coverage for the main microorganisms according to the age and clinical conditions of the patient, while considering the local resistance profile. Surgical procedures can be indicated for diagnosis, focus control, and function preservation. Acute complications include sepsis, deep venous thrombosis, and pulmonary embolism. Deaths are rare. Late complications are uncommon but may lead to deformities that compromise motor development. CONCLUSION A correct and early diagnosis, prompt implementation of adequate antimicrobial therapy, and focus control, when indicated, are critical to a better prognosis.
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Affiliation(s)
| | - Marcelo Jenné Mimica
- Santa Casa de São Paulo, Departamento de Pediatria, Setor de Infectologia Pediátrica, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Ciências Patológicas, Disciplina de Microbiologia, São Paulo, SP, Brazil.
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Valavi E, Aminzadeh M, Amouri P, Rezazadeh A, Beladi-Mousavi M. Effect of prednisolone on linear growth in children with nephrotic syndrome. J Pediatr (Rio J) 2020; 96:117-124. [PMID: 30240629 PMCID: PMC9432019 DOI: 10.1016/j.jped.2018.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study aims at determining the relationship between prednisolone cumulative dose and linear growth in pre-pubertal children with idiopathic nephrotic syndrome. METHOD This cross-sectional study was conducted on all children with idiopathic nephrotic syndrome registered to the pediatric nephrology department at the main referral children's hospital in Southwestern Iran. Inclusion criteria included age (males <12 years; females <10 years), >6 months of use, and the minimum prednisolone cumulative dose of 152mg/kg. The exclusion criteria were individuals who had entered puberty or had other diseases affecting linear growth. Based on the prednisolone cumulative dose of ≥550mg/kg (four or more relapses), the children were divided into two groups. All data regarding age, height, and weight at disease onset and the last visit, bone age, and the parents' height were collected. Secondary variables including mid-parental target height and predicted adult height were also calculated. Height data were compared between the different rates of relapse. RESULTS A total of 97 children (68% male) were enrolled. Their post-treatment mean height Z-score was less than that obtained before treatment (-0.584 vs. -0.158; p=0.001). Subjects with higher prednisolone cumulative doses were found to have more reduction in height Z-score (p=0.001). Post-treatment height prediction also showed less growth potential compared to pre-treatment target height (p=0.006). Thirty-three children (34.4%) had four or more relapses, among whom more mean-height Z-score decreases were found compared to those with less-frequent relapses (-0.84 vs. -0.28; p=0.04). CONCLUSION This study showed the negative effect of cumulative dosages of prednisolone on linear growth, which was greater in children with four or more relapses.
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Affiliation(s)
- Ehsan Valavi
- Ahvaz Jundishapur University of Medical Sciences, Chronic Renal Failure Research Center, Ahvaz, Iran
| | - Majid Aminzadeh
- Ahvaz Jundishapur University of Medical Sciences, Diabetes Research Center, Ahvaz, Iran.
| | - Parisa Amouri
- Ahvaz Jundishapur University of Medical Sciences, Chronic Renal Failure Research Center, Ahvaz, Iran
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Pensabene L, Salvatore S, Turco R, Tarsitano F, Concolino D, Baldassarre ME, Borrelli O, Thapar N, Vandenplas Y, Staiano A, Saps M. Low FODMAPs diet for functional abdominal pain disorders in children: critical review of current knowledge. J Pediatr (Rio J) 2019; 95:642-656. [PMID: 31028745 DOI: 10.1016/j.jped.2019.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/13/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This narrative review aimed to provide practitioners a synthesis of the current knowledge on the role of a low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in reducing symptoms associated with functional abdominal pain disorders in children. This review is focused on the pathophysiology, efficacy and criticism of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet in children. SOURCES Cochrane Database, Pubmed and Embase were searched using specific terms for Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet interventions and functional abdominal pain disorders. SUMMARY OF THE FINDINGS In children, only one Randomized Control Trial and one open-label study reported positive results of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols diet; one Randomized Control Trial showed exacerbation of symptoms with fructans in children with Irritable Bowel Syndrome; no effect was found for the lactose-free diet whilst fructose-restricted diets were effective in 5/6 studies. CONCLUSIONS In children there are few trials evaluating low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols in functional abdominal pain disorders, with encouraging data on the therapeutic efficacy particularly of fructose-restricted diet. Additional efforts are still needed to fill this research gap and clarify the most efficient way for tailoring dietary restrictions based on the patient's tolerance and/or identification of potential biomarkers of low Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols efficacy, to maintain nutritional adequacy and to simplify the adherence to diet by labeling Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols content in commercial products.
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Affiliation(s)
- Licia Pensabene
- University "Magna Graecia" of Catanzaro, Pediatric Unit, Department of Medical and Surgical Sciences, Catanzaro, Italy.
| | - Silvia Salvatore
- University of Insubria, Section of Pediatrics, Department of Medicine and Surgery, Varese, Italy
| | - Rossella Turco
- University of Naples "Federico II", Section of Pediatrics, Department of Translational Medical Science, Naples, Italy
| | - Flora Tarsitano
- University "Magna Graecia" of Catanzaro, Pediatric Unit, Department of Medical and Surgical Sciences, Catanzaro, Italy
| | - Daniela Concolino
- University "Magna Graecia" of Catanzaro, Pediatric Unit, Department of Medical and Surgical Sciences, Catanzaro, Italy
| | | | - Osvaldo Borrelli
- Great Ormond Street Hospital for Children, Neurogastroenterology and Motility Unit, Department of Gastroenterology, London, United Kingdom
| | - Nikhil Thapar
- Great Ormond Street Hospital for Children, Neurogastroenterology and Motility Unit, Department of Gastroenterology, London, United Kingdom
| | - Yvan Vandenplas
- Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, KidZ Health Castle, Brussels, Belgium
| | - Annamaria Staiano
- University of Naples "Federico II", Section of Pediatrics, Department of Translational Medical Science, Naples, Italy
| | - Miguel Saps
- University of Miami, Holtz Children's Hospital, Miller School of Medicine, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Miami, United States
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Lopes R, Morais MBD, Oliveira FLC, Brecheret AP, Abreu ALCS, Andrade MCD. Evaluation of carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease. J Pediatr (Rio J) 2019; 95:696-704. [PMID: 30075120 DOI: 10.1016/j.jped.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To assess the carotid intima-media thickness and factors associated with cardiovascular disease in children and adolescents with chronic kidney disease. MATERIAL AND METHODS Observational, cross-sectional study carried out at the Universidade Federal de São Paulo (chronic kidney disease outpatient clinics) with 55 patients (60% males) with a median age of 11.9 years (I25-I75: 9.2-14.8 years). Of the 55 patients, 43 were on conservative treatment and 12 were on dialysis. Serum laboratory parameters (creatinine, uric acid, C-reactive protein, total cholesterol and fractions, and triglycerides), nutritional status (z-score of body mass index, z-score of height/age), body fat (fat percentage and waist circumference), and blood pressure levels were evaluated. The carotid intima-media thickness measure was evaluated by a single ultrasonographer and compared with percentiles established according to gender and height. Data collection was performed between May 2015 and March 2016. RESULTS Of the children and adolescents with chronic kidney disease, 74.5% (95% CI: 61.0; 85.3) showed an increase (>P95) in carotid intima-media thickness. In patients with stages I and II hypertension, 90.9% had increased carotid intima-media thickness. Nutritional status, body fat and laboratory tests were not associated with increased carotid intima-media thickness. After multivariate adjustment, only puberty (PR=1.30, p=0.037) and stages I and II arterial hypertension (PR=1.42, p=0.011) were independently associated with carotid intima-media thickness alterations. CONCLUSION The prevalence of increased carotid thickness was high in children and adolescents with chronic kidney disease. Puberty and arterial hypertension were independently associated with increased carotid intima-media thickness.
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Affiliation(s)
- Renata Lopes
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil.
| | - Mauro Batista de Morais
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), Departamento de Pediatria, Disciplina de Gastroenterologia Pediátrica, São Paulo, SP, Brazil
| | - Fernanda Luisa Ceragioli Oliveira
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), Programa de Pós-Graduação em Nutrição, São Paulo, SP, Brazil
| | - Ana Paula Brecheret
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), São Paulo, SP, Brazil
| | | | - Maria Cristina de Andrade
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina (EPM), Departamento de Pediatria, Setor de Nefrologia Pediátrica, São Paulo, SP, Brazil
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Lima EDC, Matos GCD, Vieira JMDL, Gonçalves ICDCR, Cabral LM, Turner MA. Suspected adverse drug reactions reported for Brazilian children: cross-sectional study. J Pediatr (Rio J) 2019; 95:682-688. [PMID: 30030984 DOI: 10.1016/j.jped.2018.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013. METHODS A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization). RESULTS A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports. CONCLUSIONS The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children.
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Affiliation(s)
- Elisangela da Costa Lima
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Observatório de Vigilância e Uso de Medicamentos, Rio de Janeiro, RJ, Brazil.
| | - Guacira Corrêa de Matos
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Observatório de Vigilância e Uso de Medicamentos, Rio de Janeiro, RJ, Brazil
| | - Jean M de L Vieira
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Programa de Pós Graduação em Ciência e Tecnologia Farmacêutica, Rio de Janeiro, RJ, Brazil
| | - Ivana C da C R Gonçalves
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Programa de Pós Graduação em Ciência e Tecnologia Farmacêutica, Rio de Janeiro, RJ, Brazil
| | - Lucio M Cabral
- Universidade Federal do Rio de Janeiro, Faculdade de Farmácia, Observatório de Vigilância e Uso de Medicamentos, Rio de Janeiro, RJ, Brazil
| | - Mark A Turner
- University of Liverpool, Institute of Translational Medicine, Department of Women's & Children's Health, Liverpool, United Kingdom
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Abdel-Ghaffar HS, Abdel-Wahab AH, Roushdy MM. [Oral trans-mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial]. Rev Bras Anestesiol 2019; 69:469-76. [PMID: 31672419 DOI: 10.1016/j.bjan.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/20/2019] [Accepted: 06/29/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Emergence agitation is a negative behavior commonly recorded after pediatric tonsillectomy. We investigated the efficacy of preoperative premedication with oral transmucosal buccal dexmedetomidine on the incidence and severity of emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia. METHODS Ninety patients aged (3-6 years), ASA I-II were enrolled into three groups (n = 30) to receive oral transmucosal dexmedetomidine 0.5 μg.kg-1 (Group DEX I), 1 μg.kg-1 (Group DEX II) or saline placebo (Group C). Our primary endpoint was the Watcha agitation score at emergence in PACU. Secondary outcomes were preoperative sedation score, intraoperative hemodynamics, postoperative Objective Pain Scale (OPS) and adverse effects. RESULTS The patients' demographics, preoperative sedation scores and extubation time showed no difference between groups. Significant differences between groups in incidence and frequency distribution of each grade of Watcha score were evident at 5 minutes (p = 0.007), 10 minutes (p = 0.034), 30 minutes (p = 0.022), 45 minutes (p = 0.034) and 60 minutes (p = 0.026), postoperatively with significant differences between DEX I and II groups. DEX groups showed lower OPS scores at 5 minutes (p = 0.011), 10 minutes (p = 0.037) and 30 minutes (p = 0.044) after arrival at PACU, with no difference between DEX I and II groups. Patients in DEX II group exhibited lower intraoperative mean heart rate at 15 minutes (p = 0.020), and lower mean arterial pressure at 30 minutes, (p = 0.040), 45 minutes (p = 0.002) and 60 minutes (p = 0.006) with no significant differences between groups in other time points. CONCLUSION This study demonstrates the clinical advantage and the simple technique of oral transmucosal DEX premedication for emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia compared with saline placebo. TRIAL REGISTRATION Clinical Trials.gov trial registry: NCT02720705.
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Sarria EE, Mundstock E, Mocelin HT, Fischer GB, Torres RR, Garbin JGM, Leal LF, de F Arend MHR, Stein R, Booij L, de Araújo RMF, Mattiello R. Health-related quality of life in post-infectious bronchiolitis obliterans: agreement between children and their proxy. J Pediatr (Rio J) 2019; 95:614-618. [PMID: 31327498 DOI: 10.1016/j.jped.2018.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the level of agreement in health-related quality of life between children with Post-infectious Bronchiolitis Obliterans and their parent (so-called proxy). METHODS Participants aged between 8and 17 years who had been previously diagnosed with Post-infectious Bronchiolitis Obliterans were regularly followed up at a pediatric pulmonology outpatient clinic. Parents or legal guardians (caregivers) of these patients were also recruited for the study. A validated and age-appropriate version of the Pediatric Quality of Life Inventory 4.0 was used for the assessment of health-related quality of life. Caregivers completed the corresponding proxy versions of the questionnaire. The correlation between self and proxy reports of health-related quality of life was determined by intra-class correlation coefficient and dependent t-tests. RESULTS The majority of participants were males (79.4%), and the average age was 11.8 years. Intra-class correlations between each of the Pediatric Quality of Life Inventory 4.0 domains and the total score were all lower than 0.6, with a range between 0.267 (poor) and 0.530 (fair). When the means of each domain and the total score of the questionnaires were compared, caregivers were observed to have a significantly lower health-related quality of life score than children, with the exception of the social domain in which the difference was not significant. However, the differences in score exceeded the critical threshold difference of four points in all other domains. CONCLUSION Proxies of children and adolescents with Post-infectious Bronchiolitis Obliterans appear to consistently perceive their children as having lower health-related quality of life than how the patients perceive themselves.
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Affiliation(s)
- Edgar E Sarria
- Universidade de Santa Cruz do Sul (Unisc), Departamento de Biologia e Farmácia, Santa Cruz do Sul, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Eduardo Mundstock
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Prefeitura de Canela, Canela, RS, Brazil
| | - Helena T Mocelin
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
| | - Gilberto B Fischer
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Departamento de Pediatria, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
| | - Renato R Torres
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - João G M Garbin
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Escola de Medicina, Porto Alegre, RS, Brazil
| | - Lisiane F Leal
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Marcia H R de F Arend
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil
| | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil
| | - Linda Booij
- Concordia University, Department of Psychology, Montreal, Canada; University of Montreal, CHU Sainte-Justine & Department of Psychiatry, Montreal, Canada
| | - Rafael M F de Araújo
- Universidade do Vale do Taquari (UNIVATES), Centro de Ciências Médicas, Lajeado, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-graduação em Medicina e Ciências da Saúde, Porto Alegre, RS, Brazil
| | - Rita Mattiello
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil.
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da Silva PSL, Fonseca MCM. Which children account for repeated admissions within 1 year in a Brazilian pediatric intensive care unit? J Pediatr (Rio J) 2019; 95:559-566. [PMID: 29856945 DOI: 10.1016/j.jped.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/27/2018] [Accepted: 04/27/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While studies have focused on early readmissions or readmissions during the same hospitalization in a pediatric intensive care unit, little is known about the children with recurrent admissions. We sought to assess the characteristics of patients readmitted within 1 year in a Brazilian pediatric intensive care unit. METHODS This was a retrospective study carried out in a tertiary pediatric intensive care unit. The outcome was the maximum number of readmissions experienced by each child within any 365-day interval during a 5-year follow-up period. RESULTS Of the 758 total eligible admissions, 75 patients (9.8%) were readmissions. Those patients accounted for 33% of all pediatric intensive care unit bed care days. Median time to readmission was 73 days for all readmissions. Logistic regression showed that complex chronic conditions (odds ratio 1.07), severe to moderate cognitive disability (odds ratio 1.08), and use of technology assistance (odds ratio 1.17) were associated with readmissions. Multiple admissions had a significantly prolonged duration of mechanical ventilation (8 vs. 6 days), longer length of pediatric intensive care unit (7 vs 4 days) and hospital stays (20 vs 9 days), and higher mortality rate (21.3% vs 5.1%) compared with index admissions. CONCLUSION The rate of pediatric intensive care unit readmissions within 1 year was low; however, it was associated with a relevant number of bed care days and worse outcomes. A 30-day index of readmission may be inadequate to mirror the burden of pediatric intensive care unit readmissions. Patients with complex chronic conditions, poor functional status or technology assistance are at higher risk for readmissions. Future studies should address the impact of qualitative interventions on healthcare and recurrent admissions.
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Affiliation(s)
- Paulo Sérgio Lucas da Silva
- Hospital do Servidor Público Municipal, Departamento de Pediatria, Unidade de Terapia Intensiva Pediátrica, São Paulo, SP, Brazil.
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Abdel-Ghaffar HS, Abdel-Wahab AH, Roushdy MM, Osman AMM. [Preemptive nebulized ketamine for pain control after tonsillectomy in children: randomized controlled trial]. Rev Bras Anestesiol 2019; 69:350-357. [PMID: 31362882 DOI: 10.1016/j.bjan.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/10/2019] [Accepted: 03/17/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The administration of ketamine as nebulized inhalation is relatively new and studies on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized ketamine (1 and 2mg.kg-1) administered 30min before general anesthesia in children undergoing elective tonsillectomy in comparison with intravenous ketamine (0.5mg.kg-1) and saline placebo. METHODS One hundred children aged (7-12) years were randomly allocated in four groups (n=25) receive; Saline Placebo (Group C), Intravenous Ketamine 0.5mg.kg-1 (Group K-IV), Nebulized Ketamine 1mg.kg-1 (Group K-N1) or 2mg.kg-1 (Group K-N2). The primary endpoint was the total consumption of rescue analgesics in the first 24h postoperative. RESULTS The mean time to first request for rescue analgesics was prolonged in K-N1 (400.9±60.5min, 95% CI 375.9-425.87) and K-N2 (455.5±44.6min, 95% CI 437.1-473.9) groups compared with Group K-IV (318.5±86.1min, 95% CI 282.9-354.1) and Group C (68.3±21.9min, 95% CI 59.5-77.1; p<0.001), with a significant difference between K-N1 and K-N2 Groups (p<0.001). The total consumption of IV paracetamol in the first 24h postoperative was reduced in Group K-IV (672.6±272.8mg, 95% CI 559.9-785.2), Group K-N1 (715.6±103.2mg, 95% CI 590.4-840.8) and Group K-N2 (696.6±133.3mg, 95% CI 558.8-834.4) compared with Control Group (1153.8±312.4mg, 95% CI 1024.8-1282.8; p<0.001). With no difference between intravenous and Nebulized Ketamine Groups (p=0.312). Patients in intravenous and Nebulized Ketamine Groups showed lower postoperative VRS scores compared with Group C (p<0.001), no differences between K-IV, K-N1 or K-N2 group and without significant adverse effects. CONCLUSION Preemptive nebulized ketamine was effective for post-tonsillectomy pain relief. It can be considered as an effective alternative route to IV ketamine.
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Affiliation(s)
- Hala S Abdel-Ghaffar
- Assiut University, Faculty of Medicine, Department of Anesthesia and Intensive Care, Assiut, Egito
| | - Amani H Abdel-Wahab
- Assiut University, Faculty of Medicine, Department of Anesthesia and Intensive Care, Assiut, Egito.
| | - Mohammed M Roushdy
- Assiut University, Faculty of Medicine, Department of Ear, Nose and Throat, Assiut, Egito
| | - Amira M M Osman
- Assiut University, South Egypt Cancer Institute, Department of Pediatric Oncology, Assiut, Egito
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Alvim RO, Zaniqueli D, Neves FS, Pani VO, Martins CR, Peçanha MAS, Barbosa MCR, Faria ER, Mill JG. Waist-to-height ratio is as reliable as biochemical markers to discriminate pediatric insulin resistance. J Pediatr (Rio J) 2019; 95:428-34. [PMID: 29746812 DOI: 10.1016/j.jped.2018.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/26/2018] [Accepted: 04/02/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Given the importance of incorporating simple and low-cost tools into the pediatric clinical setting to provide screening for insulin resistance, the present study sought to investigate whether waist-to-height ratio is comparable to biochemical markers for the discrimination of insulin resistance in children and adolescents. METHODS This cross-sectional study involved students from nine public schools. In total, 296 children and adolescents of both sexes, aged 8-14 years, composed the sample. Waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio were determined according to standard protocols. Insulin resistance was defined as homeostatic model assessment for insulin resistance with cut-off point ≥ 3.16. RESULTS Age, body mass index, frequency of overweight, waist circumference, waist-to-height ratio, insulin, glucose, homeostatic model assessment for insulin resistance, triglycerides, triglycerides/glucose index, and triglycerides-to-HDL-C were higher among insulin resistant boys and girls. Moderate correlation of all indicators (waist-to-height ratio, triglycerides/glucose index, and triglycerides-to-HDL-C ratio) with homeostatic model assessment for insulin resistance was observed for both sexes. The areas under the receiver operational characteristic curves ware similar between waist-to-height ratio and biochemical markers. CONCLUSION The indicators provided similar discriminatory power for insulin resistance. However, taking into account the cost-benefit ratio, we suggest that waist-to-height ratio may be a useful tool to provide screening for insulin resistance in pediatric populations.
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Costa DD, Pitrez PM, Barroso NF, Roncada C. Asthma control in the quality of life levels of asthmatic patients' caregivers: a systematic review with meta-analysis and meta-regression. J Pediatr (Rio J) 2019; 95:401-9. [PMID: 30540924 DOI: 10.1016/j.jped.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To perform a systematic review with meta-analysis and meta-regression to correlate the total scores of asthma control with the increase in the total scores of health-related quality of life levels of parents of asthmatic children. SOURCES The search was carried out in the following databases: PubMed (MEDLINE); Embase and ScienceDirect (Elsevier); SciELO and LILACs (Bireme) in June 2017. The included studies assessed asthma control through the Asthma Control Questionnaire (ACQ), Asthma Control Test (C-ACT/ACT), and Global Initiative for Asthma (GINA) questionnaires, whereas the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) was applied to assess the HRQoL of parents and family members. SUMMARY OF THE FINDINGS 294 articles were evaluated in the selected databases, of which (n=38) were excluded for duplicity; (n=239) after the reading of the titles and abstracts and (n=5) after reading the studies in full, totaling 12 studies eligible for the meta-analysis. Of the 12 eligible articles, 11 (92%) were published in the last five years, and evaluated children and adolescents aged 1-20 years, totaling 2804 samples. In the evaluation of the correlation between the disease control scores by ACQ and C-ACT/ACT, the results were satisfactory for both ACQ analyses [R2: -0.88; p<0.001], and for C-ACT/ACT [R2: 0.82; p<0.001]. CONCLUSIONS The results show that asthma control levels can influence the total HRQoL scores of parents or relatives of children and adolescents with asthma.
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Akbulut UE, Emeksiz HC, Citli S, Cebi AH, Korkmaz HAA, Baki G. IL-17A, MCP-1, CCR-2, and ABCA1 polymorphisms in children with non-alcoholic fatty liver disease. J Pediatr (Rio J) 2019; 95:350-7. [PMID: 29733805 DOI: 10.1016/j.jped.2018.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/17/2018] [Accepted: 03/23/2018] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The prevalence of non-alcoholic fatty liver disease in children has risen significantly, owing to the worldwide childhood obesity epidemic in the last two decades. Non-alcoholic fatty liver disease is closely linked to sedentary lifestyle, increased body mass index, and visceral adiposity. In addition, individual genetic variations also have a role in the development and progression of non-alcoholic fatty liver disease. The aim of this study was to investigate the gene polymorphisms of MCP-1 (-2518 A/G) (rs1024611), CCR-2 (190 G/A) (rs1799864), ABCA1 (883 G/A) (rs4149313), and IL-17A (-197 G/A) (rs2275913) in obese Turkish children with non-alcoholic fatty liver disease. METHODS The study recruited 186 obese children aged 10-17 years, including 101 children with non-alcoholic fatty liver disease and 85 children without non-alcoholic fatty liver disease. Anthropometric measurements, insulin resistance, a liver panel, a lipid profile, liver ultrasound examination, and genotyping of the four variants were performed. RESULTS No difference was found between the groups in respect to age and gender, body mass index, waist/hip ratio, or body fat ratio. In addition to the elevated ALT levels, AST and GGT levels were found significantly higher in the non-alcoholic fatty liver disease group compared to the non non-alcoholic fatty liver disease group (p<0.05). The A-allele of IL-17A (-197 G/A) (rs2275913) was associated with non-alcoholic fatty liver disease (odds ratio [OR] 2.05, 95% confidence interval: 1.12-3.77, p=0.02). CONCLUSIONS The findings of this study suggest that there may be an association between IL-17A (-197 G/A) (rs2275913) polymorphism and non-alcoholic fatty liver disease development in obese Turkish children.
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Abstract
OBJECTIVES To describe the association between sleep duration and weight-height development in children and adolescents. SOURCE OF DATA A non-systematic search in the MEDLINE database was performed using the terms anthropometry, body composition, overweight, obesity, body mass index, growth, length, short stature, sleep, children, and infants and adolescents, limited to the last 5 years. The references cited in the revised articles were also reviewed, when relevant. SYNTHESIS OF DATA Sleep disorders are prevalent in the pediatric population. Among them, insomnia, which leads to a reduction in total sleep time, is the most prevalent disorder. Evidence found in the current literature allows the conclusion that sleep time reduction has a role in the current pandemic of overweight and obesity. Studies associating sleep deprivation and deficit in height growth are still insufficient. CONCLUSIONS The association between shorter sleep duration and risk of overweight and obesity is well established for all pediatric age groups. However, more evidence is needed to establish an association between insufficient sleep duration and height growth deficit. Pediatricians should include the encouragement of healthy sleep habits in their routine guidelines as an adjuvant in the prevention and management of excess weight.
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Affiliation(s)
| | - Magda Lahorgue Nunes
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Departamento de Neurociências, Porto Alegre, RS, Brazil; Instituto do Cérebro do Rio Grande do Sul (InsCer), Porto Alegre, RS, Brazil.
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Castro APP, Hermsdorff HHM, Milagres LC, Albuquerque FMD, Filgueiras MDS, Rocha NP, Novaes JFD. Increased ApoB/ApoA1 ratio is associated with excess weight, body adiposity, and altered lipid profile in children. J Pediatr (Rio J) 2019; 95:238-246. [PMID: 29438687 DOI: 10.1016/j.jped.2017.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate ApoB/ApoA1 ratio and its association with cardiovascular risk factors in children. METHODS Cross-sectional study with 258 children aged 8 and 9 years old, enrolled in all urban schools in the city of Viçosa-MG. Anthropometric and body composition assessment, as well as biochemical profile of the children was performed. Socioeconomic variables and sedentary lifestyle were evaluated through a semi-structured questionnaire. RESULTS Many children had excess weight (35.2%), abdominal adiposity (10.5%), and body fat (15.6%), as well as increased ApoB/ApoA1 ratio (14.7%), total cholesterol (51.8%), and triglycerides (19.8%). Children with excess weight and total and central fat had a higher prevalence of having a higher ApoB/ApoA1 ratio, as well as those with atherogenic lipid profile (increased LDL-c and triglycerides and low HDL-c). A direct association was found between the number of cardiovascular risk factors and the ApoB/ApoA1 ratio (p=0.001), regardless of age and income. CONCLUSION The increased ApoB/ApoA1 ratio was associated with excess weight, body adiposity (total and central), and altered lipid profile in children. Children with a higher number of cardiovascular risk factors had higher ApoB/ApoA1 ratio, in both genders.
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Affiliation(s)
| | | | | | | | | | - Naruna Pereira Rocha
- Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil
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Vieira-Ribeiro SA, Fonseca PCA, Andreoli CS, Ribeiro AQ, Hermsdorff HHM, Pereira PF, Priore SE, Franceschini SCC. The TyG index cutoff point and its association with body adiposity and lifestyle in children. J Pediatr (Rio J) 2019; 95:217-223. [PMID: 29457996 DOI: 10.1016/j.jped.2017.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To investigate the factors associated with insulin resistance in children aged 4-7 years, and to identify the cutoff point of the triglyceride-glucose index for the prediction of insulin resistance in this population. METHODS A cross-sectional study was conducted with 403 children from a retrospective cohort. Insulin resistance was also evaluated in a sub-sample using the HOMA index. Four indicators of body adiposity were assessed: body mass index, waist-to-height ratio, and the percentages of total and central body fat. Food habits were evaluated by the identification of dietary patterns, using principal component analysis. Information was also collected on lifestyle, socioeconomic status, and breastfeeding time. RESULTS The median index observed in the sample was 7.77, which did not differ between the genders. The shorter the time spent in active activities, the higher the triglyceride-glucose value; and increase in the values of body adiposity indicators was positively associated with triglyceride-glucose. The cutoff point with the best balance between sensitivity and specificity values was 7.88 (AUC=0.63, 95% CI: 0.51-0.74). CONCLUSION The present study identified that total and central body adiposity and shorter time spent in lively activities was positively associated with insulin resistance, evaluated through the triglyceride-glucose index. The cutoff point of 7.88 may be used in this population for insulin resistance risk screening, but caution is required when using it in other populations.
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Affiliation(s)
| | | | | | - Andréia Q Ribeiro
- Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil
| | - Helen H M Hermsdorff
- Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil
| | - Patrícia F Pereira
- Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil
| | - Silvia E Priore
- Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil
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Slhessarenko N, Fontes CJF, Slhessarenko ME, Azevedo RS, Andriolo A. Proposition of decision limits for serum lipids in Brazilian children aged one to 13 years. J Pediatr (Rio J) 2019; 95:173-9. [PMID: 29526481 DOI: 10.1016/j.jped.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine decision limits for total cholesterol, LDL-cholesterol, non-HDL cholesterol, HDL-cholesterol, and triglycerides in healthy children and adolescents from Cuiabá, Brazil. METHODS This was a cross-sectional study of 1866 healthy children and adolescents randomly selected from daycare centers and public schools in Cuiabá. The desirable levels of serum lipids were defined using the classic criteria, i.e., total cholesterol, LDL-cholesterol, non-HDL cholesterol, and triglycerides levels below the P75 percentile, and HDL-c above the P10 percentile. RESULTS For CT, P75 was: 160mg/dL for the age range of 1 to <3 years, 170mg/dL for ≥3 to <9 years, and 176mg/dL for ≥9 to <13 years. For non-HDL cholesterol, it was 122mg/dL for the age range of 1 to <13 years. For LDL-c, it was 104mg/dL at the age range of 1 to <9 years and 106mg/dL from ≥9 to <13 years. For TG, it was 127mg/dL from 1 to <2 years; 98mg/dL from ≥2 to <6 years; and 92mg/dL from ≥6 to <13 years. As for HDL-cholesterol, P10 was 24mg/dL, 28mg/dL, 32mg/dL, and 36mg/dL, for the age ranges of 1 to <2 years, ≥2 to <3 years, ≥3 to <4 years, and ≥4 to <13 years, respectively. CONCLUSION The decision limits for the serum lipid levels defined in this study differed from those observed in the current Brazilian and North-American guidelines, especially because it differentiates between the age ranges. Using these decision limits in clinical practice will certainly contribute to improve the diagnostic accuracy for dyslipidemia in this population group.
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Golucci APBS, Marson FAL, Valente MFF, Branco MM, Prado CC, Nogueira RJN. Influence of AIDS antiretroviral therapy on the growth pattern. J Pediatr (Rio J) 2019; 95:7-17. [PMID: 29660296 DOI: 10.1016/j.jped.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/23/2018] [Accepted: 12/07/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Human immunodeficiency virus infection can result in the early impairment of anthropometric indicators in children and adolescents. However, combined antiretroviral therapy has improved, in addition to the immune response and viral infection, the weight and height development in infected individuals. Therefore, the objective was to evaluate the effect of combined antiretroviral on the growth development of human immunodeficiency virus infected children and adolescents. SOURCE OF DATA A systematic review was performed. In the study, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) strategy was used as the eligibility criterion. The MEDLINE-PubMed and LILACS databases were searched using these descriptors: HIV, children, growth, antiretroviral therapy. The objective was defined by the population, intervention, comparison/control, and outcome (PICO) technique. Inclusion and exclusion criteria were applied for study selection. SYNTHESIS OF DATA Of the 549 studies indexed in MEDLINE-PubMed and LILACS, 73 were read in full, and 44 were included in the review (33 showed a positive impact of combined antiretroviral therapy on weight/height development, ten on weight gain, and one on height gain in children and adolescents infected with human immunodeficiency virus). However, the increase in growth was not enough to normalize the height of infected children when compared to children of the same age and gender without human immunodeficiency virus infection. CONCLUSIONS Combined antiretroviral therapy, which is known to play a role in the improvement of viral and immunological markers, may influence in the weight and height development in children infected with human immunodeficiency virus. The earlier the infection diagnosis and, concomitantly, of malnutrition and the start of combined antiretroviral therapy, the lower the growth impairment when compared to healthy children.
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Affiliation(s)
| | - Fernando Augusto Lima Marson
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Genética Médica, Campinas, SP, Brazil
| | | | - Maira Migliari Branco
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Hospital de Clínicas, Campinas, SP, Brazil
| | - Camila Carbone Prado
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Hospital de Clínicas, Campinas, SP, Brazil
| | - Roberto José Negrão Nogueira
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Pediatria, Campinas, SP, Brazil; Faculdade São Leopoldo Mandic, Campinas, SP, Brazil.
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Ferrari GLDM, Pires C, Solé D, Matsudo V, Katzmarzyk PT, Fisberg M. Factors associated with objectively measured total sedentary time and screen time in children aged 9-11 years. J Pediatr (Rio J) 2019; 95:94-105. [PMID: 29306718 DOI: 10.1016/j.jped.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/07/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify factors associated with total sedentary time and screen time in children aged 9-11 years. METHODS For seven consecutive days, 328 children (51.5% boys) used accelerometers to monitor total sedentary time. Screen time was calculated by the self-reporting method. Individual, family, family environment, and school environment questionnaires were filled out. Body composition was measured using a Tanita scale. RESULTS The mean sedentary time was 500min/day (boys: 489, girls: 511, p=0.005), and mean screen time was 234min/day (boys: 246, girls: 222, p=0.053). In both genders, factors associated with sedentary time were healthy dietary pattern and moderate-to-vigorous physical activity. In boys, only moderate-to-vigorous physical activity was significant; in girls, the healthy dietary pattern, moderate-to-vigorous physical activity, and transportation to school were significant. As for the screen time, the associated factors were body mass index and healthy dietary pattern (both genders). In boys, the associated factors were body mass index, healthy dietary pattern, and television in the bedroom. In girls, the associated factors were healthy dietary pattern, transportation to school, and physical activity policies or practice at school. CONCLUSION Several associated factors were identified in the association between total sedentary time and screen time in children; however, only the healthy dietary pattern was common between sedentary time and screen time.
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Affiliation(s)
- Gerson Luis de Moraes Ferrari
- Centro de Estudos Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS), São Caetano do Sul, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Departamento de Pediatria, Centro de Atendimento e Apoio ao Adolescente, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Departamento de Pediatria, Disciplina de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil; Universidad Mayor, Centro de Investigación en Fisiologia del Ejercicio, Santiago, Chile.
| | - Carlos Pires
- Universidade de Trás-os-Montes e Alto Douro (CM-UTAD), Centro de Matemática, Vila Real, Portugal
| | - Dirceu Solé
- Universidade Federal de São Paulo (UNIFESP), Departamento de Pediatria, Disciplina de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
| | - Victor Matsudo
- Centro de Estudos Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS), São Caetano do Sul, SP, Brazil
| | | | - Mauro Fisberg
- Universidade Federal de São Paulo (UNIFESP), Departamento de Pediatria, Centro de Atendimento e Apoio ao Adolescente, São Paulo, SP, Brazil
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Karacaer F, Biricik E, Ilgınel M, Küçükbingöz Ç, Ağın M, Tümgör G, Güneş Y, Özcengiz D. [Remifentanil-ketamine vs. propofol-ketamine for sedation in pediatric patients undergoing colonoscopy: A randomized clinical trial]. Rev Bras Anestesiol 2018; 68:597-604. [PMID: 30205906 DOI: 10.1016/j.bjan.2018.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 04/26/2018] [Accepted: 06/22/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric patients frequently require deep sedation or general anesthesia for colonoscopy. This study was designed to compare the sedative efficacy of remifentanil-ketamine combination with propofol-ketamine combination in children undergoing colonoscopy. METHODS Seventy patients, between 2 and 16 years of age, scheduled for diagnostic colonoscopy were randomly allocated into two groups. Remifentanil-ketamine group received intravenous ketamine 2mg.kg-1 and remifentanil 0.25μg.kg-1 combination, followed by 0.1μg.kg-1.min-1 remifentanil infusion. Propofol-ketamine group received intravenous propofol 1 and 2mg.kg-1 ketamine combination, followed by 1mg.kg-1.h-1 propofol infusion. In the case of children discomfort (cry, movement, and cough), remifentanil 0.1μg.kg-1 in the remifentanil-ketamine group or propofol 0.5mg.kg-1 in the propofol-ketamine group were administered to improve children discomfort. Despite the therapy given above, if children still experience discomfort, 1mg.kg-1 of ketamine was administered as a rescue drug, regardless of the group. Ramsay sedation score, hemodynamic variables, drug requirements, gastroenterologists' satisfaction, colonoscopy duration, recovery time, and side effects were recorded throughout the procedure and the recovery period. RESULTS The percentage of patients with a Ramsay sedation score of 4 or higher during the procedure was 73.5 and 37.1% in remifentanil-ketamine and propofol-ketamine groups, respectively (p=0.02). Systolic and diastolic blood pressure variables were significantly higher only after induction in the remifentanil-ketamine group than in the propofol-ketamine group (p=0.015). CONCLUSION Coadministration of ketamine with either remifentanil or propofol effectively and safely provides sedation and analgesia in children undergoing colonoscopy. Sedation scores were significantly better in remifentanil-ketamine group than in propofol-ketamine group.
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Affiliation(s)
- Feride Karacaer
- Çukurova University Medical Faculty, Anesthesiology and Reanimation Department, Adana, Turquia.
| | - Ebru Biricik
- Çukurova University Medical Faculty, Anesthesiology and Reanimation Department, Adana, Turquia
| | - Murat Ilgınel
- Çukurova University Medical Faculty, Anesthesiology and Reanimation Department, Adana, Turquia
| | - Çağatay Küçükbingöz
- Numune Training and Research Hospital, Anesthesiology and Reanimation Department, Adana, Turquia
| | - Mehmet Ağın
- Şanlıurfa Training and Research Hospital, Pediatric Gastroenterology Department, Şanlıurfa, Turquia
| | - Gökhan Tümgör
- Çukurova University Medical Faculty, Pediatric Gastroenterology Department, Adana, Turquia
| | - Yasemin Güneş
- Çukurova University Medical Faculty, Pediatric Gastroenterology Department, Adana, Turquia
| | - Dilek Özcengiz
- Çukurova University Medical Faculty, Pediatric Gastroenterology Department, Adana, Turquia
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Abdel-Rahman KAB, Abd-Elshafy SK, Sayed JA. [Effect of two different doses of dexmedetomidine on the incidence of emergence agitation after strabismus surgery: a randomized clinical trial]. Rev Bras Anestesiol 2018; 68:571-576. [PMID: 30201324 DOI: 10.1016/j.bjan.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 03/29/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Emergence agitation is a postoperative negative behavior that affects mainly children. We studied the effect of two different doses of dexmedetomidine on the incidence and degree of EA in children undergoing strabismus surgery. METHODS 90 patients were allocated into three equal groups; patients received 0.5μg.kg-1 of dexmedetomidine in high Dex group, 0.25μg.kg-1 of dexmedetomidine in low Dex group, or normal saline in the placebo group. All drugs were received with the closure of the conjunctiva before the end of the surgery. Pediatric Anesthesia Emergence Delirium (PAED) scale was used to evaluate the agitation, and Face, Legs, Activity, Cry, Consolability (FLACC) scale was used for pain assessment. Adverse effects of dexmedetomidine and recovery times were recorded. RESULTS The incidence of agitation was significantly lower in high Dex group compared to other groups and it was significantly lower in low Dex group compared to placebo group. The median (range) of FLACC score was significantly lower in both Dex groups compared to placebo group. Recovery times; time from removal of laryngeal mask to eye opening and time stay in post anesthesia care unit was significantly longer in high Dex group compared to other groups. No significant bradycardia or hypotension was recorded. Recovery time was significantly longer in high Dex group compared to the other two groups. CONCLUSION Dexmedetomidine (0.5μg.kg-1) before emergence from general anesthesia resulted in a reduction in the incidence of emergence agitation compared to a dexmedetomidine (0.25μg.kg-1) but on the expense of recovery times without adverse effects.
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Affiliation(s)
| | | | - Jehan A Sayed
- Assiut University, College of Medicine, Assiut, Egito
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Gürarslan Baş N, Karatay G, Arikan D. Weaning practices of mothers in eastern Turkey. J Pediatr (Rio J) 2018; 94:498-503. [PMID: 28893515 DOI: 10.1016/j.jped.2017.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/30/2017] [Accepted: 06/14/2017] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The study aimed to determine the practices used by breastfeeding mothers to wean their children from the breast. METHOD This qualitative-quantitative research was conducted with mothers whose children were registered the pediatric clinics of a state hospital between June and September 2016. In accordance with a purposeful sampling method, 232 mothers of children between the ages of 2 and 5 years were included in the study. Data were collected through face-to-face interviews using a questionnaire with demographic characteristics of mothers as well as their weaning practices. The data obtained were analyzed with a computer-assisted program using number and percentage distributions. RESULTS The mean breastfeeding duration was 19.00±7.11 months. It was determined that the majority of mothers (56.5%) used traditional methods for weaning their children. These included applying substances with a bad taste (58.1%) to their breasts, covering their breasts with various materials (26.2%) to make the child not want to nurse anymore, and using a pacifier or feeding bottle (9.2%) to substitute for the mother's breast. CONCLUSIONS It was observed that more than half of the mothers were used some traditional practices that could cause trauma in their children, instead of natural weaning.
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Affiliation(s)
| | - Gülnaz Karatay
- Munzur University, School of Health Science, Tunceli, Turkey
| | - Duygu Arikan
- Atatürk University, Nursing Faculty, Erzurum, Turkey
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Piccoli de Mello P, Eifer DA, Daniel de Mello E. Use of fibers in childhood constipation treatment: systematic review with meta-analysis. J Pediatr (Rio J) 2018; 94:460-470. [PMID: 29474804 DOI: 10.1016/j.jped.2017.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To gather current evidence on the use of fiber for constipation treatment in pediatric patients. SOURCE OF DATA Systematic review with meta-analysis of studies identified through Pubmed, Embase, LILACS and Cochrane databases published up to 2016. INCLUSION CRITERIA Randomized controlled trials; patients aged between 1 and 18 years and diagnosed with functional constipation receiving or not drug treatment for constipation; articles published in Portuguese, English, Spanish, French, and German in journals accessible to the researchers. SYNTHESIS OF DATA A total of 2963 articles were retrieved during the search and, after adequate evaluation, nine articles were considered relevant to the study objective. A total of 680 children were included, of whom 45% were boys. No statistical significance was observed for bowel movement frequency, stool consistency, therapeutic success, fecal incontinence, and abdominal pain with fiber intake in patients with childhood constipation. These results should be interpreted with care due to the high clinical heterogeneity between the studies and the methodological limitation of the articles selected for analysis. CONCLUSIONS There is a scarcity of qualified studies to evaluate fiber supplementation in the treatment of childhood constipation, generating a low degree of confidence in estimating the real effect of this intervention on this population. Today, according to the current literature, adequate fiber intake should only be recommended for functional constipation, and fiber supplementation should not be prescribed in the diet of constipated children and adolescents.
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Affiliation(s)
- Patricia Piccoli de Mello
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Diego Andre Eifer
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Radiologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Elza Daniel de Mello
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
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Assumpção MSD, Ribeiro JD, Wamosy RMG, Figueiredo FCXSD, Parazzi PLF, Schivinski CIS. Impulse oscillometry and obesity in children. J Pediatr (Rio J) 2018; 94:419-424. [PMID: 28843062 DOI: 10.1016/j.jped.2017.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To compare impulse oscillometry system parameters of normal-weight children with overweight and obese children. METHOD All participants were submitted to the evaluation of lung function (spirometry and impulse oscillometry) following the American Thoracic Society standards. The evaluation of respiratory mechanics was performed using the Jaeger™ MasterScreen™ Impulse Oscillometry System (Erich Jaeger, Germany), three tests were recorded, with acquisition for at least 20seconds. RESULTS The study included 81 children (30 in the control group, 21 in the overweight group, and 30 the in obesity group), matched for age and sex. Regarding spirometry data, obesity group showed higher numerical values in relation to the control group; however, there were no significant differences among the three groups. For impulse oscillometry parameters, there was a difference between control group and obesity group for respiratory impedance (p=0.036), resistance at 5hertz (p=0.026), resonant frequency (p=0.029), and reactance area (p=0.014). For the parameters expressed in percentage of predicted, there were differences in resistance at 5 hertz, resonant frequency, and reactance area between control group and obesity group. CONCLUSIONS Obese children showed increased oscillometry parameters values representative of airway obstruction, compared to normal-weight children. Changes in some oscillometry parameters can already be observed in overweight school-aged children.
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Affiliation(s)
- Maíra S de Assumpção
- Universidade Estadual de Campinas (Unicamp), Departamento de Pediatria, Campinas, SP, Brazil
| | - José D Ribeiro
- Universidade Estadual de Campinas (Unicamp), Departamento de Pediatria, Campinas, SP, Brazil
| | - Renata M G Wamosy
- Universidade do Estado de Santa Catarina (UDESC), Departamento de Fisioterapia, Florianópolis, SC, Brazil
| | | | - Paloma L F Parazzi
- Universidade Estadual de Campinas (Unicamp), Departamento de Pediatria, Campinas, SP, Brazil
| | - Camila I S Schivinski
- Universidade Estadual de Campinas (Unicamp), Departamento de Pediatria, Campinas, SP, Brazil; Universidade do Estado de Santa Catarina (UDESC), Departamento de Fisioterapia, Florianópolis, SC, Brazil.
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Sarria EE, Mundstock E, Machado DG, Mocelin HT, Fischer GB, Furlan SP, Antonello ICF, Stein R, Mattiello R. Health-related quality of life in patients with bronchiolitis obliterans. J Pediatr (Rio J) 2018; 94:374-9. [PMID: 29172039 DOI: 10.1016/j.jped.2017.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/13/2017] [Accepted: 05/31/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the overall health-related quality of life in patients with bronchiolitis obliterans. METHODS Participants with a diagnosis of post-infectious bronchiolitis obliterans, who were being followed-up at two specialized outpatient clinics of Pediatric Pulmonology in Porto Alegre, Brazil, and controls aged between 8 and 17 years, of both genders, were included in the study. Controls were paired by gender, age, and socioeconomic level in relation to the group of participants with post-infectious bronchiolitis obliterans. The version of the Pediatric Quality of Life Inventory (PedsQ) tool validated for Brazil was applied for the assessment of Health-related Quality of Life, through an interview. The comparison of the Health-related Quality of Life means between the groups was performed using Student's t-test for independent samples and the chi-squared test, for categorical variables. RESULTS 34 patients diagnosed with post-infectious bronchiolitis obliterans and 34 controls participated in the study. The mean age of the children included in the study was 11.2±2.5 years, and 49 (72%) of them were males. The groups showed no significant differences in relation to these variables. The quality of life score was significantly and clinically lower in the post-infectious bronchiolitis obliterans group when compared with controls in the health (72.36±15.6, 81.06±16.4, p=0.031) and school domains (62.34±20.7, 72.94±21.3, p=0.043), as well as in the total score (69.53±14.9, 78.02±14.8, p=0.024), respectively. CONCLUSION Patients with post-infectious bronchiolitis obliterans presented lower health-related quality of life scores when compared with healthy individuals in the total score and in the health and school domains.
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Mrad FCDC, Figueiredo AAD, Bessa JD, Bastos Netto JM. Prolonged toilet training in children with Down syndrome: a case-control study. J Pediatr (Rio J) 2018; 94:286-292. [PMID: 28869807 DOI: 10.1016/j.jped.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/18/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Children with Down syndrome have delayed psychomotor development, which is a factor that influences the level of difficulty in toilet training. The current study aims to estimate the age toilet training starts and completes in children with DS compared to children with normal psychomotor development and to evaluate the method and type of toilet training most frequently used, as well as its association with lower urinary tract symptoms and functional constipation. METHODS A case-control study was carried out from 2010 to 2015. All parents completed a questionnaire designed to assess the toilet training process. Lower urinary tract symptoms were assessed through the application of the Dysfunctional Voiding Symptom Score. The presence of functional constipation was assessed according to the Rome III criteria. RESULTS The study included 93 children with Down syndrome and 204 children with normal psychomotor development (control group [CG]). The mean age of toilet training onset was 22.8 months in those with DS and 17.5 months in the CG (p=0.001). In children with DS, the mean age when completing toilet training was 56.2 months and 27.1 months in the CG (p=0.001). Among children with DS, females completed toilet training earlier (p=0.02). The toilet training method used most often was child-oriented approach in both groups. No association was observed with the presence of lower urinary tract symptoms or functional constipation and the age of beginning and completing toilet training in both groups. CONCLUSION Children with Down syndrome experienced prolonged toilet training time. Prospective longitudinal studies are essential to gain insight into the toilet training of these children.
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Affiliation(s)
- Flávia Cristina de Carvalho Mrad
- Universidade Federal de Juiz de Fora (UFJF), Departamento de Cirurgia, Núcleo Interdisciplinar de Pesquisa em Urologia (NIPU), Juiz de Fora, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Departamento de Pediatria, Belo Horizonte, MG, Brazil.
| | - André Avarese de Figueiredo
- Universidade Federal de Juiz de Fora (UFJF), Departamento de Cirurgia, Núcleo Interdisciplinar de Pesquisa em Urologia (NIPU), Juiz de Fora, MG, Brazil
| | - José de Bessa
- Universidade Estadual de Feira de Santana (UEFS), Departamento de Cirurgia, Feira de Santana, BA, Brazil
| | - José Murillo Bastos Netto
- Universidade Federal de Juiz de Fora (UFJF), Departamento de Cirurgia, Núcleo Interdisciplinar de Pesquisa em Urologia (NIPU), Juiz de Fora, MG, Brazil; Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Hospital e Maternidade Therezinha de Jesus, Departamento de Cirurgia, Juiz de Fora, MG, Brazil
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Akbulut UE, Fidan S, Emeksiz HC, Ors OP. Duodenal pathologies in children: a single-center experience. J Pediatr (Rio J) 2018; 94:273-278. [PMID: 28888898 DOI: 10.1016/j.jped.2017.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. METHOD Patients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. RESULTS Out of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p=0.002, OR: 3.91, 95% CI: 1.59-9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%). CONCLUSION Duodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.
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Affiliation(s)
- Ulas Emre Akbulut
- Kanuni Training and Research Hospital, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Trabzon, Turkey.
| | - Sami Fidan
- Karadeniz Technical University, Faculty of Medicine, Department of Gastroenterology, Trabzon, Turkey
| | - Hamdi Cihan Emeksiz
- Kanuni Training and Research Hospital, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Orhan Polat Ors
- Istanbul Bilim University, Faculty of Medicine, Department of Anatomy, Istanbul, Turkey
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Kelishadi R, Qorbani M, Heshmat R, Djalalinia S, Sheidaei A, Safiri S, Hajizadeh N, Motlagh ME, Ardalan G, Asayesh H, Mansourian M. Socioeconomic inequality in childhood obesity and its determinants: a Blinder-Oaxaca decomposition. J Pediatr (Rio J) 2018; 94:131-139. [PMID: 28822712 DOI: 10.1016/j.jped.2017.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/08/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Childhood obesity has become a priority health concern worldwide. Socioeconomic status is one of its main determinants. This study aimed to assess the socioeconomic inequality of obesity in children and adolescents at national and provincial levels in Iran. METHODS This multicenter cross-sectional study was conducted in 2011-2012, as part of a national school-based surveillance program performed in 40,000 students, aged 6-18-years, from urban and rural areas of 30 provinces of Iran. Using principle component analysis, the socioeconomic status of participants was categorized to quintiles. Socioeconomic status inequality in excess weight was estimated by calculating the prevalence of excess weight (i.e., overweight, generalized obesity, and abdominal obesity) across the socioeconomic status quintiles, the concentration index, and slope index of inequality. The determinants of this inequality were determined by the Oaxaca Blinder decomposition. RESULTS Overall, 36,529 students completed the study (response rate: 91.32%); 50.79% of whom were boys and 74.23% were urban inhabitants. The mean (standard deviation) age was 12.14 (3.36) years. The prevalence of overweight, generalized obesity, and abdominal obesity was 11.51%, 8.35%, and 17.87%, respectively. The SII for overweight, obesity and abdominal obesity was -0.1, -0.1 and -0.15, respectively. Concentration index for overweight, generalized obesity, and abdominal obesity was positive, which indicate inequality in favor of low socioeconomic status groups. Area of residence, family history of obesity, and age were the most contributing factors to the inequality of obesity prevalence observed between the highest and lowest socioeconomic status groups. CONCLUSION This study provides considerable information on the high prevalence of excess weight in families with higher socioeconomic status at national and provincial levels. These findings can be used for international comparisons and for healthcare policies, improving their programming by considering differences at provincial levels.
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Affiliation(s)
- Roya Kelishadi
- Isfahan University of Medical Sciences, Research Institute for Primordial Prevention of Non-communicable Disease, Child Growth and Development Research Center, Department of Pediatrics, Isfahan, Iran
| | - Mostafa Qorbani
- Alborz University of Medical Sciences, Department of Community Medicine, Karaj, Iran; Tehran University of Medical Sciences, Endocrinology and Metabolism Population Sciences Institute, Chronic Diseases Research Center, Tehran, Iran.
| | - Ramin Heshmat
- Tehran University of Medical Sciences, Endocrinology and Metabolism Population Sciences Institute, Chronic Diseases Research Center, Tehran, Iran
| | - Shirin Djalalinia
- Tehran University of Medical Sciences, Endocrinology and Metabolism Population Sciences Institute, Non-communicable Diseases Research Center, Tehran, Iran; Ministry of Health and Medical Education, Deputy of Research and Technology, Development of Research & Technology Center, Tehran, Iran
| | - Ali Sheidaei
- Shahid Beheshti University of Medical Science, Department of Epidemiology and Biostatistics, Tehran, Iran
| | - Saeid Safiri
- Maragheh University of Medical Sciences, School of Nursing and Midwifery, Managerial Epidemiology Research Center, Maragheh, Iran
| | - Nastaran Hajizadeh
- Shahid Beheshti University of Medical Science, Department of Epidemiology and Biostatistics, Tehran, Iran
| | | | - Gelayol Ardalan
- Isfahan University of Medical Sciences, Research Institute for Primordial Prevention of Non-communicable Disease, Child Growth and Development Research Center, Department of Pediatrics, Isfahan, Iran
| | - Hamid Asayesh
- Qom University of Medical Sciences, Department of Medical Emergencies, Qom, Iran
| | - Morteza Mansourian
- Iran University of Medical Sciences, School of Health, Department of Health Education and Promotion, Tehran, Iran
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Chambi-Rocha A, Cabrera-Domínguez ME, Domínguez-Reyes A. Breathing mode influence on craniofacial development and head posture. J Pediatr (Rio J) 2018; 94:123-30. [PMID: 28818510 DOI: 10.1016/j.jped.2017.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/23/2017] [Accepted: 04/06/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The incidence of abnormal breathing and its consequences on craniofacial development is increasing, and is not limited to children with adenoid faces. The objective of this study was to evaluate the cephalometric differences in craniofacial structures and head posture between nasal breathing and oral breathing children and teenagers with a normal facial growth pattern. METHOD Ninety-eight 7-16 year-old patients with a normal facial growth pattern were clinically and radiographically evaluated. They were classified as either nasal breathing or oral breathing patients according to the predominant mode of breathing through clinical and historical evaluation, and breathing respiratory rate predomination as quantified by an airflow sensor. They were divided in two age groups (G1: 7-9) (G2: 10-16) to account for normal age-related facial growth. RESULTS Oral breathing children (8.0±0.7 years) showed less nasopharyngeal cross-sectional dimension (MPP) (p=0.030), whereas other structures were similar to their nasal breathing counterparts (7.6±0.9 years). However, oral breathing teenagers (12.3±2.0 years) exhibited a greater palate length (ANS-PNS) (p=0.049), a higher vertical dimension in the lower anterior face (Xi-ANS-Pm) (p=0.015), and a lower position of the hyoid bone with respect to the mandibular plane (H-MP) (p=0.017) than their nasal breathing counterparts (12.5±1.9 years). No statistically significant differences were found in head posture. CONCLUSION Even in individuals with a normal facial growth pattern, when compared with nasal breathing individuals, oral breathing children present differences in airway dimensions. Among adolescents, these dissimilarities include structures in the facial development and hyoid bone position.
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Valões CCM, Novak GV, Brunelli JB, Kozu KT, Toma RK, Silva CA. Esophageal abnormalities in juvenile localized scleroderma: is it associated with other extracutaneous manifestations? Rev Bras Reumatol Engl Ed 2017; 57:521-5. [PMID: 29173689 DOI: 10.1016/j.rbre.2016.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/30/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess esophageal involvement (EI) in juvenile localized scleroderma (JLS) population and the possible association between this gastrointestinal manifestation and demographic data, clinical features, laboratory exams, treatments and outcomes. METHODS For a period of 30 years, 5881 patients with rheumatic diseases were followed in our Pediatric Rheumatology Division. EI was defined by the presence of symptoms (solid/liquid dysphagia, heartburn, esophageal regurgitation, nausea/vomiting and epigastralgia) and confirmed by at least one EI exam abnormality: barium contrast radiography, upper gastrointestinal endoscopy and 24-hour esophageal pH-monitoring. RESULTS JLS was observed in 56/5881 patients (0.9%), mainly linear morphea subtype. EI was observed in 23/56(41%) of JLS patients. Eight(35%) of 23 EI patients with JLS were symptomatic and presented heartburn(5/8), solid and liquid dysphagia(3/8), nausea and epigastralgia(1/8). The frequency of any cumulative extracutaneous manifestations (calcinosis, arthritis/arthralgia, central nervous system, interstitial pneumonitis, mesangial nephritis and/or arrhythmia) was significantly higher in JLS patients with EI compared to those without this complication (56% vs. 24%, p=0.024). No differences were evidenced in demographic data, JLS subtypes and in each extracutaneous manifestation in both groups (p>0.05). The frequency of methotrexate use was significantly higher in JLS patients with EI compared to those without (52% vs. 12%, p=0.002). Autoantibody profile (antinuclear antibodies, anti-SCL-70, rheumatoid factor, anticentromere, anti-cardiolipin, anti-Ro/SSA and anti-La/SSB) was similar in both groups (p>0.05). CONCLUSIONS Our study demonstrated that EI was frequently observed in JLS patients, mainly in asymptomatic patients with linear subtype. EI occurred in JLS patients with other extracutaneous manifestations and required methotrexate therapy.
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Abstract
OBJECTIVES To summarize the current literature describing high-flow nasal cannula use in children, the components and mechanisms of action of a high-flow nasal cannula system, the appropriate clinical applications, and its role in the pediatric emergency department. SOURCES A computer-based search of PubMed/MEDLINE and Google Scholar for literature on high-flow nasal cannula use in children was performed. DATA SUMMARY High-flow nasal cannula, a non-invasive respiratory support modality, provides heated and fully humidified gas mixtures to patients via a nasal cannula interface. High-flow nasal cannula likely supports respiration though reduced inspiratory resistance, washout of the nasopharyngeal dead space, reduced metabolic work related to gas conditioning, improved airway conductance and mucociliary clearance, and provision of low levels of positive airway pressure. Most data describing high-flow nasal cannula use in children focuses on those with bronchiolitis, although high-flow nasal cannula has been used in children with other respiratory diseases. Introduction of high-flow nasal cannula into clinical practice, including in the emergency department, has been associated with decreased rates of endotracheal intubation. Limited prospective interventional data suggest that high-flow nasal cannula may be similarly efficacious as continuous positive airway pressure and more efficacious than standard oxygen therapy for some patients. Patient characteristics, such as improved tachycardia and tachypnea, have been associated with a lack of progression to endotracheal intubation. Reported adverse effects are rare. CONCLUSIONS High-flow nasal cannula should be considered for pediatric emergency department patients with respiratory distress not requiring immediate endotracheal intubation; prospective, pediatric emergency department-specific trials are needed to better determine responsive patient populations, ideal high-flow nasal cannula settings, and comparative efficacy vs. other respiratory support modalities.
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Affiliation(s)
- Katherine N Slain
- UH Rainbow Babies & Children's Hospital, Division of Pediatric Critical Care Medicine, Cleveland, United States; Case Western Reserve University, School of Medicine, Department of Pediatrics, Cleveland, United States
| | - Steven L Shein
- UH Rainbow Babies & Children's Hospital, Division of Pediatric Critical Care Medicine, Cleveland, United States; Case Western Reserve University, School of Medicine, Department of Pediatrics, Cleveland, United States
| | - Alexandre T Rotta
- UH Rainbow Babies & Children's Hospital, Division of Pediatric Critical Care Medicine, Cleveland, United States; Case Western Reserve University, School of Medicine, Department of Pediatrics, Cleveland, United States.
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Ferrari GLDM, Matsudo V, Katzmarzyk PT, Fisberg M. Prevalence and factors associated with body mass index in children aged 9-11 years. J Pediatr (Rio J) 2017; 93:601-609. [PMID: 28506666 DOI: 10.1016/j.jped.2016.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/26/2016] [Accepted: 12/20/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study aimed to identify the prevalence and factors associated with body mass index (BMI) in children aged 9-11 years. METHODS The study is part of the International Study of Childhood Obesity Lifestyle and the Environment (ISCOLE). Body composition was determined using the bipolar bioimpedance technique. The mean BMI value was categorized as recommended by the World Health Organization. For seven consecutive days, participants used an accelerometer to objectively monitor sedentary behavior (SB) and moderate to vigorous physical activity. Individual factors (anthropometric and behavioral), family aspects, and family and school environment were provided by participants and parents and were analyzed by multilevel linear regression adjusted for gender, ethnicity, school, number of siblings, and total annual family income. RESULTS The mean BMI was 20.1kg/m2, and 51.8% of the children were overweight/obese (50.3% boys, 53.4% girls, p=0.014). Considering all participants, the associated factors of BMI were body fat percentage (BF%, β=0.0216, p<0.001) and screen time (ST, β=0.0050, p=0.006). In boys, the associated factors were BF% (β=0.0209, p<0.001), ST (β=0.006, p=0.036), and healthy eating policies or practices (β=0.0276, p=0.025). In girls, only BF% was associated (β=0.0221, p<0.001) with BMI. CONCLUSIONS High prevalence of overweight/obesity was observed in children from São Caetano do Sul. Different associated factors were identified between the genders, with only BF% being common in both genders.
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Affiliation(s)
- Gerson Luis de Moraes Ferrari
- Centro de estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS), São Caetano do Sul, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Departamento de Pediatria, Centro de Atendimento e Apoio ao Adolescente, São Paulo, SP, Brazil.
| | - Victor Matsudo
- Centro de estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS), São Caetano do Sul, SP, Brazil
| | | | - Mauro Fisberg
- Universidade Federal de São Paulo (UNIFESP), Departamento de Pediatria, Centro de Atendimento e Apoio ao Adolescente, São Paulo, SP, Brazil
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AbuShady MM, Fathy HA, Fathy GA, Fatah SAE, Ali A, Abbas MA. Blood lead levels in a group of children: the potential risk factors and health problems. J Pediatr (Rio J) 2017; 93:619-624. [PMID: 28366628 DOI: 10.1016/j.jped.2016.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 12/01/2016] [Accepted: 12/22/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To investigate blood lead levels in schoolchildren in two areas of Egypt to understand the current lead pollution exposure and its risk factors, aiming to improve prevention politicies. SUBJECTS AND METHOD This was a cross-sectional study in children (n=400) aged 6-12 years recruited from two areas in Egypt (industrial and urban). Blood lead levels were measured using an atomic absorption method. Detailed questionnaires on sources of lead exposure and history of school performance and any behavioral changes were obtained. RESULTS The mean blood lead level in the urban area of Egypt (Dokki) was 5.45±3.90μg/dL, while that in the industrial area (Helwan) was 10.37±7.94μg/dL, with a statistically significant difference between both areas (p<0.05). In Dokki, 20% of the studied group had blood lead levels≥10μg/dL, versus 42% of those in Helwan. A significant association was found between children with abnormal behavior and those with pallor with blood lead level≥10μg/dL, when compared with those with blood lead level<10μg/dL (p<0.05). Those living in Helwan area, those with bad health habits, and those living in housing with increased exposure were at a statistically significantly higher risk of having blood lead level≥10μg/dL. CONCLUSION Lead remains a public health problem in Egypt. High blood lead levels were significantly associated with bad health habits and housing with increased exposure, as well as abnormal behavior and pallor.
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Affiliation(s)
- Mones M AbuShady
- National Research Centre, Child Health Department, Cairo, Egypt.
| | - Hanan A Fathy
- Atomic Energy Authority, National Center for Radiation Research and Technology (NCRRT), Health Radiation Research Department, Cairo, Egypt
| | - Gihan A Fathy
- National Research Centre, Child Health Department, Cairo, Egypt
| | - Samer Abd El Fatah
- Atomic Energy Authority, National Center for Radiation Research and Technology (NCRRT), Health Radiation Research Department, Cairo, Egypt
| | - Alaa Ali
- National Research Centre, Child Health Department, Cairo, Egypt
| | - Mohamed A Abbas
- National Research Centre, Child Health Department, Cairo, Egypt
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Perrone E, Zanolla TA, Fock RA, Perez ABA, Brunoni D. Determining the frequency of morphological characteristics in a sample of Brazilian children. J Pediatr (Rio J) 2017; 93:592-600. [PMID: 28756062 DOI: 10.1016/j.jped.2016.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/09/2016] [Accepted: 12/20/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To establish the frequency of 82 morphological features in a sample of Brazilian children (between 3 and 13 years old), to understand the influence of age, gender, and ethnicity. METHODS This was a cross-sectional study that evaluated 239 children with typical development (between 3 and 13 years old) regarding the presence of 82 morphological characteristics. A previously described protocol, based on the London Dysmorphology Database, was applied to evaluate the sample. This protocol was culturally adapted to Brazilian Portuguese. RESULTS The frequency of 82 morphological characteristics was established in the sample; of 82 characteristics, 50% were considered morphological anomalies (frequency less than 4%). At least 25% of the sample presented more than one minor morphological anomaly. Age was shown to influence the frequency of the following morphological characteristics: widow's peak, prominent antihelix, prominent upper lip, irregular or crowded teeth, and clinodactyly, but had no influence on the frequency of minor morphological anomalies. Gender influenced dysplastic ears and attached earlobe, but had no influence on the frequency of minor morphological anomalies; ethnicity showed influence on camptodactyly and prominent antihelix. A statistically significant divergence was observed regarding 43 of the 73 morphological characteristics that could be compared with literature data (58.9%). CONCLUSIONS The study determined the frequency of 82 morphological characteristics in 239 children with typical development. Age was the variable that showed more influence on the frequency of morphological characteristics, and comparison with literature data showed that the frequency depends on variables such as age and ethnicity.
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Andaki ACR, Quadros TMBD, Gordia AP, Mota J, Tinôco ALA, Mendes EL. Skinfold reference curves and their use in predicting metabolic syndrome risk in children. J Pediatr (Rio J) 2017; 93:490-496. [PMID: 28549740 DOI: 10.1016/j.jped.2016.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/18/2016] [Accepted: 11/16/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To draw skinfold (SF) reference curves (subscapular, suprailiac, biceps, triceps) and to determine SF cutoff points for predicting the risk of metabolic syndrome (MetS) in children aged 6-10 years old. METHODS This was a cross-sectional study with a random sample of 1480 children aged 6-10 years old, 52.2% females, from public and private schools located in the urban and rural areas of the municipality of Uberaba (MG). Anthropometry, blood pressure, and fasting blood samples were taken at school, following specific protocols. The LMS method was used to draw the reference curves and ROC curve analysis to determine the accuracy and cutoff points for the evaluated skinfolds. RESULTS The four SF evaluated (subscapular, suprailiac, biceps, and triceps) and their sum (∑4SF) were accurate in predicting MetS for both girls and boys. Additionally, cutoffs have been proposed and percentile curves (p5, p10, p25, p50, p75, p90, and p95) were outlined for the four SF and ∑4SF, for both genders. CONCLUSION SF measurements were accurate in predicting metabolic syndrome in children aged 6-10 years old. Age- and gender-specific smoothed percentiles curves of SF provide a reference for the detection of risk for MetS in children.
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Affiliation(s)
- Alynne C R Andaki
- Universidade Federal do Triângulo Mineiro (UFTM), Departamento de Ciências do Esporte, Uberaba, MG, Brazil.
| | - Teresa M B de Quadros
- Universidade Federal do Recôncavo da Bahia (UFRB), Centro de Formação de Professores, Cruz das Almas, BA, Brazil
| | - Alex P Gordia
- Universidade Federal do Recôncavo da Bahia (UFRB), Centro de Formação de Professores, Cruz das Almas, BA, Brazil
| | - Jorge Mota
- Universidade do Porto, Faculdade do Desporto, Porto, Portugal
| | - Adelson L A Tinôco
- Universidade Federal de Viçosa (UFV), Departamento de Nutrição e Saúde, Viçosa, MG, Brazil
| | - Edmar L Mendes
- Universidade Federal do Triângulo Mineiro (UFTM), Departamento de Ciências do Esporte, Uberaba, MG, Brazil
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Frota ACC, Harrison LH, Ferreira B, Menna-Barreto D, Castro RBND, Silva GPD, Oliveira RHD, Abreu TF, Milagres LG, Hofer CB. Antibody persistence following meningococcal C conjugate vaccination in children and adolescents infected with human immunodeficiency virus. J Pediatr (Rio J) 2017; 93:532-537. [PMID: 28441513 DOI: 10.1016/j.jped.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 11/25/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE HIV-infected individuals (HIVI) are threatened by meningococcal infection and presented lower response to vaccines. Data are scarce on long-term persistence of human serum bactericidal antibody (hSBA) after a meningococcal C conjugate (MCC) vaccine in HIVI youth; the authors aimed to describe this persistence in HIVI. METHODS HIVI and HIV uninfected individuals (HIVU), aged 2-18 years, CD4 >15% were recruited. Seroprotection (hSBA ≥1:4) at baseline and at 12-18 months after immunization was evaluated and the association of the different factors with the long-term persistence was calculated using logistic regression. RESULTS A total of 145 HIVI, 50 HIVU were recruited and immunized, and their median age was 11 years (median age in HIVI group was 12 years, and 10 years in HIVU group, p-value=0.02). 85 HIVI (44%) had undetectable viral load (UVL). Seroprotection rate was 27.2%: 24.1% in HIVI and 36% in HIVU 12-18 months after immunization (p=0.14). Baseline immunity (odds ratio [OR]=70.70, 95% CI: 65.2-766.6); UVL at entry (OR: 2.87, 95% CI: 0.96-8.62) and lower family income (OR: 0.09, 95% CI: 0.01-0.69) were associated with seroprotection among HIVI. CONCLUSION Seroprotection at 12-18 months after single dose of MCC was low for both groups, and higher among individuals who presented baseline immunity. Among HIVI, vaccine should be administered after UVL is achieved.
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Affiliation(s)
- Ana Cristina Cisne Frota
- Universidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Preventiva, Rio de Janeiro, RJ, Brazil
| | - Lee H Harrison
- University of Pittsburgh, Infectious Diseases Epidemiology Research Unit, Pittsburgh, United States
| | - Bianca Ferreira
- Universidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Preventiva, Rio de Janeiro, RJ, Brazil
| | - Daniela Menna-Barreto
- Universidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Preventiva, Rio de Janeiro, RJ, Brazil
| | - Raquel Bernardo Nana de Castro
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Microbiologia, Imunologia e Parasitologia, Disciplina de Microbiologia, Rio de Janeiro, RJ, Brazil
| | - Giselle Pereira da Silva
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Microbiologia, Imunologia e Parasitologia, Disciplina de Microbiologia, Rio de Janeiro, RJ, Brazil
| | | | - Thalita F Abreu
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Lucimar G Milagres
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Microbiologia, Imunologia e Parasitologia, Disciplina de Microbiologia, Rio de Janeiro, RJ, Brazil
| | - Cristina B Hofer
- Universidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Preventiva, Rio de Janeiro, RJ, Brazil.
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Almeida AND, Ramos V, Almeida HND, Escobar CG, Garcia C. Analysis of contextual variables in the evaluation of child abuse in the pediatric emergency setting. J Pediatr (Rio J) 2017; 93:374-381. [PMID: 28457948 DOI: 10.1016/j.jped.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/14/2016] [Accepted: 09/14/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This article comprises a sample of abuse modalities observed in a pediatric emergency room of a public hospital in the Lisbon metropolitan area and a multifactorial characterization of physical and sexual violence. The objectives are: (1) to discuss the importance of social and family variables in the configuration of both types of violence; (2) to show how physical and sexual violence have subtypes and internal diversity. METHODS A statistical analysis was carried out in a database (1063 records of child abuse between 2004 and 2013). A form was applied to cases with suspected abuse, containing data on the child, family, abuse episode, abuser, medical history, and clinical observation. A factorial analysis of multiple correspondence was performed to identify patterns of association between social variables and physical and sexual violence, as well as their internal diversity. RESULTS The prevalence of abuse in this pediatric emergency room was 0.6%. Physical violence predominated (69.4%), followed by sexual violence (39.3%). Exploratory profiles of these types of violence were constructed. Regarding physical violence, the gender of the abuser was the first differentiating dimension; the victim's gender and age range were the second one. In the case of sexual violence, the age of the abuser and co-residence with him/her comprised the first dimension; the victim's age and gender comprised the second dimension. CONCLUSION Patterns of association between victims, family contexts, and abusers were identified. It is necessary to alert clinicians about the importance of social variables in the multiple facets of child abuse.
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Affiliation(s)
| | - Vasco Ramos
- Universidade de Lisboa, Instituto de Ciências Sociais, Lisboa, Portugal.
| | - Helena Nunes de Almeida
- Hospital Professor Doutor Fernando da Fonseca, Departamento de Pediatria, Unidade de Urgência e Cuidados Intensivos, Amadora, Portugal
| | - Carlos Gil Escobar
- Hospital Professor Doutor Fernando da Fonseca, Departamento de Pediatria, Unidade de Urgência e Cuidados Intensivos, Amadora, Portugal
| | - Catarina Garcia
- Hospital Professor Doutor Fernando da Fonseca, Departamento de Pediatria, Unidade de Urgência e Cuidados Intensivos, Amadora, Portugal
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Schweiger C, Manica D, Pereira DRR, Carvalho PRA, Piva JP, Kuhl G, Sekine L, Marostica PJC. Undersedation is a risk factor for the development of subglottic stenosis in intubated children. J Pediatr (Rio J) 2017; 93:351-355. [PMID: 28130966 DOI: 10.1016/j.jped.2016.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/25/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis. METHODS All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis. RESULTS The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p=0.004). CONCLUSION Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.
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Affiliation(s)
- Cláudia Schweiger
- Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Denise Manica
- Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Denise Rotta Rutkay Pereira
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Paulo Roberto Antonacci Carvalho
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, Brazil
| | - Jefferson Pedro Piva
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, Brazil
| | - Gabriel Kuhl
- Hospital de Clínicas de Porto Alegre, Unidade de Otorrinolaringologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Otorrinolaringologia e Oftalmologia, Porto Alegre, RS, Brazil
| | - Leo Sekine
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Epidemiologia, Porto Alegre, RS, Brazil
| | - Paulo José Cauduro Marostica
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre, Unidade de Pneumologia Pediátrica, Porto Alegre, RS, Brazil
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