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- ItemAcesso aberto (Open Access)Abordagem estereotáxica guiada por imagem de lesões do sistema nervoso central: precisão diagnóstica, morbidade, mortalidade(Academia Brasileira de Neurologia - ABNEURO, 1999-09-01) Hisatugo, Marcelo Ken-iti; Stávale, João Norberto [UNIFESP]; Bidó, José Orlando; Ferraz, Fernando Patriani [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)We studied seventy-five patients with brain lesions biopsied by stereotaxis from March 1993 to December 1998 at Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina. The three most frequent lesions were: metastasis, low grade astrocytomas and glioblastoma multiforme. The morbidity rate was 2.66% due to: one case of scalp infection in a patient with thalamic cyst; and a partial seizure during surgery in a patient with lynphoma. The mortality rate was 1.33% due to increasing of cerebral edema after biopsy and the patient died after one week. The diagnostic accuracy was 89.33%.
- ItemSomente MetadadadosAcute pancreatitis in pediatrics: a systematic review of the literature(Soc Brasil Pediatria, 2012-03-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Silva, Felipe Duarte; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hosp Israelite Albert Einstein; Hosp Santa CatarinaObjective: To describe the main epidemiological, clinical, diagnostic and treatment aspects of children with acute pancreatitis.Sources: Systematic review of MEDLINE and SciELO databases in the last 5 years about acute pancreatitis in children, as well as consultation of relevant references on the texts obtained.Summary of the findings: Cases of acute pancreatitis in children have received growing attention in recent years, and an increase in the number of cases has been reported in several studies. the main etiologies in children involve biliary disease, drug-induced pancreatitis, recurrent hereditary pancreatitis and trauma, and up to 30% of cases have no defined etiology. the diagnosis is based on the combination of clinical and laboratory aspects with the increase of acinar enzymes and radiologic tests. Initial support treatment, with proper volume replacement and correction of the metabolic disturbances, besides specific nutritional therapy, are the fundamental points in the handling of acute conditions. Long term complications are unusual, and mortality rates are inferior to the rates for the adult population.Conclusions: the early diagnosis and the appropriate handling can contribute to a better outcome for the child with pancreatitis and to prevent the immediate and late complications related to the disease. More studies are required to better explain aspects related to the clinical and radiological diagnosis of pancreatitis in children, as well as aspects related to the nutritional therapy for this age group.
- ItemSomente MetadadadosAPO A-V-1131T -> C polymorphism frequency and its association with morbidity in a Brazilian elderly population(Walter de Gruyter & Co, 2006-01-01) Chen, E. S.; Cendoroglo, M. S.; Ramos, L. R.; Araujo, LMQ; Carvalheira, GMG; Labio, R. W. de; Burbano, R. R.; Payao, SLM; Smith, MDC; Universidade Federal de São Paulo (UNIFESP); Fac Med MariliaIdentification of genetic polymorphisms as risk factors for complex diseases affecting older people can be relevant for their prevention, diagnosis and management. the -1131T -> C polymorphism of the apolipoprotein A-V gene (APO A-V) is tightly linked to lipid metabolism and has been associated with increased triglyceride levels and familial dyslipidemia. the aims of this study were to analyze the allele and genotype frequencies of this polymorphism in a Brazilian elderly population and to investigate any association between the polymorphism and major morbidities affecting elderly people. This polymorphism was investigated in 371 individuals, aged 66-97 years, in a Brazilian Elderly Longitudinal Population Study. Major morbidities investigated were: cerebrovascular diseases (CVD); myocardial infarction (MI); type 2 diabetes; hypertension; obesity; dementia; depression; and neoplasia. DNA was isolated and amplified by PCR and its products were digested with restriction enzyme Tru1I. T and C allele frequencies were 0.842 and 0.158, respectively. Our population showed allele frequencies that were similar to European and Afro-American and different from Asiatic populations. Genotype distributions were not within Hardy-Weinberg equilibrium only for the obesity subject sample. On the other hand, a significant association between the C allele and obesity in the presence of CVDX depression interaction was observed. Logistic analysis showed no association of the polymorphism with each morbidity group. Therefore, the C allele in elderly Brazilian subjects may represent a risk factor for these morbidity interactions, which may lead to better comprehension of their pathophysiology.
- ItemAcesso aberto (Open Access)Crescimento de lactentes não-anêmicos suplementados com diferentes doses profiláticas de ferro(Sociedade Brasileira de Pediatria, 2008-08-01) Silva, Danielle Goes da [UNIFESP]; Franceschini, Sylvia do Carmo Castro [UNIFESP]; Sigulem, Dirce Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Viçosa Departamento de Nutrição e Saúde Programa de Pós-Graduação em Ciência da NutriçãoOBJECTIVE: To compare the effects of different prophylactic iron doses on the growth and nutritional status of non-anemic infants. METHODS: Prospective randomized study. Infants aged 5.0 to 6.9 months who met the inclusion criteria and showed capillary hemoglobin ≥ 11 g/dL were randomly allocated into three groups who received the following prophylactic doses of iron supplement (ferrous sulfate): 1 mg/kg/day (n = 39); 2 mg/kg/day (n = 36); and 25 mg/week (n = 39). This supplementation was given during 16 weeks. Both weight and length were measured. The nutritional status was evaluated by comparing z scores for weight/age, length/age and weight/length based on the World Health Organization (2006) references. Morbidity information was collected during monthly visits. RESULTS: The groups showed similar nutritional status before supplementation. There were no differences in daily nutrient intake among groups. During the study, weight and length gain, and increments in anthropometric indices did not differ statistically among supplemented groups either. The occurrence and duration of morbidity episodes did not differ statistically among groups. In general, improvements were observed in both weight/age and weight/length indices in the population under study, whereas length/age showed no differences before and after supplementation. CONCLUSION: Different prophylactic iron doses had no different effects on the growth and nutritional status of non-anemic infants.
- ItemAcesso aberto (Open Access)Diarreia persistente: ainda um importante desafio para o pediatra(Sociedade Brasileira de Pediatria, 2011-06-01) Andrade, Jacy Alves Braga de [UNIFESP]; Fagundes-Neto, Ulysses [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To provide recent guidelines to reduce the incidence of diarrheal diseases. We discuss the definition, clinical aspects, pathophysiology, diagnosis, management, and prevention of persistent diarrhea. SOURCES: Electronic search of the MEDLINE database, Google search. SUMMARY OF THE FINDINGS: Acute diarrhea may be caused by a variety of agents, including bacterial, viral, and protozoan pathogens. The top priority in treatment of diarrhea is replacement of fluid and electrolytes losses, particularly at the acute stage, and, under certain circumstances, eradication of the enteropathogenic agent. On the other hand, treatment of persistent diarrhea should focus on prevention and management of food intolerance and malnutrition. CONCLUSIONS: Promotion of breastfeeding, adequate interventions in the treatment of acute diarrheal episodes, introduction of safe dietary strategies for prevention of malnutrition, and improvements in sanitation and hygiene conditions, including sewage and clean water, are essential measures for the reduction of diarrheal morbidity and mortality rates in children under 5 years of age.
- ItemAcesso aberto (Open Access)Manejo do paciente no período perioperatório em neurocirurgia pediátrica(Associação Médica Brasileira, 2012-06-01) Mekitarian Filho, Eduardo [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Cavalheiro, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); UPA Hospital Israelita Albert Einstein; Hospital Santa Catarina; Hospital Santa Catarina Unidade de Terapia Intensiva PediátricaOBJECTIVES: To describe the main pathophysiological differences in neurosurgical procedures between children and adults; the main complications and adverse events resulting from pediatric neurosurgery reported in studies; the singularities in anesthetic and intraoperative management in several neurosurgical diseases; the more specific and common complications and their management in the most frequent pediatric neurosurgical procedures, as well as causes and treatment for the main complications found in children undergoing neurosurgery. METHODS: A non-systematic review in literature databases PubMed, EMBASE, and SciELO was performed by using the keywords pediatrics, children, neurosurgery, risk factors, intraoperative complications, and postoperative period, as well as their matches in Portuguese and Spanish from January 2001 to January 2011, in addition to using important references from the selected material over any period of time. RESULTS: The three procedures most commonly performed in children are hydrocephalus, craniostenosis repair, and brain tumor resection. Complications as fever, bleeding, metabolic disturbances (hyponatremia and hyperglycemia), brain swelling, and transient focal deficits (limb weakness, speech and swallowing disorders) are frequent, but their course is often towards prompt improvement. Up to 50% of children may have an uneventful evolution over the postoperative period. Special attention must be given to the prevention of postoperative infections and seizures with the use of a drug therapy that suits each case. CONCLUSION: The complexity of neurosurgical procedures in children is increasing, and observation and recognition of complications in pediatric intensive care units are fundamental. Anticipating complications in order to achieve an early treatment and adverse event prophylaxis can contribute to reduced morbidity and mortality and increased patients' safety.
- ItemSomente MetadadadosPremature rupture of membranes before 28 weeks managed expectantly: Maternal and perinatal outcomes in a developing country(Informa Healthcare, 2012-01-01) Fernandes, G. L.; Torloni, M. R.; Hisaba, W. Jou; Klimke, D.; Novaes, J.; Sancovski, M. [UNIFESP]; Peixoto, S. [UNIFESP]; Hosp Municipal Univ; Fac Med ABC; Universidade Federal de São Paulo (UNIFESP)This study aimed to assess outcomes of expectant management for early preterm premature rupture of membranes (PPROM). This retrospective cohort involved 66 women with PPROM <28 weeks managed in a single hospital (1999-2006). Main outcomes were chorioamnionitis, severe maternal morbidity (maternal sepsis, haemorrhage/blood transfusion, hysterectomy or admission to intensive care unit), maternal mortality, low birth weight, preterm birth, neonatal infection and perinatal mortality. Mean gestational ages at PPROM and delivery were 21.7 +/- 4.2 and 28.4 +/- 5.9 weeks, respectively. Chorioamnionitis was diagnosed in 47%; no cases of severe maternal morbidity or mortality occurred. Stillbirth rate was 25.7% and >80% of infants were delivered before 34 weeks. Neonatal infection was diagnosed in 42.9% of the 49 live-births. Overall survival rate was 57.6%. Expectant management of PPROM <28 weeks resulted in high rates of chorioamnionitis and preterm deliveries but in over half of the cases, a live infant was discharged home.
- ItemAcesso aberto (Open Access)Prospective assessment of the risk of postoperative pulmonary complications in patients submitted to upper abdominal surgery(Associação Paulista de Medicina - APM, 1999-07-01) Pereira, Eanes Delgado Barros; Fernandes, Ana Luisa Godoy [UNIFESP]; Anção, Meide Silva [UNIFESP]; Peres, Clovis de Araujo [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Federal University of Ceará; Universidade Federal de São Paulo (UNIFESP); University of São Paulo; São Paulo HospitalOBJECTIVE: To investigate associations between preoperative variables and postoperative pulmonary complications (PPC) in elective upper abdominal surgery. DESIGN: Prospective clinical trial. SETTING: A tertiary university hospital. PATIENTS: 408 patients were prospectively analyzed during the preoperative period and followed up postoperatively for pulmonary complications. MEASUREMENTS: Patient characteristics, with clinical and physical evaluation, related diseases, smoking habits, and duration of surgery. Preoperative pulmonary function tests (PFT) were performed on 247 patients. RESULTS: The postoperative pulmonary complication rate was 14 percent. The significant predictors in univariate analyses of postoperative pulmonary complications were: age >50, smoking habits, presence of chronic pulmonary disease or respiratory symptoms at the time of evaluation, duration of surgery >210 minutes and comorbidity (p <0.04). In a logistic regression analysis, the statistically significant predictors were: presence of chronic pulmonary disease, surgery lasting >210 and comorbidity (p <0.009).CONCLUSIONS: There were three major clinical risk factors for pulmonary complications following upper abdominal surgery: chronic pulmonary disease, comorbidity, and surgery lasting more than 210 minutes. Those patients with three risk factors were three times more likely to develop a PPC compared to patients without any of these risk factors (p <0.001). PFT is indicated when there are uncertainties regarding the patient s pulmonary status.
- ItemAcesso aberto (Open Access)União interétnica de nipo-brasileiros associada a hábitos alimentares menos saudáveis e ao pior perfil de risco cardiometabólico(Sociedade Brasileira de Endocrinologia e Metabologia, 2009-07-01) Yamashita, Carla; Damião, Renata; Chaim, Rita; Harima, Helena Aiko [UNIFESP]; Kikuchi, Mário [UNIFESP]; Franco, Laercio Joel [UNIFESP]; Ferreira, Sandra Roberta Gouvea [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal do Triângulo Mineiro; Universidade do Sagrado Coração Faculdade de Nutrição; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Interethnic marriage between nikkey Brazilians and non-nikkey Brazilians may favor the westernization of diet. Dietary consumption, clinical data and frequencies of metabolic diseases were compared in a Japanese-Brazilian population, with intraethnic or interethnic marriage. METHODS: T test, Mann-Whitney, chi-square and Person coefficient were used. RESULTS: Among 1009 Japanese-Brazilians there were 18.9% of interethnic marriage, being more frequent among nikkey men. These showed higher means of BMI, waist, blood pressure, glycemia and triglyceridemia than women. Overall frequencies of obesity, hypertrigliceridemia and metabolic syndrome were 47.7%, 68.1% and 45.2%, being higher in interethnic than intraethnic marriage. Comparing individuals with interethnic marriages, hypertriglyceridemia was more common among men while low-HDL among women. Energy, fat, groups of alcohol, sweets and oils were higher in interethnic marriage. Individuals with intraethnic marriage consumed more carbohydrate, proteins, fibers, vitamins, minerals, vegetables, fruits/juice, cereals and missoshiru. Comparing individuals with interethnic marriages, nikkey men showed a more westernized dietary pattern than nikkey women. CONCLUSION: Interethnic marriage was associated with less healthy food habits and worse cardiometabolic profile.