Navegando por Palavras-chave "Pediatric"

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    O Brincar como recurso de enfrentamento da hospitalização e a visão dos familiares
    (Universidade Federal de São Paulo (UNIFESP), 2018-12-11) Ribeiro, Kamilla Mariano Macedo [UNIFESP]; Silva, Carla Cilene Baptista da [UNIFESP]; http://lattes.cnpq.br/7118155019861351; http://lattes.cnpq.br/3591898420148246
    Introdução: O diagnóstico de câncer na infância é devastador para a família e para a criança, assim o brincar apresenta um papel fundamental no enfrentamento da hospitalização e da doença, o que torna relevante compreender como a atividade do brincar contribui com esse processo e qual a visão dos pais frente a esse instrumento. Objetivo: O projeto buscou compreender a percepção dos pais sobre a importância do brincar e das atividades lúdicas propostas pelo Projeto de Extensão da UNIFESP – PROENCC, durante o processo de hospitalização de seus filhos. Metodologia: Trata-se de uma pesquisa de caráter qualitativo descritivo que foi realizada no ambulatório de oncologia pediátrica na Irmandade Santa Casa da Misericórdia, Santos/ SP (ISCMS), com o uso de entrevistas semiestruturadas realizadas com a amostra de 7 pais de crianças hospitalizadas, com idades entre 5 e 13 anos. Os dados foram categorizados a partir da Analise de Conteúdo temática de Minayo (2010). A pesquisa foi aprovada pelo CEP da UNIFESP, sob número CAEE 83197918.0.0000.5505. Resultados e Discussão: Quanto aos núcleos temáticos que surgiram nas entrevistas sobre o brincar, os pais o analisam de duas maneiras distintas a primeira como sendo atividade que permite o desenvolvimento infantil e a segunda forma como sendo um instrumento de cuidado paliativo, visto que o contexto hospitalar interfere na maneira como os mesmos enxergam o brincar. Com relação ao núcleo temático finais de semana, ficou claro que todos os participantes não concordam que a brinquedoteca fique fechada nos finais de semanas, pois isso gera impactos negativos em seus filhos. Já o núcleo temático referente às atividades propostas pelo projeto de extensão teve como resultado o reconhecimento positivo pelos pais das atividades propostas pelas estudantes aos seus filhos. Considerações finais: As questões trazidas pelos pais a partir das entrevistas, mostraram como o brincar pode ser um recurso fundamental para o enfrentamento da hospitalização, contudo é necessário realizar intervenções em prol dessa atividade, visto que existem momentos em que a criança é privada de brincar, podendo acarretar impactos negativos na criança durante o processo de hospitalização.
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    Correlatos da atividade física de moderada a vigorosa, tempo sedentário, tempo de tela e índice de massa corporal de crianças
    (Universidade Federal de São Paulo (UNIFESP), 2016-08-19) Ferrari, Gerson Luis de Moraes [UNIFESP]; Fisberg, Mauro Fisberg [UNIFESP]; http://lattes.cnpq.br/2084196778725842; http://lattes.cnpq.br/8630482126111425; Universidade Federal de São Paulo (UNIFESP)
    Purpose: Identify potential correlates of moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB), screen time (ST) and body mass index (BMI) in children of São Caetano do Sul. Methods: Data collection was performed in the city of São Caetano do Sul as part of the International Study of Childhood Obesity Lifestyle and the Environment (ISCOLE). For seven consecutive days, 328 children (169 boys) used accelerometers to objectively monitor the MVPA and SB. The ST was calculated from the number of hours/day in children spent watching television (TV), computer and video games. BMI was measured using bioelectrical impedance. The participating children and their parents/guardians completed questionnaires regarding individual related (anthropometric and behavioral), family and home and school environment. All aspects associated (p<0.10) with MVPA, SB, ST and BMI in univariate analysis were entered in the final models and those with p<0.05 in the final models were considered correlates of MVPA, SB, ST and BMI. We use multi-level linear regression and included sex, ethnicity, number of siblings and total annual household income and school as covariates in all multivariate models. Results: Mean MVPA and SB (min/day) were 59.3 (44.5% met MVPA guidelines: 63.9% of boys and 25.1% girls: p<0.001) and 500 (boys: 489; girls: 511; p=0.005), respectively. The average ST was 234 (boys: 246; girls: 222; p=0.053) min/day. Overall, 51.8% of children were classified as overweight/obesity (50.3% of boys and 53.4% girls: p=0.014) and the mean BMI was 20.1 kg/m2 (boys: 20.1; girls; 20.2; p=0.713). To MVPA, we found the following correlates: waist circumference (WC; ?=-0.011), travel mode to school (active; ?=0.133) and maternal employment status (part-time or less; (?=-0.195) in boys. Already in girls, only travel mode to school (active; ?=-0.143). As for the SB, just found MVPA (?=-1.434) as correlates in boys and girls were healthy diet pattern score (?=-19.301), MVPA (?=-1.896) and time of travel to school (?15 min: ?=-41.642; ]15-30] min: ?=57.918). In ST, correlates were BMI (?=0.019), the healthy dietary pattern score (?=-0.090) and TV in bedroom (?=0.201) in boys. Healthy diet pattern score (?=-0.184), travel mode to school (active; ?=-0.230) and policies or practices on physical activity (?=-0.281) were related in girls. The correlates of BMI in boys were the percentage of body fat (%BF; ? =0.0209), ST (?=0.0059) and policies or practices on healthy eating (?=0.0276). Already in girls, only the% BF was considered correlate (?=0.0221) of BMI. Conclusion: Several factors have been identified as correlates of MVPA, SB, ST and BMI in children of São Caetano do Sul. They were common in both boys and girls, travel to school (MVPA), MVPA (SB), healthy diet pattern score (ST), and %BF (BMI). These results should be used by researchers and public health professionals who want to implement interventions to increase MVPA, reduce SB, ST and BMI of children.
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    Enzyme replacement therapy with galsulfase in 34 children younger than five years of age with MPS VI
    (Elsevier B.V., 2013-05-01) Horovitz, Dafne D. G.; Magalhaes, Tatiana S. P. C.; Acosta, Angelina; Ribeiro, Erlane M.; Giuliani, Liane R.; Palhares, Durval B.; Kim, Chong A.; Paula, Ana Carolina de; Kerstenestzy, Marcelo; Pianovski, Mara A. D.; Costa, Maria Ione F.; Santos, Francisca C.; Martins, Ana Maria [UNIFESP]; Aranda, Carolina Sanchez [UNIFESP]; Correa Neto, Jordao; Moreira Holanda, Gervina Brady; Cardoso, Laercio; Silva, Carlos A. B. da; Bonatti, Renata C. F.; Ribeiro, Bethania F. R.; Rodrigues, Maria do Carmo S.; Llerena, Juan C.; Fiocruz MS; Universidade Federal da Bahia (UFBA); Hosp Albert Sabin; Universidade Federal de Mato Grosso do Sul (UFMS); Universidade de São Paulo (USP); Hosp Barao de Lucena; Univ Fed Parana; Ctr Reabilitacao Infantil; Hosp Univ Maranhao; Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande do Norte; Univ Fortaleza; Univ Fed Triangulo Mineiro; Hosp Clin Acre; Univ Fed Espirito Santo
    Background: Mucopolysaccharidosis type VI (MPS VI) is a progressive, chronic and multisystem lysosomal storage disease with a wide disease spectrum. Clinical and biochemical improvements have been reported for MPS VI patients on enzyme replacement therapy (ERT) with rhASB (recombinant human arylsulfatase B; galsulfase, Naglazyme (R), BioMarin Pharmaceutical Inc.), making early diagnosis and intervention imperative for optimal patient outcomes. Few studies have included children younger than five years of age. This report describes 34 MPS VI patients that started treatment with galsulfase before five years of age.Methods: Data from patients who initiated treatment at <5 years of age were collected from patients' medical records. Baseline and follow-up assessments of common symptoms that led to diagnosis and that were used to evaluate disease progression and treatment efficacy were evaluated.Results: A significant negative correlation was seen with treatment with ERT and urinary GAG levels. of those with baseline and follow-up growth data, 47% remained on their pre-treatment growth curve or moved to a higher percentile after treatment. of the 9 patients with baseline and follow-up sleep studies, 5 remained unaffected and 1 patient initially with mild sleep apnea showed improvement. Data regarding cardiac, ophthalmic, central nervous system, hearing, surgical interventions and development are also reported. No patient discontinued treatment due to an adverse event and all that were treatment-emergent resolved.Conclusions: the prescribed dosage of 1 mg/kg IV weekly with galsulfase ERT is shown to be safe and effective in slowing and/or improving certain aspects of the disease, although patients should be closely monitored for complications associated with the natural history of the disease, especially cardiac valve involvement and spinal cord compression. A long-term follow-up investigation of this group of children will provide further information on the benefits of early treatment as well as disease progression and treatment efficacy and safety in this young patient population. (C) 2013 Elsevier Inc. All rights reserved.
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    Erros de medicação em pediatria
    (Associação Brasileira de Enfermagem, 2011-06-01) Belela, Aline Santa Cruz [UNIFESP]; Pedreira, Mavilde da Luz Gonçalves [UNIFESP]; Peterlini, Maria Angélica Sorgini [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Concerns regarding patient safety affect healthcare, and medication errors are the most frequent category of medical errors and linked with severe consequences. This study discusses epidemiologic characteristics of medication errors in pediatric patients and points out prevention strategies. Approximately 8% of the studies on the subject of medication errors identified in different national and international databases are distinctively related to the pediatric population. Children are vulnerable to medication errors due to intrinsic factors, such as proper anatomic and physiological characteristics; and due to extrinsic factors, with emphasis on the lack of public health politics and changes in the pharmaceutical industry to attend children's needs. The available evidences indicate, as imperative, the implementation of strategies to prevent medication errors, contributing to promote patient safety.
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    A experiência de vulnerabilidade da família da criança hospitalizada em Unidade de Cuidados Intensivos Pediátricos
    (Universidade de São Paulo, Escola de Enfermagem, 2011-08-01) Côa, Thatiana Fernanda [UNIFESP]; Pettengill, Myriam Aparecida Mandetta [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The objective of this study was to understand the vulnerability experienced by the family of children hospitalized in a Pediatric Intensive Care Unit (PICU). The Symbolic Interactionism and the Concept of Family Vulnerability were the frameworks used to understand this experience. Qualitative Content Analysis was used. Data was collected through interviews and observation with 11 families of children hospitalized in a PICU of a university hospital in São Paulo. Six analytical categories regarding the family experience emerged. The categories were compared to the conceptual categories of Family and Vulnerability, and revealed the elements that defined the concept within this context. The child's hospitalization in a PICU triggers intense suffering within the family, as it refers to the possibility of losing their child. Thus, the power and the autonomy of the family in relation to their child are reduced, intensifying the feeling of vulnerability.
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    Factors associated with not meeting the recommendations for micronutrient intake in critically ill children
    (Elsevier Science Inc, 2016) Santos, Marcella dos Reis [UNIFESP]; Leite, Heitor Pons [UNIFESP]; Pereira, Aline Maria Luiz [UNIFESP]; Cassão, Bruna Dell'Acqua [UNIFESP]; Iglesias, Simone Brasil de Oliveira [UNIFESP]
    Objective: Children admitted to the intensive care unit (ICU) are at risk of not meeting their nutritional requirements. This study aimed to identify factors associated with failure to meet the dietary recommended intake (DRI) of zinc, selenium, cholecalciferol, and thiamine in critically ill children receiving enteral tube feeding during their stay in the ICU. Methods: We analyzed prospectively 260 cases, corresponding to 206 patients who received enteral tube feeding for a minimum of 3 days up to 10 days during the first 10 d of ICU stay. Individual intake was compared to estimated average requirement (EAR) and adequate intake (AI) values during the first 10 d of ICU stay. The outcome variable was defined as not meeting the recommended intake of the micronutrients studied. Potential explanatory variables for the outcome were age <1 year, malnutrition (WHO), clinical severity scores, heart disease, severe sepsis or septic shock, use of alpha-adrenergic drugs, and renal replacement therapy (RRT). The effect of the explanatory variables on the outcome was analyzed by logistic regression analysis. Results: The majority of patients did not meet the recommendations for micronutrients. After adjusting for covariates, age <1 year, malnutrition, heart disease, use of alpha-adrenergic drugs, and renal replacement therapy were associated with failure to meet the recommendations for at least one of the micronutrients studied. Conclusions: Factors associated with failure to meet the recommendations for micronutrient intake in children receiving enteral tube feeding during their ICU stay are linked to patients' low weight, restriction in fluid intake, and clinical severity of the disease. (C) 2016 Elsevier Inc. All rights reserved.
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    Fungemia caused by Candida species in a children's public hospital in the city of São Paulo , Brazil: study in the period 2007-2010
    (Instituto de Medicina Tropical, 2014-07-01) Oliveira, Vanessa Kummer Perinazzo; Ruiz, Luciana da Silva; Oliveira, Nélio Alessandro Jesus; Moreira, Débora; Hahn, Rosane Christine; Melo, Analy Salles de Azevedo [UNIFESP]; Nishikaku, Angela Satie; Paula, Claudete Rodrigues; University of São Paulo Institute of Biomedical Science II Department of Microbiology; University of Minnesota Dept. of Medicine Lillehei Heart Institute; Federal University of Mato Grosso Division of Infectious and Tropical Diseases; Universidade Federal de São Paulo (UNIFESP); University of São Paulo School of Dentistry Department de Stomatology
    Candidemia remains a major cause of morbidity and mortality in the health care environment. The epidemiology of Candida infection is changing, mainly in relation to the number of episodes caused by species C. non-albicans. The overall objective of this study was to evaluate the frequency of yeasts of the genus Candida, in a four-year period, isolated from blood of pediatric patients hospitalized in a public hospital of the city of São Paulo, Brazil. In this period, yeasts from blood of 104 patients were isolated and, the identified species of Candida by phenotypic and genotypic methods were: C. albicans (39/104), C. tropicalis (25/104), C. parapsilosis (23/104), Pichia anomala (6/104), C. guilliermondii (5/104), C. krusei (3/104), C. glabrata (2/104) and C. pararugosa (1/104). During the period of the study, a higher frequency of isolates of C. non-albicans (63.55%) (p = 0.0286) was verified. In this study we verified the increase of the non-albicans species throughout the years (mainly in 2009 and 2010). Thus, considering the peculiarities presented by Candida species, a correct identification of species is recommended to lead to a faster diagnosis and an efficient treatment.
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    Ionized hypocalcemia is an early event and is associated with organ dysfunction in children admitted to the intensive care unit
    (Elsevier B.V., 2013-10-01) Barbosa Dias, Cacilda Rosa [UNIFESP]; Leite, Heitor Pons [UNIFESP]; Nogueira, Paulo Cesar Koch [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Purpose: the purpose was to determine the frequency and risk factors of ionized hypocalcemia and to evaluate this disturbance as a predictor of mortality in a pediatric intensive care unit (ICU).Materials and Methods: in a prospective cohort study, 337 children admitted consecutively to an ICU were monitored regarding serum ionized calcium concentrations during the first 10 days of admission. the following variables were analyzed as independent of hypocalcemia: age; malnutrition; sepsis; Pediatric Index of Mortality 2; first 3 days organ dysfunction score (Pediatric Logistic Organ Dysfunction); and use of steroids, furosemide, and anticonvulsants. Hypocalcemia was defined as a serum ionized calcium concentration less than 1.15 mmol/L.Results: the rate of hypocalcemia was 77.15%. in a multivariate model, higher Pediatric Logistic Organ Dysfunction scores during the first 3 days of ICU stay were independently associated with hypocalcemia (odds ratio, 2.24; 95% confidence interval, 1.23-4.07; P = .008). Medications associated with hypocalcemia were furosemide (dose >= 2 mg/[kg d]) and methylprednisolone (dose >= 2 mg/[kg d]). No significant association was found between hypocalcemia and 10-day mortality.Conclusions: Ionized hypocalcemia is common during the ICU stay, particularly in the first 3 days of admission. This disturbance was not found to be a predictor of mortality, but it is independently associated with more severe organ dysfunction. (C) 2013 Elsevier Inc. All rights reserved.
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    Malnutrition as an independent predictor of clinical outcome in critically ill children
    (Elsevier B.V., 2012-03-01) Menezes, Fernanda de Souza [UNIFESP]; Leite, Heitor Pons [UNIFESP]; Nogueira, Paulo Cesar Koch [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To determine the nutritional status of a cohort of children admitted to a pediatric intensive care unit (ICU) and to assess the effect of malnutrition as an independent risk factor affecting outcome in this patient group.Methods: in a prospective cohort study, 385 children admitted to the ICU of a teaching hospital over a 2-y period were assessed for nutritional status at admission and clinical outcome. the outcome variables were 30-d mortality, length of ICU stay, and length of mechanical ventilation. Potential exposure variables were gender, age, diagnosis (clinical versus surgical), septic shock, malnutrition, and scores on the Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction. Nutritional status was determined using z scores of weight for age, height for age, and body mass index, based on the World Health Organization child growth standards. Patients with z score < -2 of anthropometric indexes were considered malnourished.Results: 175 patients (45.5%) were malnourished on admission. Sixteen patients of the malnourished group (9.14%) and 25 patients (11.9%) of the non-malnourished group died. Malnutrition was associated with greater length of mechanical ventilation and length of ICU stay, but not with mortality on univariate analysis. Malnutrition was associated with greater length of ventilation on the multiple logistic regression model (OR 1.76, 95%; CI 1.08-2.88; P = 0.024).Conclusion: Malnutrition is common among children admitted to an ICU. This factor was not a predictor of mortality but showed independent association with length of mechanical ventilation. (C) 2012 Elsevier Inc. All rights reserved.
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    Mobilização precoce para crianças na unidade de terapia intensiva: uma revisão sistemática
    (Universidade Federal de São Paulo, 2021) Gomes, Samantha Guerra Cabó Nunes [UNIFESP]; Flumignan, Ronald Luiz Gomes [UNIFESP]; Nakano, Luis Carlos Uta [UNIFESP]; http://lattes.cnpq.br/7498955151131694; http://lattes.cnpq.br/6751410694690699; http://lattes.cnpq.br/9438817772644460
    Contexto: As evidências atuais sugerem que a reabilitação baseada na mobilização precoce (MP) em adultos internados em unidades de terapia intensiva (UTI) pode reduzir complicações decorrentes da imobilidade e doença crítica. No entanto, há uma falta de diretrizes de prática e há evidências conflitantes sobre a segurança e os benefícios na população pediátrica. Objetivos: Avaliar a eficácia e a segurança da MP em pacientes pediátricos internados em UTIs. Métodos: Revisão sistemática da literatura de ensaios clínicos randomizados (ECR) seguindo as recomendações do Cochrane Handbook for Systematic Reviews of Interventions. As bases de dados Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed, Excerpta Medica Database (EMBASE) via Elsevier, Literatura Latino Americana em Ciências da Saúde e do Caribe (LILACS) via portal da Biblioteca Virtual em Saúde (BVS), Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, Physioterapy Evidence Database (PEDro) e Cumulative Index to Nursing and Allied Health Literature (CINAHL) via Ebsco foram utilizadas para recuperar os ECRs. Além disso, foram realizadas buscas manuais em resumos de conferências relacionados ao tema proposto. Não houve restrição quanto ao idioma ou data de publicação das citações recuperadas. Dois autores, de forma independente, selecionaram os estudos, assim como extraíram os dados e avaliaram o risco de vies dos ECR encontrados. Resultados: Foi encontrado um ECR que avaliou a eficácia da MP em pacientes pediátricos internados em UTI. Há muito baixa certeza de que não há diferença entre usar MP ou usar cuidados usuais em crianças internadas em UTIs com relação a mortalidade [RR: 0,17; IC 95% (0,01 a 3,94); 30 participantes; 1 estudo] e eventos adversos, incluindo deterioração funcional [RR: 1,21; IC 95% (0,78 a 1,90); 30 participantes; 1 estudo] e dor durante a terapia [RR: 2,62; IC 95% (0,14 a 49,91); 30 participantes; 1 estudo]. Outros desfechos clinicamente importantes não foram avaliados. Uma vez que as evidências são escassas e de muito baixa certeza, não é possível tirar conclusões sobre a efetividade e segurança da MP nesta população. O único ECR atualmente disponível na literatura demonstra que a MP é viável em pacientes pediátricos. Conclusão: Não há evidências suficientes para apoiar ou refutar a eficácia e segurança da MP em crianças internadas em UTIs.
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    Pediatric cataracts: clinical aspects, frequency of strabismus and chronological, etiological, and morphological features
    (Conselho Brasileiro de Oftalmologia, 2014-06-01) Tartarella, Marcia Beatriz [UNIFESP]; Britez-Colombi, Gloria Fátima [UNIFESP]; Milhomem, Suanne [UNIFESP]; Lopes, Márcia Cordeiro Emery [UNIFESP]; Fortes Filho, João Borges [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); University of Rio Grande do Sul Hospital de Clínicas de Porto Alegre Department of Ophthalmology
    Objetivos: Avaliar as frequências do estrabismo e as características cronológica, etiológica e morfológica das cataratas pediátricas. Método: Estudo retrospectivo dos prontuários de crianças atendidas no Ambulatório de Catarata Congênita do Departamento de Oftalmologia da Universidade Federal de São Paulo no período entre 2001 e 2011. Foram incluídos pacientes com diagnóstico de catarata congênita ou de desenvolvimento. Foram excluídos os pacientes com catarata traumática; secundárias a uveíte, radiação ou medicamentos; pacientes operados em outro serviço; pacientes com glaucoma; leucocorias não cristalinianas (retinoblastoma, retinopatia da prematuridade, leucocorias pré-cristalinianas), e com sub-luxação do cristalino. Foram avaliadas: as frequências cronológicas, etiológicas e morfológicas das cataratas; a lateralidade e a ocorrência de estrabismo associado nestes pacientes. Resultados: Foram incluídos 207 pacientes. Cento e dezessete (56,5%) apresentavam catarata congênita e 90 (43,5%) apresentavam catarata de desenvolvimento. Cento e nove (52,6%) pacientes eram portadores de catarata unilateral. Quanto à morfologia, 72 crianças (33,8%) apresentavam catarata zonular e 66 (31,9%) apresentavam catarata total. A etiologia idiopática foi a mais frequente (72,5%) afetando 150 pacientes. Foram observados 108 pacientes (52,2%) com estrabismo associado, especialmente endotropias secundárias. Conclusões: A etiologia idiopática foi a mais frequente neste estudo. O tipo morfológico zonular foi o mais frequentemente diagnosticado. Cataratas unilaterais ocorreram mais frequentemente em pacientes com persistência da vasculatura fetal. O estrabismo associado ocorreu em 52% dos pacientes. A análise dos resultados deste estudo pode contribuir para diagnosticar a catarata pediátrica precocemente e de modo mais preciso.
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    Pediatric minor head trauma: do cranial CT scans change the therapeutic approach?
    (Hospital Clinicas, Univ Sao Paulo, 2016) Andrade, Felipe P.; Montoro Neto, Roberto; Oliveira, Renan; Loures, Gabriela; Flessak, Luana; Gross, Roberta; Donnabella, Camille; Puchnick, Andrea [UNIFESP]; Suzuki, Lisa; Regacini, Rodrigo
    OBJECTIVES: 1) To verify clinical signs correlated with appropriate cranial computed tomography scan indications and changes in the therapeutic approach in pediatric minor head trauma scenarios. 2) To estimate the radiation exposure of computed tomography scans with low dose protocols in the context of trauma and the additional associated risk. METHODS: Investigators reviewed the medical records of all children with minor head trauma, which was defined as a Glasgow coma scale >= 13 at the time of admission to the emergency room, who underwent computed tomography scans during the years of 2013 and 2014. A change in the therapeutic approach was defined as a neurosurgical intervention performed within 30 days, hospitalization, > 12 hours of observation, or neuro-specialist evaluation. RESULTS: Of the 1006 children evaluated, 101 showed some abnormality on head computed tomography scans, including 49 who were hospitalized, 16 who remained under observation and 36 who were dismissed. No patient underwent neurosurgery. No statistically significant relationship was observed between patient age, time between trauma and admission, or signs/symptoms related to trauma and abnormal imaging results. A statistically significant relationship between abnormal image results and a fall higher than 1.0 meter was observed (p=0.044). The mean effective dose was 2.0 mSv (0.1 to 6.8 mSv), corresponding to an estimated additional cancer risk of 0.05%. CONCLUSION: A computed tomography scan after minor head injury in pediatric patients did not show clinically relevant abnormalities that could lead to neurosurgical indications. Patients who fell more than 1.0 m were more likely to have changes in imaging tests, although these changes did not require neurosurgical intervention
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    The psychosocial experience of individuals living with osteogenesis imperfecta: a mixed-methods systematic review
    (Springer, 2016) Tsimicalis, Argerie; Denis-Larocque, Gabrielle; Michalovic, Alisha; Lepage, Carolann; Williams, Karl; Yao, Tian-Ran; Palomo, Telma [UNIFESP]; Dahan-Oliel, Noemi; Le May, Sylvie; Rauch, Frank
    Osteogenesis imperfecta (OI) is a genetic disorder (prevalence: 1:10,000), leading to bone fragility, frequent fractures, and varying degrees of physical limitations. Despite a substantial amount of research on the genetics, pathophysiology, and treatments related to OI, there remains a paucity of knowledge concerning the lived psychosocial experience of the OI population. This mixed-methods systematic review aimed to review, appraise, and synthesize the literature on the psychosocial experience of children and adults with OI with the goal of identifying implications for research, practice, and policy-making. Using a systematic methodology, quantitative, qualitative, and mixed-methods studies were accessed through database searching, screened, assessed for eligibility, and appraised. Data from the selected studies fulfilling the eligibility and quality criteria were extracted and synthesized using thematic analysis with an inductive approach. A total of four qualitative and 20 quantitative studies, with various study designs and methodologies ranging in quality, were included in the review (n = 800
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    Simulações em computador aplicadas ao desenvolvimento de suspensões de uso oral contendo fexofenadina
    (Universidade Federal de São Paulo, 2021-08-25) Ferreira, Marina Machado da Mata [UNIFESP]; Duque, Marcelo Dutra [UNIFESP]; http://lattes.cnpq.br/7085580900560038; http://lattes.cnpq.br/6437126650970356
    A fexofenadina é fármaco empregado em tratamentos de estados alérgicos, pertencente à classe IV do Sistema de Classificação Biofarmacêutica. O presente trabalho teve como objetivo avaliar a influência da dissolução na absorção e a bioequivalência em população virtual simulada, de formulações de suspensões pediátricas de uso oral contendo fexofenadina, por meio de simulações em computador. Foram preparadas quatro formulações contendo 0,6 % de fexofenadina, 0,25% de carboximetilcelulose sódica e água purificada, sendo que a F1 continha apenas essa composição. Além destes componentes, o propilenoglicol (PPG) e o lauril sulfato de sódio (LSS) também foram empregados em F2 (5% de PPG), F3 (0,02% de LSS) e F4 (5% PPG + 0,02% de LSS). O percentual de fexofenadina dissolvida em 45 minutos de ensaio de dissolução foi de 51,52% (F1), 77,57% (F2), 42,01% (F3) e 95,89% (F4). Utilizando simulações em computador por meio do programa GastroPlus®, um modelo farmacocinético de três compartimentos foi desenvolvido utilizando o módulo PKPlus™ empregando a curva plasmática do medicamento referência Allegra® pediátrico suspensão oral (Sanofi-Aventis Farmacêutica Ltda.), proveniente da literatura. O modelo de dissolução utilizado para descrever os perfis de dissolução foi o Z-factor. O modelo farmacocinético foi verificado por meio de ensaios de bioequivalência virtual simulada e comparação com dados in vivo da literatura, onde foi confirmada a adequabilidade do modelo. Após verificação do modelo, simulações das curvas plasmáticas das suspensões F1-F4 desenvolvidas, foram conduzidas, sendo possível estabelecer uma relação entre os perfis de dissolução com a absorção do fármaco. Além disso, foi construído um safe-space (espaço seguro) para os valores de Z-factor capaz de predizer o atendimento aos critérios de bioequivalência em perfis de dissolução com quantidade dissolvida de fexofenadina maior que 80% após 20 minutos. A formulação F4 demonstrou ser bioequivalente in silico ao medicamento referência Allegra® suspensão oral (Sanofi-Aventis Farmacêutica Ltda.), por meio de estudo de bioequivalência virtual.
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    Sono, qualidade de vida e humor em profissionais de enfermagem em Unidades de Terapia Intensiva Infantil
    (Univ Sao Paolo, 2016) Guerra, Priscilla Caetano [UNIFESP]; Oliveira, Nilton Ferraro [UNIFESP]; Ramos Ascensao Terrei, Maria Teresa de Sande e Lemos [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]
    Objective: To assess sleep, quality of life and mood of nursing professionals of pediatric intensive care units. Method: Quantitative, cross-sectional and descriptive study. Professionals grouped by morning, afternoon and evening shifts were assessed by means of the instruments: Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Generic questionnaire for the assessment of quality of life (SF-36); Beck Depression Inventory; Beck Anxiety Inventory; State-Trait Anxiety Inventory. Results: Sample consisted of 168 professionals, with prevalence of neutral typology (57.49%). There was no statistical significance regarding sleep, despite scores showing a poor quality of sleep and excessive daytime sleepiness for the three shifts. Quality of life did not reveal any statistical significance, but in the field "social role functioning" of the evening shift, a lower score was observed (p<0.007). There was no statistical significance regarding levels of anxiety and depression. Conclusion: The results suggest that these professionals may present sleeping problems, but they do not have lower scores of quality of life or mood disorders. Likely explanations for these findings may include an adaptation to their work type over time and the fact that working with children is rewarding.
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    Total urogenital mobilization by CAH: A step-by-step illustration of the technique
    (Elsevier B.V., 2015-02-01) Macedo, Antonio [UNIFESP]; Cruz, Marcela Leal da [UNIFESP]; Liguori, Riberto [UNIFESP]; Trivelato, Rodrigo [UNIFESP]; Ottoni, Sergio Leite [UNIFESP]; Gomes Oliveira, Diego Estevam [UNIFESP]; Souza, Georgia Rubiane [UNIFESP]; Ortiz, Valdemar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    IntroductionCongenital adrenal hyperplasia (CAH) resulting from deficient 21-hydroxylase activity is an autosomal recessive disorder with an incidence of 1: 5000-25,000 in Caucasian populations. Despite various techniques to treat CAH, total urogenital mobilization (TUM) has gained popularity. This technique has low morbidity, and can be performed by the perineal route with the patient in the dorsal lithotomy position without the need to separate the urethra from the vagina. We aim to demonstrate in this video the TUM technique step by step.MethodsA 9-month-old child, born with ambiguous genitalia (Prader 3) with a 46XX karyotype and CAH diagnosis presented to our facility. Endoscopy showed a 2-cm common channel.Results and discussionThe patient was treated as described in the video and she had an uneventful clinical outcome with complete healing. TUM is an excellent alternative for treating CAH.
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    Tradução e adaptação cultural das escalas Pediatric Cerebral Performance Category (PCPC) e Pediatric Overall Performance Category (POPC) para o português brasileiro
    (Universidade Federal de São Paulo, 2021-08-24) Chiarastelli, Talita de Castro [UNIFESP]; Carvalho, Raquel de Paula [UNIFESP]; Sá, Cristina dos Santos Cardoso de [UNIFESP]; http://lattes.cnpq.br/9259523998158401; http://lattes.cnpq.br/7980384093582831; http://lattes.cnpq.br/9099484336191286; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Traduzir e adaptar culturalmente para a população brasileira as escalas Pediatric Cerebral Performance Category (PCPC) e Pediatric Overall Performance Category (POPC). Métodos: Duas pessoas bilingues, com perfis distintos, traduziram as escalas originais para o português do Brasil, sendo as duas versões fundidas em um documento. Esse documento foi retrotraduzido para o inglês, por duas pessoas nativas da língua inglesa, gerando duas versões, as quais foram fundidas em um documento único que foi confrontado com a versão original. Em seguida, um comitê de especialistas verificou a validade do conteúdo gerando a versão final das escalas, que foi testada em 25 crianças por 25 profissionais de uma Unidade de Terapia Intensiva, a fim de verificar a tradução e adaptação cultural para o português do Brasil. Um processo de auditoria foi realizado para verificar a consistência do processo metodológico. Resultados: Não foi necessária a realização de mudanças importantes no conteúdo do instrumento, entretanto foi observada a necessidade da criação de um guia com instruções sobre a aplicação das escalas. Conclusão: As fases de tradução e adaptação cultural das escalas foram concluídas, resultando nas versões PCPC-BR e POPC-BR. Futuros estudos são necessários para os testes de validade e confiabilidade das escalas para garantir a acurácia da aplicação na população brasileira.
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    Ultrasound evaluations of internal jugular vein punction techniques in children: the easiest method to reach the target area
    (Springer, 2009-01-01) Ybarra, Luiz Fernando [UNIFESP]; Ruiz, H. [UNIFESP]; Silva, M. P. [UNIFESP]; Lederman, H. M. [UNIFESP]; Schettini, S. T. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The objective of this study is to determine the best way to access and the position in which the patients must remain in order to obtain the best transversal section of the right internal jugular vein (RIJV) section during the catheterization by ultrasound, allowing a safer and precise access. the three possible ways to access the RIJV, anterior, lateral and posterior, from 57 healthy children, were examined by ultrasound in one similar sequence of positions: horizontal dorsal decubitus with the head centered in neutral position with and without the use of a pillow; horizontal dorsal decubitus with contralateral rotation of the head with and without the use of a pillow; horizontal dorsal decubitus with the head centered in neutral position and the patient in the Trendelenburg position without the use of a pillow. the relation between the different positions and punction regions in RIJV were established using analysis of variance. As a result, the lateral punction with the patient in the Trendelemburg position offered a largest area of the RIJV transversal section in comparison to all the other options (P < 0.0001). in conclusion, this study demonstrated that the safer and precise way for the RIJV catheterization in pediatric patients is obtained in Trendelenburg position with lateral access and without a pillow.
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    Value of clinical pulmonary infection score in critically ill children as a surrogate for diagnosis of ventilator-associated pneumonia
    (Elsevier B.V., 2014-08-01) Lucas da Silva, Paulo Sergio; Aguiar, Vania Euzebio de; Carvalho, Werther Brunow de; Machado Fonseca, Marcelo Cunio [UNIFESP]; Hosp Servidor Publ Municipal; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    Rationale: Although the modified clinical pulmonary infection score (mCPIS) has been endorsed by national organizations, only a very few pediatric studies have assessed it for the diagnosis of ventilator-associated pneumonia (VAP).Methods: Seventy children were prospectively included if they fulfilled the diagnosis criteria for VAP referenced by the Centers for Disease Control and Prevention. the primary outcome was performance of mCPIS calculated on day 1 to accurately identify VAP as defined by microbiological data.Results: the data showed that an mCPIS of 6 or higher had a sensitivity of 94%, specificity of 50%, positive predictive value of 64%, negative predictive value of 90%, a positive likelihood ratio of 1.88, and a negative likelihood ratio of 0.11. the area under the receiver operating characteristic curve was 0.70. A positive posttest result increased the disease probability by 15.4%, whereas a negative test result reduced the probability by 38.6%. Patients with an mCPIS of 6 or higher had longer length of mechanical ventilation and pediatric intensive care unit stay compared with patients with an mCPIS lower than 6.Conclusion: the mCPIS had a clinically acceptable performance, and it can be a helpful screening tool for VAP diagnosis. An mCPIS lower than 6 was highly able in distinguishing patients without VAP. Despite its high sensitivity and negative predictive value of this score, further studies are required to assess the use of mCPIS in guiding therapeutic decisions. (C) 2014 Elsevier Inc. All rights reserved.
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    What are the factors that influence the attainment of satisfactory energy intake in pediatric intensive care unit patients receiving enteral or parenteral nutrition?
    (Elsevier B.V., 2013-01-01) Menezes, Fernanda Souza de [UNIFESP]; Leite, Heitor Pons [UNIFESP]; Nogueira, Paulo Cesar Koch [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: Children admitted to the intensive care unit (ICU) are at risk of inadequate energy intake. Although studies have identified factors contributing to an inadequate energy supply in critically ill children, they did not take into consideration the length of time during which patients received their estimated energy requirements after having achieved a satisfactory energy intake. This study aimed to identify factors associated with the non-attainment of estimated energy requirements and consider the time this energy intake is maintained.Methods: This was a prospective study involving 207 children hospitalized in the ICU who were receiving enteral and/or parenteral nutrition. the outcome variable studied was whether 90% of the estimated basal metabolic rate was maintained for at least half of the ICU stay (satisfactory energy intake). the exposure variables for outcome were gender, age, diagnosis, use of vasopressors, malnutrition, route of nutritional support, and Pediatric Index of Mortality and Pediatric Logistic Organ Dysfunction scores.Results: Satisfactory energy intake was attained by 20.8% of the patients, within a mean time of 5.07 +/- 2.48 d. in a multivariable analysis, a diagnosis of heart disease (odds ratio 3.62, 95% confidence interval 1.03-12.68, P = 0.045) increased the risk of insufficient energy intake, whereas malnutrition (odds ratio 0.43, 95% confidence interval 0.20-0.92, P = 0.030) and the use of parenteral nutrition (odds ratio 0.34, 95% confidence interval 0.15-0.77, P = 0.001) were protective factors against this outcome.Conclusion: A satisfactory energy intake was reached by a small proportion of patients during their ICU stay. Heart disease was an independent risk factor for the non-attainment of satisfactory energy intake, whereas malnutrition and the use of parenteral nutrition were protective factors against this outcome. (C) 2013 Elsevier Inc. All rights reserved.