Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

Abstract Background: Efficacy studies on the treatment of anorexia nervosa (AN) in childhood and adolescence are scarce and systematic reviews are almost non-existent. Objective: Systematic review of the literature regarding the modalities of psychological intervention based on evidence used in the treatment of AN in childhood and adolescence. Methods: The research was carried out in the databases: PubMed, PsycINFO and Cochrane, using the combined keywords: anorexia nervosa and evidence-based therapy. Articles published between 1990 and 2015 were assessed. Results: Of the 139 eligible articles, 14 were selected, of which 10 (71.4%) were conducted in the United States and England. The sample ranged from 9 to 167 participants. Randomized Clinical Trial represented the most frequent design (n = 9; 63.4%), with more than half of the interventions structured in 20 or more sessions (n = 9, 64.3%). Nine types of treatments were tested, with the most tested being Family-Based Treatment (FBT) (n = 7; 50%). Interventions involving the family seem to be more effective, however, the rates for complete remission are modest. Discussion: Although evidence of efficacy was verified in the treatments analyzed, the limited number of studies, the various methodological limitations and the methodological heterogeneity between studies make the findings inconclusive.

Compromiso pulmonar en pacientes hospitalizados con infección por el virus de inmunodeficiencia humana en el Hospital Pablo Tobón Uribe (Medellín, Colombia) / Pulmonary compromise in inpatients with human immunodeficiency virus infection at Pablo Tobón Uribe Hospital, Medellín, Colombia

Más de la mitad de los pacientes con infección por virus de inmunodeficiencia humana (VIH) pueden tener compromiso pulmonar en el transcurso de su vida. Este puede ser multicausal y las infecciones oportunistas son las principales, sin embargo, las causas no infecciosas no son menos importantes. Objetivo: Describir las características del compromiso pulmonar en pacientes hospitalizados con infección por VIH. Metodología: Estudio descriptivo observacional. Resultados: Se incluyó a 63 pacientes, el 85,7% fueron hombres. La edad promedio fue 40,6 ± 12 años. El 21,4% tuvieron antecedente de promiscuidad sexual y 28,6% fueron hombres con sexo con hombres. Se identificó tabaquismo en 60,3%, alcoholismo en 52,4% y consumo de drogas en 20,6%. El 23,8% tuvo historia de tuberculosis. Al ingreso, el 79,4% tenía sida, el recuento promedio de CD4 fue 138,5 ± 17,7 células/mm3 y el 49,2% tenía CD4 < 100 células/mm3. Las principales comorbilidades fueron: enfermedad neoplásica 20,6%, diarrea crónica 19%, EPOC 6,3% y diabetes mellitus 3,2%. Los principales síntomas al ingreso fueron: respiratorios 66,7%, gastrointestinales 47,6% y neurológicos 34,9%. Los principales oportunistas documentados fueron Mycobacterium spp, H. capsulatum y P. jirovecii. El sarcoma de Kaposi, la enfermedad lifoproliferativa y la EPOC fueron causas de compromiso no infeccioso. Los principales hallazgos radiográficos fueron: infiltrados intersticiales (42,9%), compromiso pleural (23,8%) y lesiones cavitarias (7,9%). El compromiso multilobar fue evidente en el 15,9%. Las principales complicaciones fueron falla respiratoria, disfunción orgánica múltiple y falla renal aguda. El 19% requirió ingreso a UCI y, de estos, el 83,3% necesitó ventilación mecánica. La estancia hospitalariapromedio fue de 18 ± 20 días y la mortalidad del 17,5%. Discusión: Las infecciones por oportunistas son las principales causas de compromiso pulmonar y, dentro de estas, las causadas por micobacterias. Puede ocurrir más de una infección oportunista simultáneamente, pero en nuestra población fueron infrecuentes. Las causas noinfecciosas también son importantes.

More than a half of patients with HIV infection have pulmonary involvement throug-hout their lives. Opportunistic infections are the main cause; however, many patients havenoninfectious pulmonary involvement. Objective: To describe the characteristics of pulmonary involvement in inpatients with HIVinfection.Methods: Descriptive observational study. Results: A total of 63 patients were included, and 85.7% were men. The average age was40.6 ± 12 years. Some 21.4% had a history of sexual promiscuity and 28.6% were men whohad sex with men. Smoking was found in 60.3%, alcoholism in 52.4% and drug abuse in 20.6%.A tuberculosis history was documented in 23.8% of patients. At admission, 79.4% had AIDS, themean CD4 count was 138.5 ± 17.7 cells/mm3and 49.2% had CD4 counts < 100 cells/mm3. Majorcomorbidities included neoplastic disease in 20.6%, chronic diarrhea in 19%, COPD in 6.3% anddiabetes in 3.2%. Major opportunistic agents were Mycobacterium spp, H. capsulatum and P.jirovecii. Kaposi's sarcoma, lymphoproliferative disease and COPD were causes of noninfectiouspulmonary involvement. The main radiographic findings included interstitial infiltrates in 42.9%,pleural involvement in 23.8%, alveolar infiltrates in 7.9% and cavitary lesions in 7.9%. Multilobarcompromise was evident in 15.9% of the patients. The major complications were respiratoryfailure, multiple organ dysfunction and acute renal failure. Some 19% required care in the ICUand 83.3% of these required mechanical ventilation. The mean stay was 18 ± 20 days and themortality was 17.5%. Discussion: Opportunistic infections are the main causes of lung involvement and mycobacterialdiseases were most frequent. Mycobacterial diseases can occur simultaneously with an oppor-tunistic infection, but in our series this was infrequent. Non-infectious diseases are importantbut are less common.

Fatores associados ao consumo de bebidas açucaradas entre pré-escolares brasileiros: inquérito nacional de 2006 / Factors associated with the consumption of soft drinks among Brazilian preschool children: national survey of 2006

Resumo O crescente consumo de bebidas açucaradas como os refrigerantes ou sucos artificiais está associado à prevalência de obesidade no Brasil e no mundo. Este estudo se propõe a conhecer a frequência de consumo destas bebidas entre crianças brasileiras de 24 a 59 meses e investigar associações com variáveis demográficas, socioeconômicas e nutricionais. Utilizando dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher − 2006, o padrão alimentar foi obtido com o questionário de frequência de alimentos e bebidas nos sete dias anteriores à data da entrevista e a antropometria usou medidas de peso e de estatura das crianças. Entre os pré-escolares, 37,3% consumiram refrigerantes e sucos artificiais 4 dias ou mais por semana. Os fatores que apresentaram associação estatisticamente significante com consumo frequente de BA foram residir em regiões de maior desenvolvimento econômico do país, em áreas urbanas, pertencer ao estrato de maior poder aquisitivo, mães que assistiam TV regularmente e excesso de peso da criança, estavam associados ao consumo de refrigerantes e sucos artificiais em 4 ou mais dias por semana. Novos estudos são necessários para a compreensão da real contribuição das bebidas açucaradas na epidemia de obesidade infantil.

Abstract The rising consumption of sweetened beverages such as soft drinks or artificial juices is associated with the prevalence of obesity in Brazil and around the world. This study seeks to verify the frequency of consumption of these beverages among Brazilian children aged 24-59 months and to investigate the association of soft drinks with demographic, socioeconomic and nutritional variables. Using data from the National Survey on Demography and Health of Women and Children − 2006, the eating habits were obtained using the food and drink frequency questionnaire for the seven days preceding the interview, and anthropometry recorded the weight and height of children. Among preschoolers, 37.3% consumed soft drinks and artificial juices 4 or more days per week. The factors significantly associated with frequent consumption of soft drinks were living in regions of higher economic development of the country, in urban areas, belonging to the higher income bracket, with mothers watching TV regularly and excess weight of the child, were associated with consumption of soft drinks and artificial juices 4 or more days per week. Further studies are needed to understand the effective contribution of soft drinks on the epidemic of childhood obesity.

Características sociodemográficas e nutricionais de crianças brasileiras menores de 2 anos beneficiárias de programas de transferência condicionada de renda em 2006 / Socio-demographic and nutritional characteristics of Brazilian children under 2 years of age who were beneficiaries of conditional cash transfer programs in 2006

Programas de transferência condicionada de renda (PTCR) visam o combate à pobreza e à fome e a garantia da segurança alimentar. Crianças menores de 2 anos de famílias beneficiárias são mais vulneráveis às condições ambientais. Este estudo objetiva caracterizar esta população segundo variáveis socioeconômicas, demográficas e nutricionais. Utilizaram-se dados secundários da Pesquisa Nacional de Demografia e Saúde da Crian ça e da Mulher (PNDS-2006). Descreveram-se os dados em média e desvios-padrão. Para as associações utilizou-se o teste qui-quadrado e intervalos de confiança de 95%. Das 1735 crianças 29,4% eram beneficiárias de PTCR com renda média familiar de R$430,20 e valor médio dos benefícios de R$75. Dentre as que residiam no Nordeste ou na região rural do país, uma em cada três recebiam PTCR. Entre as que viviam em insegurança alimentar grave, 52,3% pertenciam a PTCR. Classes econômicas D e E e baixa escolaridade materna associaram-se a PTCR. Entre os desvios nutricionais das crianças beneficiárias, prevaleceu o peso elevado para idade. Das que interromperam o aleitamento materno exclusivo antes dos dois meses, 31,2% eram de PTCR. Identifica-se a necessidade de educação nutricional preventiva a fim de otimizar a utilização do benefício.

The conditional cash transfer programs (PTCR) seek to combat poverty and hunger and to ensure food security. Children under the age of two of beneficiary families are more vulnerable to environmental conditions. This study seeks to describe this population according to socio-economic, demographic and nutritional variables. Secondary data from the National Survey on Demography and Health of Women and Children (PNDS-2006) were used. Data were described using mean and standard deviations. Associations were described using the chi-square test with confidence intervals of 95%. Of the 1735 children, 29.4% were PCTR beneficiaries with average family income of R$430.20 and average benefits of R$75. Among those living in the Northeast or in the rural area of the country, one in every three received benefits. Among those experiencing severe food insecurity, 52.3% were PTCR beneficiaries. Children from socio-economic classes D and E and whose mothers had less than four years education were associated with PTCR. Among the nutritional disorders of child beneficiaries, overweight for age prevailed. Of those who ceased exclusive breastfeeding in less than two months, 31.2% were beneficiaries. The need for preventive nutritional education was identified in order to optimize the use of benefits.

Síndrome hepatopulmonar en paciente con hipertensión portal no cirrótica. Reporte de caso / Case report of hepatopulmonary syndrome in patients with non-cirrhotic portal hypertension

Presentamos el caso de una paciente con diagnóstico de síndrome hepatopulmonar (SHP) secundario a hipertensión portal no cirrótica subyacente, en el contexto de trombosis crónica de la vena porta y la mesentérica, por trombofilia primaria (deficiencia de proteína C-S). Se hizo el diagnóstico de SHP al encontrar una ecocardiografía contrastada con solución salina agitada positiva para un shunt extracardíaco, una gammagrafía con macroagregados de albúmina con evidencia de captación a nivel cerebral e hipoxemia persistente con gradiente alvéolo-arterial elevado para la edad de la paciente.

We report the case of a female patient diagnosed with hepatopulmonary syndrome (HPS) which occurred in the context of chronic thrombosis of the portal and mesenteric veins resulting from primary thrombophilia (protein C and protein S deficiencies). This case of HPS was diagnosed when echocardiography with agitated saline contrast showed the patient was positive for extra cardiac shunt. Scintigraphy using albumin macro-aggregates showed evidence of uptake in the brain and persistent hypoxemia with elevated alveolar-arterial gradient for the age of the patient.

Correlación de Candida con hábito de fumar, parámetros clínicos y patógenos periodontales de pacientes con periodontitis crónica / Correlation of Candida with smoking, clinical parameters and periodontal pathogens in patients with chronic periodontitis

Fundamento: la presencia de Candida en placa subgingival de pacientes con enfermedad periodontal puede tener implicaciones clínicas y terapéuticas. Objetivo: identificar la presencia de Candida en pacientes con periodontitis crónica y establecer su correlación con patógenos periodontales, parámetros clínicos y hábito de fumar. Método: se estudiaron 76 pacientes con periodontitis crónica. Se obtuvieron muestras subgingivales que se procesaron mediante cultivo. Se utilizó la prueba no paramétrica de Spearman para determinar la correlación entre patógenos periodontales, variables clínicas y hábito de fumar con la presencia de Candida (P< 0.05). Resultados: la prevalencia de Candida fue del 13.2 por ciento. La Candida albicans fue la especie más prevalente. Se observaron correlaciones positivas estadísticamente significativas entre presencia de especies de Cándida con hábito de fumar, nivel de inserción clínica y presencia de Prevotella melaninogenica. Se encontraron correlaciones negativas estadísticamente significativas entre la presencia de Candida con Fusobacterium nucleatum, Prevotella intermedia/nigrescens y Aggregatibacter actinomycetemcomitans. Conclusiones: los resultados del estudio muestran una correlación entre especies de Candida y condiciones periodontales adversas. La correlación negativa y la ausencia de correlación de Candida con algunos periodontopatógenos de debe a su ubicación externa en la biopelícula, le podrían proporcionar un carácter refractario a las periodontitis que presentan este tipo de microorganismo en placa subgingival.

Background: the presence of Candida in subgingival plaque of patients with periodontal disease may have clinical and therapeutic implications. Objective: identify the presence of Candida in patients with chronic periodontitis and establish its correlation to periodontal pathogens, clinical parameters and smoking. Method: seventy-six patients with chronic periodontitis were studied. Subgingival samples were processed by culture. Spearman´s nonparametric test was used to determine the correlation between periodontal pathogens, clinical and smoking with the presence of Candida. Results: the prevalence of Candida was 13.2 percent. Candida albicans was the most prevalent species. There were statistically significant positive correlations between the presence of Candida species with smoking, clinical attachment level and presence of Prevotella melaninogenica. Also found statistically significant negative correlations between the presence of Candida with Fusobacterium nucleatum, Prevotella intermedia / nigrescens and Aggregatibacter actinomycetemcomitans. Conclusions: the results of this study show a correlation between Candida species and adverse periodontal conditions. The negative correlation and no correlation with some periodontal pathogens, apparently due to its external location in the biofilm, could provide refractory characters to periodontitis with this type of microorganism in subgingival plaque.

Asociación de Aggregatibacter actinomycetemcomitans y microorganismos del complejo rojo con parámetros clínicos de pacientes con periodontitis crónica / Association of Aggregatibacter actinomycetemcomitans and red complex microorganisms with clinical parameters of patients with chronic periodontitis

Fundamento: en Latinoamérica se ha estudiado muy poco la asociación entre Aggregatibacter actinomycetemcomitans y microorganismos del complejo rojo con los parámetros clínicos de pacientes con periodontitis crónica. Objetivo: identificar la presencia de Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis y Tanerella forsythia en pacientes con periodontitis crónica, y establecer su asociación con parámetros clínicos y hábito de fumar. Método: se examinaron los parámetros clínicos (profundidad de bolsa, nivel de inserción, sangrado al sondaje, índice de placa y supuración) y la presencia de periodontopatógenosen 76 pacientes con periodontitis crónica en Medellín, Colombia. Las muestras subgingivales se procesaron mediante cultivo. Para determinar las diferencias de las variables clínicas y el hábito de fumar con la presencia o ausencia de periodontopatógenos se utilizaron pruebas de chi cuadrado y U de Mann-Whitney (P< 0.05). Resultados: se encontró A. actinomycetemcomitans, P. gingivalis y T. forsythia en el 23.7 porciento, 64.4 porciento y 40.8 porciento de los pacientes respectivamente. Los sujetos que presentaron A. actinomycetemcomitans y P. gingivalis mostraron peores parámetros clínicos, diferencias que fueron altamente significativas (P<0.0001). T. forsythia se asoció significativamente con mayor profundidad de sondaje (P=0.02), presencia de sangrado (P<0.0001) y placa bacteriana (P<0.0001). Se observó una asociación altamente significativa entre hábito de fumar y presencia de A. actinomycetemcomitans y P. gingivalis (P<0.0001). Conclusiones: P. gingivalis, T. forsythia y A. actinomycetemcomitans se asociaron con condiciones periodontales adversas. Es importante realizar exámenes microbiológicos de las poblaciones con periodontitis debido a que la composición particular de la placa subgingival puede determinar un adecuado tratamiento periodontal.

Background: the association between Aggregatibacter actinomycetemcomitans and red complex microorganisms with clinical parameters of patients with chronic periodontitis has been studied very little in Latin America. Objective: to identify the presence of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tanerella forsythia in patients with chronic periodontitis, and establish their association with clinical parameters and smoking. Method: we examined clinical parameters (probing depth, attachment level, bleeding on probing, suppuration and plaque index) and the presence of periodontal pathogens in 76 patients with chronic periodontitis in Medellín, Colombia. Subgingival samples were processed by culture. Chi square and Mann-Whitney test were used to determine differences in clinical variables and smoking in the presence or absence of periodontal pathogens (P<0.05). Results: We found A. actinomycetemcomitans, P. gingivalis and T. forsythia in 23.7 percent, 64.4 percent and 40.8 percent of patients respectively. Patients whit A. actinomycetemcomitans and P. gingivalis showed worse clinical parameters, differences were highly significant (P<0.0001). T. forsythia was associated with significantly higher probing depth (P= 0.02), presence of bleeding (P<0.0001) and plaque (P<0.0001). There was a highly significant association between smoking and presence of A. actinomycetemcomitans and P. gingivalis (P<0.0001). Conclusions: P. gingivalis, T. forsythia and A. actinomycetemcomitans were associated with adverse periodontal conditions. It is important to conduct microbiological tests on populations with periodontitis because the particular composition of subgingival plaque determines an appropriate periodontal treatment.

Puntaje de riesgo para morbilidad y mortalidad en pacientes sometidos a intervencionismo coronario percutáneo / Morbimortality risk score in patients submitted to percutaneous coronary intervention

El objetivo principal de este estudio observacional, fue establecer un puntaje de riesgo para morbilidad y mortalidad intrahospitalaria en pacientes sometidos a intervención coronaria percutánea luego de sufrir alguno de los siguientes síndromes coronarios agudos: angina inestable, infarto agudo del miocardio sin elevación del segmento ST o infarto agudo del miocardio con elevación del segmento ST. Se realizó una recolección de datos clínicos y demográficos a partir de 1.310 pacientes atendidos en la clínica, entre 2003 a 2006, de manera retro-prospectiva, con el fin de elaborar un puntaje válido para la población colombiana. Esto se realizó mediante una base de datos de múltiples variables pre-procedimiento (antecedentes personales), variables intra-procedimiento (tiempo transcurrido desde la hora de la consulta al servicio de urgencias hasta el momento del cateterismo, número de vasos enfermos entre otros) y variables post-procedimientos (complicaciones de morbi-mortalidad). Luego, el análisis de los datos se llevó a cabo mediante un modelo de regresión logística, para determinar cuáles de los factores de riesgo fueron estadísticamente significativos para causar alguno de los resultados evaluados. Los principales resultados evaluados fueron: muerte, eventos hematológicos adversos y estancia hospitalaria. Luego del análisis se encontró que los principales factores relacionados con la morbi-mortalidad de los pacientes fueron el tipo de paciente (o tipo de síndrome coronario sufrido), su edad y su estado hemodinámico al ingreso (presencia de shock cardiogénico). A partir de estos resultados, se desarrolló el puntaje de riesgo a través de las variables pre-operatorias e intra-operatorias.