ABSTRACT
Objetivo Descrever as manifestações clínicas e analisar os achados laboratoriais indicativos de dengue, na Unidade de Urgência Referenciada Pediátrica do Hospital de Clínicas da Universidade Estadual de Campinas, durante epidemia na região, entre janeiro de 2007 e março de 2008. Métodos Foi feito estudo transversal de 231 pacientes com suspeita de dengue e idade entre zero e 15 anos. Os casos foram divididos em dois grupos, confirmados ou não, utilizando-se sorologias e/ou teste rápido ou critério clínico-epidemiológico durante a epidemia. Levantaram-se variáveis clínicas e laboratoriais, que foramprocessadas e comparadas entre os grupos, usando-se o programa Statistical Package for the Social Sciences (SPSS) 16.0 e os testes estatísticos Qui-quadrado, teste-exato de Fisher, teste t de Student e regressão logística univariada, adotando- -se p<0,05. Resultados Confirmou-se dengue em 156 pacientes: 115 (73,7%) por critério clínico-epidemiológico, 20 (12,8%) por sorologia, 11 (7,1%) por teste rápido e 10 (6,4%) por ambos. O grupo portador de dengue apresentou maior média de idade, mais queixas de prostração, cefaleia, exantema, menos de diarreia e dor abdominal, necessitando menos de hidratação venosa e internação hospitalar. Encontrou-se também maior média de hematócrito e menor de leucócitos e plaquetas. Apenas um paciente preencheu critérios para febre hemorrágica do dengue. Dois evoluíram para óbito (sepse e febre maculosa). Conclusão Na poopulação analisada, os sinais clínicos sugestivos para diagnóstico de dengue foram: idade, prostração, cefaleia e exantema, sendo pouco frequentes diarreia e dor abdominal. Alterações no hemograma mostraram-se estatisticamente significantes. Foram poucos os casos graves, um de febre hemorrágica do dengue e dois óbitos que não confirmaram dengue como causa mortis
Objective This study described the clinical manifestations and analyzed the laboratory findings indicative of dengue fever in the Reference Pediatric Emergency Unit of the Universidade Estadual de Campinas Clinics Hospital during an epidemic in the region from January 2007 to March 2008. Methods A cross-sectional study was done of 231 patients with suspicion of dengue fever aged 0 to 15 years. The cases were divided into two groups, confirmed or not, using serology and/or rapid test or clinical epidemiological criteria during the epidemic. Clinical and laboratory variables were processed and compared between the groups by the software Statistical Package for the Social Sciences 16.0 and by the chi-square test, Fisher?s exact test, Student?s t-test and univariate logistic regression, with the significance level set at p<0.05. Results Dengue fever was confirmed in 156 patients: 115 (73.7%) by clinical and epidemiological criteria, 20 (12.8%) by serology, 11 (7.1%) by rapid test and 10 (6.4%) by both. The group with dengue fever had higher mean age, complained more of prostration, head ache and rash and less of diarrhea and abdominal pain, requiring less intravenous fluids and hospitalization. The dengue fever group also presented higher mean hematocrit and lower mean leucocyte and platelet counts. Only one patient presented the symptoms of dengue hemorrhagic fever. Two patients died, one of sepsis and one of Brazilian spotted fever. Conclusion In the studied population, the clinical signs suggestive of dengue fever were: age, prostration, head ache and rash; diarrhea and abdominal pain were uncommon. The complete blood count of the patients presented significant changes. There were few severe cases, one of dengue hemorrhagic fever and two deaths, but dengue fever was not confirmed as the cause of deat
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Child , Dengue , Disease Outbreaks , Signs and SymptomsABSTRACT
OBJETIVO: Descrever o perfil de pacientes portadores de fibrose cística (FC). MÉTODOS: Estudo transversal, prospectivo, avaliando fibrocísticos de < 18 anos, durante o período de março a julho de 2006, em um centro de referência no nordeste do Brasil. A avaliação nutricional foi realizada pelo escore Z de altura/idade (A/I), peso/idade (P/I) e peso/altura (P/A) e por centopeso/altura ( por centoP/A), além de medidas de composição corporal. Foram obtidos dados socioeconômicos e clínicos. RESULTADOS: Foram avaliados 21 pacientes, sendo 12 (57,1 por cento) do sexo feminino. A média de idade de diagnóstico foi de 3,8 ± 3,9 anos, e as principais características ao diagnóstico foram infecção respiratória (85,7 por cento), esteatorreia (66,7 por cento) e déficit nutricional (47,6 por cento). A média de escore Z para P/I, A/I e P/A, respectivamente, foi de -0,73 ± 0,28, -0,34 ± 0,21 e -0,73 ± 0,35. A média de por centoP/A foi de 94,52 ± 1,58. O percentual de desnutridos divergiu quando avaliado pelo escore Z e por centoP/A (déficit nutricional em 66,7 por cento e 33,3 por cento, respectivamente; p > 0,05). Os pacientes eutróficos apresentaram melhores condições socioeconômicas (p > 0,05) e clínicas, com melhor escore de Shwachman (p < 0,05) quando comparados aos distróficos. CONCLUSÕES: Eutrofia foi encontrada através dos indicadores nutricionais (P/I, A/I e P/A), ao passo que déficit nutricional foi encontrado quando avaliada a composição corporal. As condições socioeconômicas apresentaram-se favoráveis, principalmente em relação ao grau de instrução materna e renda per capita. A idade de diagnóstico foi maior do que o relatado na literatura, embora o escore de Shwachman e o número de infecções respiratórias tenham demonstrado que os pacientes tinham boas condições clínicas.
OBJECTIVE: To describe the profile of patients with cystic fibrosis (CF). METHODS: A prospective, cross-sectional study involving CF patients < 18 years of age, evaluated between March and July of 2006 at a referral center in northeastern Brazil. Nutritional assessment was performed using Z scores for height/age (H/A), weight/age (W/A) and weight/height (W/H), as well as percentweight/height ( percentW/H) and body composition measurements. Socioeconomic and clinical data were obtained. RESULTS: Twenty-one patients were evaluated, 12 (57.1 percent) of whom were female. Mean age at diagnosis was 3.8 ± 3.9 years. The principal features at diagnosis were respiratory infection (85.7 percent), steatorrhea (66.7 percent) and nutritional deficit (47.6 percent). The mean Z scores for W/A, H/A and W/H were 0.73 ± 0.28, 0.34 ± 0.21 and 0.73 ± 0.35, respectively. Mean percentW/H was 94.52 ± 1.58. The percentage of malnourished children assessed by Z score differed from that assessed by percentW/H (nutritional deficit in 66.7 percent and 33.3 percent, respectively; p > 0.05). Socioeconomic status, clinical status and Shwachman score were better among well-nourished patients than among those classified as malnourished (p < 0.05 for Shwachman score). CONCLUSIONS: Normal nutritional status was identified based on nutritional indicators (W/A, H/A and W/H), whereas nutritional deficit was identified by assessing body composition. Socioeconomic factors proved favorable, especially maternal education and per capita income. Age at diagnosis was higher than that reported in the literature, although the Shwachman score and the incidence of respiratory infections demonstrated that the patients presented good clinical status.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Cystic Fibrosis , Malnutrition/diagnosis , Nutrition Assessment , Nutritional Status/physiology , Age of Onset , Analysis of Variance , Body Mass Index , Brazil , Cross-Sectional Studies , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Cystic Fibrosis/therapy , Malnutrition/etiology , Prospective Studies , Socioeconomic FactorsABSTRACT
Con el objetivo de escribir ciertos aspectos clínicos y genéticos de la fibrosis quística, se realizó un estudio descriptivo con 35 pacientes fibroquísticos registrados por la comisión provincial que atiende esta enfermedad, desde 1977 hasta 1995, a través de la revisión de historias clínicas y entrevistas a los padres. Las manifestaciones respiratorias resultaron las más frecuentes. El 91.42% (N=32) de los pacientes iniciaron la enfermedad durante la lactancia y de ellos 17 están ya fallecidos. La mayor mortalidad se presentó en aquellos menores de un año (N=13; 76.48%). El 25% de los cromosomas estudiados portaban la mutación mayor (AF508) y la presencia de ésta, incluso, en los heterocigotos se asoció a los cuadros clínicos más severos que llevaron a los niños más afectados a la muerte antes de los cinco años de vida. El 74.19% (N=23) de las parejas de riesgo recibieron asesoramiento genético. De ellos, cinco han solicitado diagnóstico prenatal en un posterior embarazo de uno de ellos. En conclusión, la fibrosis quística sigue siendo fatal en nuestro medio, por lo que se requiere del diagnóstico y tratamiento precoz, así como perfeccionar el asesoramiento genético y la caracterización molecular de las familias, con el fin de prevenirla .
To describe some clinical and genetic aspects of Cystic Fibrosis, a descriptive study on 35 fibrocystic patients registered by the Cystic Fibrosis Provincial comision since 1977 to 1995, througth clinical records review and parents interview was carried out. Respiratory symptoms were the most frequent 91.42% (N=32) of patients, initiated the disease during the firts year of life, and 17 of them are already deceased. Most of the patients disd during the lactation period 25% of all the studied chromosomes carried de major mutation (A F 508) and the presence of this mutation, ever in the heterocygotes was associated with the most severe clinical manifestations that lead the affected children to death before five years 74.19% of couples risk received genetic counselling. Five out of them subsequent pregnancy termination of one of them. In inclusion, Cystic Fibrosis continues being fatal in our milietr, that is why early diagnosis and treatment are necessary, as well as genetic couselling must be improved and molecular characterization of fibrocystic families must be don with aim of preventing the disease.