Manejo de deshidratación con alteración del sodio en pacientes pediátricos / Management of dehydration with sodium alteration in pediatric patients

Los cuadros de deshidratación son frecuentes en pediatría, muchos de ellos acompañados de alteraciones electrolíticas. La deshidratación asociada a trastornos del sodio puede implicar riesgos para la salud de los pacientes pediátricos tanto en el desarrollo del cuadro como en su tratamiento. Objetivo: crear un algoritmo de manejo de los cuadros de deshidratación asociados a lateraciones del sodio para manejo de pacientes pediátricos. Métodos: se realizó revisión de la literatura disponible sobre deshidratación con hiper e hiponatremia, en inglés y español, incluyendo libros y artículos de revistas. Se presenta en el actual documento los aspectos básicos sobre la fisiopatología de la deshidratación asociada a trastornos del sodio, su clínica, diagnóstico y manejo detallado, para el uso en la práctica clínica diaria.

Dehydration is common in pediatric patients, frequently accompanied with electrolite disturbances. Dehydration associated with sodium disturbances can involve risk for pediatric patient health during the development of the disease and during its treatment. Objective: to create an algorithm of management of dehydration with sodium disturbances in pediatric patients. Methods: review of literature about dehydration with hypernatremia and hyponatremia, in english and spanish, including books and published articles. We present in this document the basic aspects of physiopathology of dehydration with sodium disturbances, clinical presentation, diagnosis and detailed management, so it can be consulted for clinical practice.

Weight loss thresholds to detect early hypernatremia in newborns / Limites de perda de peso para detecção de hipernatremia precoce em recém-nascidos

ABSTRACT Objective: The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors. Methods: A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium ≥ 145 mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping. Results: There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity = 77.6%; specificity = 73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level. Conclusions: The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.

RESUMO Objetivo: A literatura indica um único ponto de corte universal na perda de peso após o nascimento para risco de hipernatremia, sem considerar outros fatores. Nosso objetivo foi criar e validar internamente pontos de corte para o percentual de perda de peso associado ao risco de hipernatremia considerando fatores de risco. Métodos: Foi feito um estudo prospectivo que incluiu 165 neonatos com idade gestacional ≥ 35 semanas, acompanhados por três dias. A principal variável de resultado foi hipernatremia leve ou moderada (sódio sérico ≥ 145 mmol/L). As variáveis secundárias (fatores de risco) foram variáveis maternas e dos neonatos. Um modelo multivariado de regressão logística foi criado para diagnosticar hipernatremia, obteve sua probabilidade e o ponto de corte discriminativo ideal para hipernatremia (análise da Característica de Operação do Receptor). Com base nesse ponto, obtivemos então os valores limites de perda de peso de acordo com as outras variáveis. Esses valores foram internamente validados por. Resultados: Há 51 casos (30,9%) de hipernatremia. O percentual de perda de peso para neonatos hipernatrêmicos foi 8,6% e 6,0% para o restante. As variáveis associadas no modelo multivariado incluíram maior perda de peso, sexo masculino, maior nível de escolaridade, multiparidade e cesárea. O modelo apresentou uma área sob a curva da Característica de Operação do Receptor de 0,84 (sensibilidade = 77,6%; especificidade = 73,2%). Valores semelhantes foram obtidos na validação da bootstrapping. O menor percentual de perda de peso foi 4,77% para cesárea em neonatos do sexo masculino de mães com maior nível de escolaridade. Conclusões: Os valores percentuais de perda de peso dependem do tipo de parto, paridade, sexo do recém-nascido e nível de escolaridade materna. São necessários estudos externos para validar esses valores.

Diarrea aguda en el lactante y preescolar / Acute diarrhea in toddlers and infants

Acute diarrhea (AD) is the increase in frequency and volume of bowel movements with decrease in their consistency that lasts less than 14 days. AD is a major public health problem and is still nowadays a cause of significant morbidity and mortality during childhood, especially in children with nutritional deficits. At a younger age, there is a greater susceptibility to diarrhea, which is more intense and more likely cause dehydration. The prevention and management of dehydration is the mainstay of treatment. The use of medications must be used with caution, analyzing individual cases and based on the best available evidence. We will analyze the subject with special emphasis on treatment according to scientific evidence.

La diarrea aguda (DA) se define como el aumento en la frecuencia y volumen de las deposiciones con disminución de la consistencia y que dura menos de 14 días. La DA es un gran problema de salud pública y es aún hoy en día una causa de importante morbimortalidad durante la infancia en especial en niños con déficits nutricionales. A menor edad hay mayor susceptibilidad de presentar diarrea, siendo ésta de mayor intensidad y con mayores posibilidades de producir deshidratación. La prevención y el manejo de la deshidratación es el pilar fundamental del tratamiento. El uso de medicamentos debe ser criterioso, analizando cada caso individual y basado en la mejor evidencia disponible. Analizaremos el tema con especial énfasis en el tratamiento según evidencia científica.

Cardiac sympathetic modulation increase after weight loss in combat sports athletes / Aumento da modulação cardíaca simpática depois de perda ponderal em atletas de combate / Aumento de la modulación cardíaca simpáticadespués de la pérdida ponderal en atletas de combate

INTRODUCTION: Although the rapid weight loss process is undertaken by combat sports athletes very often, the impact of this practice on cardiovascular health is not fully understood. OBJECTIVE: To verify the effects of the rapid weight loss process undertaken by combat sports athletes on hemodynamic parameters, cardiovascular autonomic modulation and mood state. METHODS: Eight male fighters (21.62±1.49 years, 71.25±3.54 kg, 1.74±0.03 cm) were assessed in the city of São Paulo. The subjects had 5.37±0.77 years of practice and were training 5.75±0.45 days per week, for 3.05±0.69 hours per day. The athletes were assessed on 2 occasions: 14 days before and 1 day before official weigh-in. Weight, height and bioimpedance were used for body composition analysis. Mood state was assessed using the Brums Mood Scale. Blood pressure was measured at rest with a digital meter. Cardiovascular autonomic modulation was obtained through an analysis of heart rate variability recorded for 25 minutes at rest. The Student's t-test for dependent samples was used for comparison between time points. Values of p<0.05 were considered significant. RESULTS: No differences in body composition were observed between the time points evaluated. After the weight loss strategy, increases in mood state parameters related to anger, vigor and fatigue categories were observed. Blood pressure did not change between the time points evaluated. However, an increase in heart rate associated with greater sympathetic modulation was observed after the weight loss strategy. There were no differences in autonomic modulation parameters representing parasympathetic activity. CONCLUSIONS: The study provided evidence of a higher cardiovascular risk in athletes as a result of this rapid weight loss practice, which is very concerning since combat sports athletes repeat this process several times during their lives. Level of Evidence IV; Study type: Case series

INTRODUÇÃO: Apesar de o processo de perda ponderal rápida ser realizado por atletas de esporte de combate com muita frequência, os impactos dessa prática sobre a saúde cardiovascular não estão totalmente esclarecidos. OBJETIVO: Verificar os efeitos do processo de perda ponderal rápida realizado pelos atletas de esportes de combate sobre parâmetros hemodinâmicos, modulação autonômica cardiovasculares estado de humor. MÉTODOS: Foram avaliados oito lutadores do sexo masculino (21,62 ± 1,49 anos, 71,25 ± 3,54 kg, 1,74±0,03 cm) na cidade de São Paulo. Os sujeitos tinham 5,37 ± 0,77 anos de prática, treinavam 5,75 ± 0,45 dias por semana, durante 3,05 ± 0,69 horas por dia. Os atletas foram avaliados em duas oportunidades: 14 dias e 1 dia antes da pesagem. Foram realizadas avaliações de massa corporal, altura e bioimpedância para análise da composição corporal. O estado de humor foi avaliado pela da escala de humor de Brums. A pressão arterial foi aferida em repouso com medidor digital. A modulação autonômica cardiovascular foi obtida pela análise de variabilidade da frequência cardíaca gravada durante 25 minutos em repouso. Para a comparação entre os momentos, foi utilizado teste t de Student para amostras dependentes. Os valores de p < 0,05 foram considerados significativos. RESULTADOS: Não foram observadas diferenças na composição corporal entre os momentos avaliados. Após a estratégia de perda ponderal, foram observados aumentos dos parâmetros de humor relacionados às categorias raiva, vigor e fadiga. A pressão arterial não se alterou entre os momentos avaliados. Entretanto, verificou-se aumento da frequência cardíaca associado à maior modulação simpática após a estratégia de perda ponderal. Os parâmetros de modulação autonômica representativos de atividade parassimpática não apresentaram diferenças. CONCLUSÕES: Houve maior risco cardiovascular nos atletas em decorrência dessa prática de perda ponderal rápida, o que é muito preocupante, tendo em vista que os atletas de esportes de combate repetem esse processo várias vezes durante a vida. Nível de Evidência IV; Tipo de estudo: Série de casos.

INTRODUCCIÓN: A pesar de que el proceso de pérdida ponderal rápida sea realizado por atletas de deporte de combate con mucha frecuencia, los impactos de esta práctica sobre la salud cardiovascular no están totalmente aclarados. OBJETIVO: Verificar los efectos del proceso de pérdida ponderal rápida realizado por los atletas de deportes de combate sobre parámetros hemodinámicos, modulación autonómica cardiovascular y el estado de humor. MÉTODOS: Se evaluaron 8 luchadores del sexo masculino (21,62±1,49 años, 71,25±3,54 kg, 1,74±0,03 cm) en la ciudad de São Paulo. Los sujetos tenían 5,37±0,77 años de práctica, entrenaban 5,75±0,45 días a la semana, durante 3,05±0,69 horas al día. Los atletas fueron evaluados en dos oportunidades: 14 días y 1 día antes del pesaje. Se realizaron evaluaciones de masa corporal, altura y bioimpedancia para análisis de la composición corporal. El estado de humor fue evaluado a través de la escala de humor de Brums. La presión arterial se midió en reposo con medidor digital. La modulación autonómica cardiovascular fue obtenida a través del análisis de variabilidad de la frecuencia cardíaca grabada durante 25 minutos en reposo. Para la comparación entre los momentos, se utilizó la prueba t de Student para muestras dependientes. Los valores de p <0,05 se consideraron significativos. RESULTADOS: No se observaron diferencias en la composición corporal entre los momentos evaluados. Después de la estrategia de pérdida ponderal, se observaron aumentos en los parámetros de humor relacionados con las categorías rabia, vigor y fatiga. La presión arterial no se alteró entre los momentos evaluados. Sin embargo, se observó un aumento en la frecuencia cardíaca asociado a la mayor modulación simpática después de la estrategia de pérdida ponderal. Los parámetros de modulación autonómica representativos de actividad parasimpática no presentaron diferencias. CONCLUSIONES: Hubo mayor riesgo cardiovascular en los atletas como consecuencia de esta práctica de pérdida ponderal rápida, lo que es muy preocupante, teniendo en cuenta que los atletas de deportes de combate repiten este proceso varias veces durante su vida. Nivel de Evidencia: IV. Tipo de estudio: Serie de casos.

Comparación entre hidratación con leche chocolatada descremada y bebida deportiva posterior al ejercicio físico en militares / Comparison between hydration with chocolate skim milk and sports drink after physical exercise in militaries

Introducción: dos factores importantes han sido descritos como contribuyentes en la aparición de fatiga durante el ejercicio físico: la disminución de las reservas de glucógeno muscular y la pérdida de agua con electrolitos a través del sudor, que favorecen la deshidratación. Debido a esto, la reposición de líquidos y electrolitos posterior al ejercicio físico se transforma en la prioridad para restablecer la homeostasis corporal alterada durante el ejercicio físico. Por su composición nutricional, la leche parece ser una buena alternativa natural como bebida rehidratante posterior al ejercicio físico. Objetivo: comparar la efectividad como bebida de rehidratación de la leche descremada chocolatada contra una bebida deportiva artificial en militares, a partir de la hipótesis de que la leche descremada chocolatada tiene iguales o mejores efectos sobre la hidratación post ejercicio, que una bebida deportiva artificial. Método: 30 militares (23,0 ± 3,2 años) se dividieron en 2 grupos: 1) rehidratación con bebida deportiva con 6 pòr ciento de carbohidratos y relación de Na/K 2:1 (grupo ISO). Rehidratación con leche descremada chocolatada (grupo LECHE). Se evaluó la retención de fluidos a través del peso corporal y la gravedad específica de la orina (GEO) antes y después del ejercicio físico y posterior a las 2 horas de rehidratación. Resultados: se encontraron diferencias significativas (p< 0,05) en la retención de fluidos en el grupo LECHE comparado con el grupo ISO. No hubo diferencias significativas entre la GEO de ambos grupos. Conclusión: Los resultados muestran que la rehidratación con leche descremada es más efectiva en la retención de fluidos y recuperación del peso previo al ejercicio que la bebida deportiva(AU)

ntroduction: Two important factors have been described as contributing to the onset of fatigue during physical exercise: Decreased muscle glycogen stores and the loss of water with electrolytes through sweating, favoring dehydration. Because of this, fluid and electrolyte replacement after physical exercise becomes the priority to restore altered body homeostasis during physical exercise. Due to its nutritional composition, milk appears to be a good natural alternative as a rehydration beverage after exercise. Objective: To compare the effectiveness chocolate skim milk as pots-exercise rehydration beverage with an artificial sports drink in the military, based on the hypothesis that chocolate skim milk has equal or better effects on post-exercise hydration than an artificial sports drink. Method: 30 soldiers (23.0 ± 3.2 years) were divided into 2 groups: 1) rehydration with sports drink with 6 percent carbohydrates and ratio of Na / K 2: 1 (ISO group). Rehydration with chocolate skim milk (LECHE group). Fluid retention was assessed through body weight and the specific gravity of urine (GEO) before and after physical exercise and after 2 hours of rehydration. Results: significant differences were found (p < 0.05) in fluid retention in the LECHE group compared to the ISO group. There were no significant differences between the GEO of both groups. Conclusion: The results show that rehydration with skim milk is more effective in fluid retention and weight recovery prior to exercise than sports drink(AU)

Central diabetes insipidus: alert for dehydration in very low birth weight infants during the neonatal period. A case report / Diabete insípido central: alerta para desidratação no período neonatal em recém-nascidos de muito baixo peso. Um relato de caso

CONTEXT: Central diabetes insipidus (CDI) is a rare cause of hypernatremia during the neonatal period. The diagnosis is particularly difficult in very low birth weight (VLBW) newborns. CASE REPORT: We report on a preterm newborn who presented CDI soon after birth. On the third day of life, signs of dehydration were present despite normal fluid supply. The diuresis rate was 4.4 ml/kg/h. Although the fluid supply was then increased, the dehydration continued, with hypernatremia, normal glycemia, diuresis of 7.4 ml/kg/h and urine density of 1005 mOsmol/l. Thus, a diagnostic hypothesis of diabetes insipidus was raised. A test with a nasal vasopressin analogue (dDAVP) was performed and CDI was confirmed. Reduction of the fluid supply became possible through appropriate treatment. CONCLUSION: The diagnosis of CDI is rarely made during the neonatal period, especially in VLBW newborns, because of the difficulty in detecting elevated diuresis. Persistent hypernatremia, usually accompanied by hyperthermia despite abundant fluid supply, weight loss and low urine osmolality are important signs of alert. .

CONTEXTO: Diabete insípido central (DIC) é uma rara causa de hipernatremia durante o período neonatal. O diagnóstico é difícil, particularmente em recém-nascidos (RN) de muito baixo peso (RNMBP). RELATO DE CASO: Relatamos um RN que apresentou DIC logo após o nascimento. No terceiro dia de vida, apresentava sinais de desidratação, embora estivesse recebendo aporte adequado de líquidos. A diurese aferida era de 4,4 ml/kg/h. Apesar do aumento do aporte hídrico, manteve-se desidratado, com hipernatremia, valores normais de glicemia e diurese de 7,4 ml/kg/h com densidade urinária de 1005 mOsmol/l. Desta forma, a hipótese diagnóstica de diabete insípido foi considerada. O teste com análogo da vasopressina (dDAVP) foi realizado e DIC foi confirmado. A redução do aporte de líquidos foi possível com o tratamento adequado. CONCLUSÃO: O diagnóstico de DIC raramente é realizado durante o período neonatal, particularmente em RNMBP, devido à dificuldade em detectar diurese aumentada. Hipernatremia persistente, geralmente acompanhada de hipertermia, apesar do abundante aporte de água, perda de peso e osmolaridade urinaria baixa, são importantes sinais de alerta. .

Perceptions regarding oral rehydration solutions for the management of diarrhea in Guatemalan children: implications for diarrheal management in the Americas / Ideas con respecto a las soluciones de rehidratación oral en el tratamiento de la diarrea de los niños guatemaltecos: repercusiones sobre el tratamiento de la diarrea en las Américas

OBJECTIVE: To describe knowledge and perceptions regarding the use of oral rehydration solution (ORS) for the management of diarrheal diseases among formal and informal health care providers and community caregivers in the Guatemalan department of Santa Rosa, and to recommend strategies to increase ORS use for management of diarrhea in children. METHODS: From July to September 2008, in-depth, semi-structured interviews were conducted with formal health care providers; open-ended interviews were conducted with informal health care providers; and focus group discussions and pile sorting were carried out with community caregivers. RESULT: The study participants attributed episodes of diarrhea in children to culturally recognized or folk ailments (empacho, cuajo, and varillas) that are primarily treated by traditional healers. There were knowledge deficits about 1) dehydration as a manifestation of diarrhea, and 2) management of dehydration, including the use of ORS and the need to continue feedings during diarrheal episodes. Caregivers perceived bottled/ready-made ORS products and the more expensive over-the-counter antidiarrheal medications as superior to ORS packets in the treatment of diarrhea. CONCLUSIONS: In Guatemala, folk etiologies of disease differ from those of the biomedical establishment and influence the decisions made by caregivers when treating ill children, including those related to the use of ORS. Public health campaigns addressing the treatment and management of diarrheal diseases in Santa Rosa should recognize the ailments known as empacho, cuajo, and varillas and target them for ORS use by community caregivers as well as health care providers in both the formal and informal health sectors.

OBJETIVO: Describir los conocimientos y las ideas que tienen las personas que prestan atención de salud en el sector convencional, el sector no convencional y los cuidadores de la comunidad con respecto al uso de las soluciones de rehidratación oral en el tratamiento de las enfermedades diarreicas, en el departamento guatemalteco de Santa Rosa y recomendar estrategias encaminadas a aumentar la utilización de estas soluciones en el tratamiento de la diarrea en los niños. MÉTODOS: De julio a septiembre del 2008 se llevaron a cabo entrevistas exhaustivas semiestructuradas a los profesionales de salud y entrevistas con preguntas abiertas a los proveedores no convencionales de atención sanitaria y se organizaron debates en grupos de opinión y ejercicios de ordenamiento de tarjetas con los cuidadores de la comunidad. RESULTADOS: Los participantes en el estudio atribuyeron la causa de los episodios de diarrea en los niños a dolencias culturalmente aceptadas o populares (empacho, cuajo y varillas), que tratan principalmente los curanderos. Se observaron deficiencias en los conocimientos acerca de 1) la deshidratación como una manifestación de la diarrea y 2) el tratamiento de la deshidratación, incluido el uso de las soluciones de rehidratación oral y la necesidad de continuar la alimentación durante los episodios diarreicos. Los cuidadores consideraron las soluciones de rehidratación embotelladas o preparadas y los medicamentos antidiarreicos de venta libre, que son más costosos, como mejores opciones para el tratamiento de la diarrea que las soluciones de rehidratación oral. CONCLUSIONES: En Guatemala, el concepto popular y el de las instituciones biomédicas sobre la causa de las enfermedades es diferente e influye sobre las decisiones que toman los cuidadores al tratar a los niños enfermos, por ejemplo, las relacionadas con el uso de soluciones de rehidratación oral. Las campañas de salud pública que abordan el tratamiento y el manejo de las enfermedades diarreicas en Santa Rosa deben incorporar las dolencias conocidas como empacho, cuajo y varillas y fomentar el uso de las soluciones de rehidratación oral en estos casos, por parte de los cuidadores de la comunidad, los profesionales de salud del sector convencional y los proveedores de atención del sector no convencional.

Linha de corte / Slitting Line

Quais são os limites do corpo humano? Correr 15 km em 52 minutos e 12 segundos? Cortar 52 toneladas de cana por dia? Essas marcas foram alcançadas por dois cortadores de cana que tinham em comum o árduo trabalho no campo. Com esse tempo, Maria Zeferina Baldaia conquistou o primeiro lugar na São Silvestre em 2001. Valdecir da Silva Reis conquistou um salário um pouco maior, muitas dores e uma morte prematura. O documentário "Linha de corte" mostra o impacto do sistema de pagamento por produção na saúde do trabalhador, desnudando a precariedade do trabalho no interior dos canaviais das modernas usinas paulistas, cenário de pouca visibilidade social

Masked Hydronephrosis

No abstract available.

Terapia de reidratação oral no setor de emergência / Oral rehydration therapy in emergency departments

OBJETIVO: Descrever o manejo da diarreia aguda na emergência, explorando fatores associados à prescrição da terapia de reidratação oral (TRO) versus terapia de reidratação venosa (TRV) para crianças com desidratação não grave. MÉTODOS: Estudo descritivo conduzido de janeiro a maio de 2008 em duas unidades de emergência em Recife (PE), A e B, sendo a emergência B vinculada a um hospital-escola, com observação do manejo de crianças com desidratação não grave por diarreia aguda. As principais variáveis foram: 1) tipo de hidratação prescrito; 2) associação com características das crianças e local. RESULTADOS: Cento e sessenta e seis crianças participaram do estudo. A indicação de TRO foi semelhante nos dois serviços (32,2 versus 31,6 por cento em A e B, respectivamente, p = 0,93) e menor para os casos com desidratação moderada (17,6 por cento) em relação à forma leve (35,6 por cento), p = 0,07. Não havia sala de reidratação oral nos serviços. CONCLUSÕES: A maioria das crianças não fez uso de TRO, principalmente aquelas com desidratação moderada, não havendo diferença em relação ao tipo de serviço, assistencial ou de ensino.

OBJECTIVE: To describe the management of acute diarrhea in emergency departments with emphasis on the type of hydration and exploring factors associated with prescription of oral rehydration therapy vs. intravenous rehydration therapy for children with dehydration that is not severe. METHODS: This was a descriptive study conducted from January to May of 2008 observing case management of children with non-severe dehydration due to acute diarrhea at two emergency units (A and B) in Recife, Brazil. Emergency unit B is affiliated to a teaching hospital. The primary variables were: 1) type of hydration prescribed, 2) associations with the characteristics of the children and emergency department (A or B). RESULTS: A total of 166 children took part in the study. The rates of prescription of oral rehydration therapy were similar at both services (32.2 vs. 31.6 percent for A and B, respectively, p = 0.93) and were lower for cases with moderate dehydration (17.6 percent) compared with mild dehydration (35.6 percent) (p = 0.07). Neither service had a dedicated oral rehydration room. CONCLUSIONS: Most children were given intravenous rehydration therapy, especially those with moderate dehydration, without differences according type of service: whether a teaching institution or healthcare provider only.

Frequency of rota virus infection in children with acute diarrhea

To determine the frequency of rotavirus infection in children admitted to the Military Hospital Rawalpindi with acute watery diarrhea. Descriptive study. Department of Pediatrics Military Hospital Rawalpindi, in collaboration with Virology department of Armed Forces Institute of Pathology, Rawalpindi from January to June 2007. A total of 200 patients of acute watery diarrhea in age group 3 months to 5 years were included. After taking informed consent, stool samples were taken and tested for rotavirus [group A] antigen by Latex Agglutination. Results were entered in pre-designed proformas. Out of 200 patients with acute watery diarrhea ninety eight [49%] were male and 102 [51%] were female with mean age of 14.8 months [SD +/- 9.1]. Rotavirus serology was positive in 62 patients [31%]. Among Rotavirus positive, 35 patients were male [56.5%] and 27 were female [43.5%] with mean age of 17.2 months [SD +/- 8.8]. The peak age was between 13-24 months. Among rotavirus positive patients 60% had some dehydration while 40% had severe dehydration as compared to 55% and 19% respectively in patients negative for rotavirus [p-value=<0.05]. Average number of loose stools was 10 stools per day [SD + 9.2] in rotavirus positive cases as compared to 8 per day [SD + 8.5] in negative cases [p-value=<0.05]. More than 96% patients with rotavirus presented with vomiting as compared to 62% patients who were negative for rotavirus. Fever was present in more than 93% of the patient with rotavirus disease while only 33% patients were febrile in the rotavirus negative group [p-value=<0.05]. Rotavirus is an important cause of acute watery diarrhea resulting in server diarrhea and vomiting leading to subsequent dehydration. As this study estimated only burden of Group A rotavirus, overall burden of all serotypes is expected to be much more

Generalidades en diarrea aguda: [revisión] / General aspects in acute diarrhea: [review]

Existen dos avances en el manejo de la diarrea, que podrían reducir el número de muertes infantiles; el primero la formulación de Sales de Rehidratación Oral con menor concentración de glucosa y sodio; el segundo la suplementación con zinc para disminuir la duración, severidad y episodios futuros. La OMS/OPS define la diarrea aguda como la eliminación de tres o más evacuaciones intestinales líquidas o semilíquidas en 24 horas. El enterocito, como unidad funcional del intestino, posee una serie de transportadores donde ocurre el proceso de movilización de glucosa y de iones, para mantener el equilibrio eléctrico adecuado. En la evaluación del paciente la anamnesis se realiza con el fin de precisar la severidad de la diarrea y su posible causa. En el examen físico se tendrá en cuenta que esta enfermedad puede ser un signo o síntoma que se relaciona con trastornos extraintestinales. El examen de heces puede ser una herramienta útil en la investigación etiológica. Puede cuantificarse el gradiente osmótico (GAP fecal) y determinar si estamos en presencia de una diarrea osmótica o secretora. La presencia de 5 o más leucocitos fecales sugiere un proceso invasivo siendo de utilidad la realización de un recuento diferencial, si los polimorfonucleares se encuentran en 64% o más, puede ser posible recuperar bacterias en el coprocultivo. Este último tendrá indicación en algunos grupos que por edad o patología se consideran de riesgo elevados por ser no inmuno competentes. La serología para rotavirus permitiría el aislamiento rápido de pacientes infectados para limitar un brote.

Two recent advances in the management of diarrhea which could reduce child deaths are the formulation of Oral Rehydration Salts with a lower concentration of glucose and sodium, and zinc supplementation to decrease the duration and severity of future episodes. Acute diarrhea is defined by the WHO as the passage of three or more loose stools in 24 hours. The enterocyte, as the functional unit of the intestine, has a number of carriers which contribute to the mobilization process of glucose and ions to maintain the proper electrical balance. In the evaluation of the patient, the medical history will clarify the severity of diarrhea and its possible cause. During the physical examination, the fact that this disease may be a sign or symptom associated with extra intestinal disorders should be taken into account. Feces analysis may be a diagnostic tool. Osmotic gradient can be quantified (fecal GAP) to distinguish osmotic from secretory diarrhea. The presence of 5 or more fecal leukocytes suggests an invasive process and if PMNs are found in 64% or more in the differential cell count, it maybe possible to recover bacteria in a stool culture. The latter is indicated in some children considered of high risk for their low immune competence due to their age or to certain pathologies. Serology for rotavirus allows the rapid isolation of infected patients in order to limit an outbreak.

Serological detection of rotavirus among children with diarrhea in relation to different environmental conditions

Rotaviruses are the single most important etiologic agents of severe diarrhea of infants and young children worldwide. In the present study, serological detection of rotavirus was done using an enzyme linked immunosorbent assay [ELISA], on 247 stool specimens. These were collected from children with acute diarrhea attending the outpatient clinic of Alexandria University Children's Hospital at El-Shatby, from October 2005 to April 2007. Rotavirus was detected in 33.6% of the collected samples; no specific age group or sex predilection was observed. It was presented with a marked seasonal peak during autumn and winter [58.3% and 40.5%, respectively]. Rotavirus was found to be infecting most commonly under-weight children [46.9%] resulting into fluid loss and severe dehydration [80%]. Rotavirus acute gastroenteritis was found to be associated with fever [38.8%], vomiting [39.9%], watery stools, and long duration of diarrheal episodes lasting from one up to six days. The appearance of convulsions among rotavirus-positive cases even in the absence of fever [84.6%] was an important finding. Exclusive formula-fed infants appeared to exhibit the highest disease incidence [50%] while exclusive breast-fed infants had a lower incidence level [35.2%] of the disease. The virus was found to be significantly affecting children living in rural areas of Egypt [43.8%] rather than urban ones [26.1%]. Environmental factors that were shown to affect the disease incidence include: the presence of impurities in water [41.6%], broken pipes [58.1%] and water tanks [58.7%] at the residence place. On the other hand, neither the kind of water source nor the presence of a sewage-disposal network was significantly related to the disease. Therefore the study recommended to screen for rotavirus in children with diarrhea in order to avoid the use of unnecessary medications. In addition, encouragement of breast feeding practices and improvement of environmental conditions are important means of prevention of rotavirus infection

Association of distal renal tubular acidosis with hypercalcemia; report on three cases

Hypercalcemia is an endocrine emergency that should be diagnosed as soon as possible and managed carefully. For better management multiple causes of hypercalcemia must be taken into consideration. We observed three infants with hypercalcemia and distal renal tubular acidosis at the time of diagnosis during 5 years. The patients were referred with severe dehydration and failure to thrive. There was no reason for hypercalcemia found in these patients except distal renal tubular acidosis. So we suggest distal renal tubular acidosis as a cause for hypercalcemia

[ etiology of acute renal failure in the newborn infants admitted to the NICU at Afzalipour medical centre, Kerman, Iran]

Despite the countless benefits of breast milk, each year many infants are admitted to NICU's with clinical symptoms and laboratory indicators of dehydration and renal failure due to the lack of a national program to monitor post discharge breastfeeding over the first few days of life. In addition to identifying the role of inadequate breast milk intake as a cause of renal failure, the purpose of this study was to assess causes, clinical presentations and laboratory tests in acute renal failure and to identify the most available and practical laboratory test to differentiate prerenal from renal azotemia. A cross-sectional prospective study was performed between April 2005 and May 2006 [14 months] at Afzalipour Medical Centre in Kerman, Iran. All neonates with high serum blood urea and creatinine were included in the study. The percentage of weight loss, breast feeding, mode of delivery, and clinical presentations were recorded. Laboratory tests such as blood urea, serum and urine sodium and creatinine and, urine specific gravity were done. Data were analyzed by SPSS software, chi- square test and t- test. Among 36 neonates, who were eligible for the study, 29 cases [80%] had dehydration [group I] and 7 cases [20%] had intrinsic renal failure [group II]. In the first group, mean weight loss was 14% and mean age at admission was 10 days. Reasons for admission were poor feeding [69%], lethargy [58%], fever [30%], jaundice, vomiting and seizure. The mode of delivery in 69% of cases were vaginal route and 82% of cases were breast-fed. Decreased urine frequency in the previous day [<6 times per day] was considered more significant than decreased stool frequency [< 3 times per day]. Serum sodium and urine specific gravity in group I was significantly higher than group II [P<0.05]. This study confirms that an excessive weight loss over the first few days of life and decreased urine and stool frequency might be considered as a warning for failure of receiving enough milk. Serum sodium and urine specific gravity are the most sensitive laboratory parameters, for the assessment of dehydration

Perspectivas atuais do tratamento da cetoacidose diabética em pediatria: [revisão] / Current perspectives for treating children with diabetic ketoacidosis: [review]

OBJETIVO: Revisar os conceitos atuais da fisiopatologia, diagnóstico e tratamento da cetoacidose diabética (CAD) na infância, assim como as medidas preventivas para evitar o edema cerebral. FONTES DOS DADOS: Os autores selecionaram artigos na MEDLINE com as palavras-chave diabetes, cetoacidose, hiperglicemia e edema cerebral, priorizando estudos realizados em crianças, que tenham textos completos publicados em inglês, português ou espanhol. Revisaram, ainda, capítulos de livros publicados no Brasil descrevendo o tratamento de CAD em unidade de tratamento intensivo pediátrico. Baseados na literatura revisada e em sua experiência, apresentam as medidas mais eficazes e recomendadas no manejo da CAD. SÍNTESE DOS DADOS: Consolida-se cada vez mais a utilização de solução fisiológica (NaCl 0,9 por cento) tanto na fase de reposição rápida quanto na fase de hidratação, em substituição às soluções diluídas (hipotônicas), assim como a contra-indicação do uso de bicarbonato de sódio para corrigir acidose metabólica na CAD. A insulina regular deve ser utilizada sob a forma de infusão contínua (0,1 UI/kg/h) sem a necessidade de dose de ataque. Para rápidas correções das oscilações da glicemia, é apresentado um esquema prático com duas bolsas de soluções eletrolíticas. Revisam edema cerebral, seu mecanismo fisiopatológico e o tratamento atual. CONCLUSÕES: O uso de infusão contínua de insulina regular associada à reposição hídrica adequada com soluções isotônicas, além de tratamentos efetivos da CAD, preserva a osmolaridade plasmática e previne a ocorrência de edema cerebral.

OBJECTIVE:To review current concepts of physiopathology, diagnosis and treatment of diabetic ketoacidosis (DKA) in childhood, as well as preventive measures to avoid cerebral edema. SOURCES: The authors selected articles from MEDLINE with the keywords diabetes, ketoacidosis, hyperglycemia and cerebral edema, and priority was given to studies including children and that contained complete texts published in English, Portuguese or Spanish. Chapters of books published in Brazil describing the treatment of DKA in pediatric intensive care unit were also reviewed. Based on the reviewed literature and on the author's experience, the most efficient and recommended measures for DKA management are presented. SUMMARY OF THE FINDINGS: Normal saline solution (NaCl 0.9 percent) has been increasingly used for fast replacement and hydration, as a substitute to diluted (hypotonic) solutions, as well as contraindication of sodium bicarbonate to repair metabolic acidosis in DKA. Regular insulin should be used as continuous infusion (0.1 IU/kg/h) without the need of a loading dose. For fast corrections of glucose oscillations, a practical scheme using two bags of electrolytic solutions is presented. Cerebral edema, its physiopathological mechanism and current treatment are reviewed. CONCLUSIONS: Use of continuous infusion of regular insulin associated with adequate water and electrolyte replacement using isotonic solutions, besides being an effective treatment for DKA, preserves plasma osmolarity and prevents cerebral edema.