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1.
Av. enferm ; 38(2): 140-148, May-Aug. 2020. tab
Article in English | LILACS (Americas), BDENF, COLNAL | ID: biblio-1114684

ABSTRACT

Abstract Background: Delirium has been identified as a risk factor for the mortality of critically ill patients, generating great social and economic impacts, since patients require more days of mechanical ventilation and a prolonged hospital stay in the intensive care unit (ICU), thus increasing medical costs. Objective: To describe the prevalence and characteristics of delirium episodes in a sample of 6-month to 5-year-old children who are critically ill. Methods: Cohort study at a Pediatric Intensive Care Unit (PICU) in Bogotá (Colombia). Participants were assessed by the Preschool Confusion Assessment Method for the ICU (psCAM-lCU) within the first twenty-four hours of hospitalization. Results: One quarter of the participants (25.8%) presented some type of delirium. Among them, two sub-types of delirium were observed: 62.5% of the cases were hypoactive and 37.5% hyperactive. Moreover, from them, six were male (75%) and 2 female (25%). Primary diagnosis was respiratory tract infection in 62.55% of the patients, while respiratory failure was diagnosed in the remaining 37.5%. Conclusions: The implementation of delirium monitoring tools in critically ill children provides a better understanding of the clinical manifestation of this phenomenon and associated risk factors in order to contribute to the design of efficient intervention strategies.


Resumen Introducción: el delirium se ha identificado como un factor de riesgo para la mortalidad de pacientes en estado crítico, lo que genera un mayor impacto social y económico, teniendo en cuenta que los pacientes requieren más días de ventilación mecánica y una estancia hospitalaria prolongada en la unidad de cuidados intensivos (UCI), lo que incrementa los costos médicos de su estadía. Objetivo: describir la prevalencia y las características de los episodios de delirium en una muestra de niños de seis meses a cinco años en estado crítico. Métodos: estudio de cohorte en una Unidad de Cuidados Intensivos Pediátricos (UCIP) en Bogotá (Colombia). Los participantes fueron evaluados por el método de evaluación de confusión preescolar para la UCI (psCAM-UCI) dentro de las 24 horas iniciales del período de hospitalización. Resultados: una cuarta parte de los participantes (25,8 %) presentó algún tipo de delirium. Entre ellos, se observaron dos subtipos de delirium: el 62,5 % de los casos era hipoactivo y el 37,5 % hiperactivo. Además, el 75% (6) de los participantes delirantes eran hombres y el 25 % (2) mujeres. En 62,5 % de los pacientes el diagnóstico primario fue infección de las vías respiratorias, mientras que la insuficiencia respiratoria fue diagnosticada en el 37,5 % restante. Conclusiones: la implementación de herramientas de monitoreo del delirium con niños en estado crítico proporciona una mejor comprensión de la presentación clínica de este fenómeno y los factores de riesgo asociados, con lo cual es posible contribuir al diseño de estrategias de intervención eficientes.


Resumo Introdução: o delirium foi identificado como um fator de risco para a mortalidade de pacientes graves, o que gera maior impacto social e econômico, visto que os pacientes necessitam de mais dias de ventilação mecânica e internação prolongada na unidade de terapia intensiva (UTI), o que aumenta os custos médicos para a sua estadia. Objetivo: descrever a prevalência e as características dos episódios de delirium em uma amostra de crianças de 6 meses a 5 anos, gravemente doentes. Métodos: estudo de coorte em uma Unidade de Terapia Intensiva Pediátrica (UTIP) em Bogotá (Colômbia). Os participantes foram avaliados pelo método de avaliação de confusão pré-escolar para a UTI (psCAM-UTl) dentro das primeiras 24 horas do período de internação. Resultados: um quarto dos participantes (25,8%) apresentou algum tipo de delirium. Entre eles, dois subtipos de delirium foram observados: 62,5% dos casos eram hipoativos e 37,5% hiperativos. Além disso, 75% (6) dos participantes delirantes eram do sexo masculino e 25% (2) feminino. Em 62,5 % dos pacientes, o diagnóstico primário foi infecção das vias respiratórias, enquanto a insuficiência respiratória foi diagnosticada em 37,5 % restante. Conclusões: a implementação de instrumentos de monitorização do delirium com crianças gravemente doentes permite uma melhor compreensão da apresentação clínica do fenômeno e dos fatores de risco associados, de forma a contribuir para o desenho de estratégias de intervenção eficazes.


Subject(s)
Humans , Infant , Child, Preschool , Pediatrics , Psychomotor Agitation , Intensive Care Units, Pediatric , Child, Preschool , Critical Care , Delirium , Respiration, Artificial , Child , Nursing , Colombia , Intensive Care Units
2.
Revista Digital de Postgrado ; 9(2): 205, ago. 2020. tab
Article in Spanish | LILACS (Americas), LIVECS | ID: biblio-1102879

ABSTRACT

La Parálisis Cerebral (PC) es un conjunto de alteraciones motrices no progresivas en la población infantojuvenil, ocasionadas por lesión ­a nivel cerebral- de neuronas o fibras de esa vía, de sus aferencias o de las que la modulan; para su diagnóstico deben conocerse otras patologías también frecuentes y que pueden incidir simultánea o causalmente en la motricidad del paciente; la resultante sería disfunción motora tanto voluntaria como involuntaria, refleja o con propósito, de la postura y/o del tono muscular. Objetivo: detectar errores innatos metabólicos (EIM) que causan o se asocian con PC en una serie significativa. Métodos: Estudio descriptivo-interpretativo, se revisaron los expedientes clínicos del Centro de Parálisis Cerebral de Caracas, en cuyos diagnósticos se presentaron ambas alteraciones, entre los años 1988 y 2018. Resultados: De las 2.000 historias clínicas revisadas, el exámen clínico y las pruebas de laboratorio permitieron seleccionar 174 casos de EIM. Conclusiones: Se tipificaron los errores innatos metabólicos en diez formas clínicas distintas, se evidenciaron en pacientes con PC atendidos en un centro público de Caracas, es posible que la casuística sea varias veces mayor en Venezuela dado que ya no se aplica la pesquisa en los centros de atención pública(AU)


Cerebral Palsy (CP) is a set of non-progressive motor alterations in the child and youth population, caused by injury - at the brain level - of neurons or fibers of that pathway, their afferences or those that modulate it; for its diagnosis, other pathologies that are also frequent and that can simultaneously or causally affect the motor skills of the same patient must be known; The result would be both voluntary and involuntary motor dysfunction, reflected or with purpose, of posture and / or muscle tone. Objective: to detect inborn metabolic errors (EIM) that cause or are associated with CP in a significant series. Methods: Descriptive-interpretive study, we reviewed the clinical records of the Cerebral Palsy Center of Caracas, in whose diagnoses both alterations were presented, between the years 1988 and 2018. Results: Of the 2,000 clinical histories reviewed, the clinical examination and tests Laboratory tests allowed the selection of 174 cases of IMD. Conclusions: Inborn metabolic errors were typified in ten different clinical forms, they were evidenced in patients with CP treated in a public center in Caracas, it is possible that the casuistry is several times greater in Venezuela since the investigation is no longer applied in the centers of public attention(AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Cerebral Palsy/pathology , Metabolism, Inborn Errors , Neurons/metabolism , Pediatrics , Nervous System Diseases
3.
Rev. hered. rehabil ; 3(1): 34-41, ene.-jun. 2020. tab, graf
Article in Spanish | LILACS (Americas), LIPECS | ID: biblio-1116203

ABSTRACT

Objetivo: caracterizar la demanda actual de Especialización en Terapia ocupacional (TO) en el Perú a través de las preferencias de los Terapeutas ocupacionales y las posibles áreas de interés. Material y Métodos: El estudio fue descriptivo transversal. Se aplicó una encuesta virtual a 177 Terapeutas ocupacionales del Perú, respondiendo un total de 11 preguntas y completando un consentimiento informado. Se utilizó el programa estadístico SPSS para el análisis de datos como herramienta estadística. Resultados: Los Terapeutas ocupacionales prefirieron las especialidades de Pediatría (22,2%) y Neurorrehabilitación (15,8%). La especialidad de salud mental y Rehabilitación de manos alcanzaron el 13,5%, mientras que Educación el 8,8%. La de menor preferencia fue geriatría alcanzando el 2,9%. Conclusiones: Las primeras especialidades de TO en ser creadas deberían ser Pediatría y neurorrehabilitación. Las temáticas en cada una de las especialidades merecen un análisis especifico. Sin embargo, es necesario aún crear un ámbito de debate puesto que las especialidades no deben enfocadas únicamente a aspectos biomédicos si no también a ámbitos sociales. (AU)


Objective: To characterize the current preference of Specialization in Occupational Therapy (OT) in Peru and the possible areas of interest. Material and Methods: The study was descriptive cross-sectional. An online survey was applied to 177 Occupational Therapists of Peru, responding a total of 11 questions and completing an informed consent. Descriptive and association statistics were used. Results: OT preferred the specialties of Paediatrics (22.2%) and Neurorehabilitation (15.8%). The specialty of mental health and hand rehabilitation reached 13.5%, while Education 8.8%. The least preferred was geriatrics. Conclusions: The first OT specialties to be created should be Paediatrics and neurorehabilitation. The themes in each of the specialties deserve specific analysis. However, it is still necessary to create an area for debate since specialties should not only focus on biomedical aspects but also on social areas.(AU)


Subject(s)
Humans , Male , Female , Pediatrics , Specialization , Occupational Therapy , Epidemiology, Descriptive , Cross-Sectional Studies
4.
Rev. SOBECC ; 25(2): 120-123, 30/06/2020.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1102204

ABSTRACT

Objetivo: Relatar a experiência dos primeiros seis casos de cirurgia robótica pediátrica e a atuação dos enfermeiros especialistas em cirurgia robótica em uma instituição oncológica. Método: Trata-se de um relato de experiência vivenciada na prática clínica que fomentou a discussão acerca dos primeiros seis casos de cirurgia robótica pediátrica, ocorridos entre 2017 e 2019. Resultados: O processo de implantação da cirurgia robótica pediátrica começou em 2017, com dois casos iniciais (adrenalectomia e nefrectomia). Todos os casos foram acompanhados e executados na presença do cirurgião urologista proctor para auxiliar a cirurgiã oncológica pediátrica. O posicionamento cirúrgico depende do local a ser abordado e do procedimento robótico que será realizado. Conclusão: Identificou-se a necessidade de uma simulação realística com a participação de todos os membros da equipe para melhoria dos processos assistenciais e da educação permanente na formação da equipe.


Objective: To report the experience of the first six cases of pediatric robotic surgery and the role of nurses who are specialists in robotic surgery in an oncology institution. Method: This is an account of experience report in clinical practice which encouraged the discussion about the first six cases of pediatric robotic surgery, which occurred between 2017 and 2019. Results: The process of implantation of pediatric robotic surgery started in 2017, with two initial cases (adrenalectomy and nephrectomy). All cases were followed up and performed in the presence of the proctor urologist surgeon to assist the pediatric oncology surgeon. Surgical positioning depends on the location to be approached and the robotic procedure that will be performed. Conclusion: The need for a realistic simulations with the participation of all team members to improve the care processes and permanent education in team formation was identified.


Objetivo: informar la experiencia de los primeros seis casos de cirugía robótica pediátrica y el papel de las enfermeras especialistas en cirugía robótica en una institución de oncología. Método: Este es un relato de la experiencia en la práctica clínica, que fomentó la discusión sobre los primeros seis casos de cirugía robótica pediátrica, que ocurrieron entre 2017 y 2019. Resultados: El proceso de implantación de cirugía robótica pediátrica comenzó en 2017, con dos casos iniciales (adrenalectomía y nefrectomía). Todos los casos fueron seguidos y realizados en presencia del cirujano urólogo supervisor para ayudar al cirujano oncólogo pediátrico. El posicionamiento quirúrgico depende de la ubicación a abordar y del procedimiento robótico que se realizará. Conclusión: Se identificó la necesidad de una simulación realista con la participación de todos los miembros del equipo para mejorar los procesos de atención y la educación permanente en la formación del equipo.


Subject(s)
Humans , Pediatrics , General Surgery , Robotics , Safety , Perioperative Period , Nurses, Male
5.
Ludovica pediátr ; 23(1): 11-19, marzo 2020.
Article in Spanish | LILACS (Americas), BINACIS | ID: biblio-1102850

ABSTRACT

A partir de la sanción de la ley Nacional N.º 27447, conocida popularmente como "Ley Justina", se genera un nuevo Protocolo para el diagnóstico de cese irreversible de las funciones encefálicas. Nuestro Hospital, a través del servicio de Terapia Intensiva, tuvo la oportunidad de participar en su confección.El protocolo consta de criterios de inclusión, periodos de evaluación, métodos auxiliares y la consideración de cómo arribar al diagnóstico en diferentes situaciones especiales.Los cambios más importantes se realizaron en la edad pediátrica, donde se logró acortar los tiempos de evaluación para arribar a un diagnóstico de certeza, acortando la espera familiar


From the enactment of National Law No. 27447, popularly known as the Justina law, a new Protocol for the Diagnosis of Irreversible Cessation of Encephalic Functions was created. Our Hospital, through the Intensive Care Service, had the opportunity to participate in its preparation.The protocol consists of inclusion criteria, evaluation periods, ancillary methods and the consideration of how to arrive at the diagnosis in different special situations.The most important changes were made in the pediatric age where the evaluation times were shortened to arrive at a diagnosis of certainty, shortening the family wait


Subject(s)
Pediatrics , Diagnosis , Brain Death
7.
Asunción; MSPBS; 16 DE MARZO DE 2020. 38 p p.
Monography in Spanish | LILACS (Americas), BDNPAR | ID: biblio-1053218
8.
Demetra (Rio J.) ; 15(1): e42004, jan.- mar.2020. tab
Article in English, Portuguese | LILACS (Americas) | ID: biblio-1117021

ABSTRACT

Introdução: A triagem nutricional em crianças é de extrema importância no ambiente hospitalar, pois é uma ferramenta simples e eficiente. Objetivo: Detectar o risco nutricional, a partir do método de triagem nutricional pediátrica Strong Kids, em crianças e adolescentes com cardiopatias congênitas. Método: Foram avaliados 81 crianças e adolescentes com cardiopatia congênita, até 48 horas de internação, no período de agosto de 2016 a maio de 2017. Dados foram coletados através de triagem nutricional pediátrica. A análise estatística se deu através do teste qui-quadrado, a fim de verificar o nível de significância, p < 0,05. Resultados: Dentre os resultados obtidos, houve maior prevalência de crianças com cardiopatia congênita internadas do gênero feminino 60,49% (n=49). De acordo com a classificação das fases de vida, a predominância ocorreu na fase pré-escolar 46,91%, seguida de lactentes 27,16%, adolescentes 13,58% e escolar 12,35%. Não houve déficit nutricional para 74,07%. Segundo o teste qui-quadrado, observou-se relevância do médio risco nutricional. Conclusão: A triagem nutricional pediátrica é fundamental na prática clínica, e sua melhor forma de avaliação é a intervenção nutricional precoce. Isto implicará um tratamento nutricional adequado, em especial para crianças com cardiopatia congênita. (AU)


Introduction: The nutritional screening in children is extremely important in the hospital environment because it is a simple and efficient tool. Objective: Detecting the nutritional risk, from pediatric nutritional screening Strong Kids method in children and adolescents with congenital heart desease. Method: 81 children and adolescents were evaluated with congenital heart desease until 48 hours of hospitalization, in the period from August 2016 to May 2017. The data collection was through a pediatric nutritional screening. The statistical analysis was through chi-square test for the purpose of verify the level of significance, p < 0,05. Results: Among the results obtained, there was a higher prevalence of children with hospitalized congenital heart desease of the female gender 60,49% (n=49). According to the classification of the life phases, the highest predominance was in the pre school phase (46,91%), then infants (27,16%), adolescents (13,58%) and scholar (12,35%). There was no nutritional deficit for 74,07%. According chi-square test, it was observed a relevance to the medium nutritional risk. Conclusion: The pediactric nutritional screening is extremely important in clinical practice, in view of the best form of evaluation through the reach of early nutritional intervention, this will entail adequate nutritional treatment, specially children with congenital heart desease. (AU)


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Pediatrics , Heart Defects, Congenital , Nutrition for Vulnerable Groups , Child Nutrition Disorders
9.
Rev. cuba. pediatr ; 92(1): e947, ene.-mar. 2020. tab, graf
Article in Spanish | LILACS (Americas), CUMED | ID: biblio-1093743

ABSTRACT

Introducción: No existen referentes en Cuba de estudios que aborden la producción científica de grupos de docentes-investigadores que imparten la pediatría como especialidad. Objetivo: Caracterizar la producción científica del claustro de profesores de la Especialidad de Pediatría de la Universidad de Ciencias Médicas de Matanzas durante el proceso de acreditación de esta especialidad. Métodos: Estudio transversal realizado con los profesores que constituyeron el claustro físico de esta especialidad en el quinquenio 2014-2018, en total 43. El campo de acción se situó en las publicaciones llevadas a cabo por dichos profesores en el período citado. Para ello se revisaron los mini-currículos de los profesores y se localizaron sus publicaciones vía internet. Las principales variables estudiadas fueron: especialidad, categoría y grado científico, categoría docente e investigativa, sexo, años de experiencia docente, publicaciones, razón publicación/profesor, fuente de la publicación, tipo de artículo, temática y país. En el análisis se emplearon indicadores de productividad científica, colaboración y circulación-dispersión. Resultados: El índice de publicaciones fue de 110 trabajos y la razón número de publicaciones/profesor fue 2,55. Las publicaciones se concentraron en 21 profesores, con tres grandes productores. El índice de coautoría fue 3,77 y el patrón de colaboración que predominó fue a nivel nacional. Predominaron los artículos originales (24,5 por ciento) y las publicaciones en revistas médicas multitemáticas (36 por ciento). Conclusiones: Las publicaciones del claustro de la Especialidad de Pediatría cumplen con los requisitos de calidad del Subsistema de Evaluación y Acreditación de Especialidad de Posgrado en Cuba para la obtención del nivel de Certificado(AU)


Introduction: There are no references in Cuba of studies that deal with the scientific production of groups of teachers-researchers who taught Pediatrics as a specialty. Objective: To characterize the scientific production of Pediatrics specialty´s professors staff at the Medical Sciences University of Matanzas during the accreditation process of this specialty. Methods: Cross-sectional study conducted to the 43 teachers who constituted the staff of this specialty in the five-year period from 2014 to 2018. The study was focused in the publications carried out by such professors in the above mentioned period. There were reviewed the mini-resumes of the teachers and their publications were located via internet. The main variables studied were: specialty, category and scientific degree, teaching and research category, sex, years of teaching experience, publications, ratio publication/teacher, source of the publication, type of article, thematic and country. The analysis used indicators of scientific productivity, collaboration, and movement-dispersion. Results: The index of publications was of 110 paper works and the ratio number of publications/teacher was 2.55. The publications focused on 21 teachers, with three large producers. The co-authorship index was 3.77 and the pattern of collaboration that prevailed was at the national level. Original articles (24.5 percent) and publications in multi-topic medical journals (36 percent) predominated. Conclusions: The publications of the Pediatrics specialty´s staff meet the quality requirements of the Subsystem for the Evaluation and Accreditation of Postgraduate specialties in Cuba for obtaining the certificate level(AU))


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pediatrics , Teaching/education , Scientific Publication Indicators , Accreditation/methods , Cross-Sectional Studies
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-811419

ABSTRACT

PURPOSE: To determine the long-term efficacy of the anti-tumor necrosis factor (TNF) agents, infliximab (IFX) and adalimumab (ADA), in pediatric luminal Crohn's disease (CD) by performing a systematic literature review.METHODS: An electronic search was performed in Medline, Embase, and the Cochrane Library from inception to September 26, 2019. Eligible studies were cohort studies with observation periods that exceeded 1 year. Studies that reported time-to-event analyses were included. Events were defined as discontinuation of anti-TNF therapy for secondary loss of response. We extracted the probabilities of continuing anti-TNF therapy 1, 2, and 3 years after initiation.RESULTS: In total, 2,464 papers were screened, 94 were selected for full text review, and 13 studies (11 on IFX, 2 on ADA) met our eligibility criteria for inclusion. After 1 year, 83–97% of patients were still receiving IFX therapy. After 2 and 3 years the probability of continuing IFX therapy decreased to 67–91% and 61–85%, respectively. In total, 5 of the 11 studies subgrouped by concomitant medication consistently showed that the probabilities of continuing IFX therapy in patients with prolonged immunomodulator use were higher than those in patients on IFX monotherapy.CONCLUSION: This review of real-world evidence studies confirms the long-term therapeutic benefit of IFX therapy in diverse cohorts of children with luminal CD. Moreover, it supports the view that combination therapy with an immunomodulator prolongs the durability of IFX therapy in patients who previously failed to recover following first-line therapy. The limited number of time-to-event studies in patients on ADA prevented us from drawing definite conclusions about its long-term efficacy.


Subject(s)
Adalimumab , Child , Cohort Studies , Crohn Disease , Humans , Infliximab , Necrosis , Pediatrics , Phenobarbital , Survival Analysis , Treatment Outcome
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-782493

ABSTRACT

BACKGROUND: Barley is a grain that is consumed in various forms in Asia. Studies on barley allergy are limited to a few case reports about hypersensitivity reactions to beer, but there is no barley allergy study in children. This study aimed to identify the phenotype and immunologic findings in Korean children with barley allergy.METHODS: Forty-two participants with a history of ingesting barley who underwent serum specific immunoglobulin E to barley (barley-sIgE) assay at the Department of Pediatrics in Ajou Medical Center were enrolled through a retrospective analysis of medical records from March 2008 to February 2018. The demographic characteristics, symptoms, and immunologic parameters of the patients were assessed.RESULTS: Twenty subjects presented with clinical barley allergy (B-allergic group), and 22 were atopic controls without allergic reactions after the ingestion of barley (B-tolerant group). The median ages of the B-allergic and B-tolerant groups were 1 and 3 years, respectively. In the B-allergic group, the cutaneous system (90.0%) was most frequently affected, followed by the respiratory system (40.0%). Anaphylaxis was observed in 35.0% of the B-allergic group. The median level of barley-sIgE was 13.90 kU(A)/L (range, 0.14–101.00 kU(A)/L) in the B-allergic group, and this value was significantly higher (P < 0.001) than that of the B-tolerant group (0.30 kU(A)/L; range, 0.01–24.40 kU(A)/L), with an optimal cutoff level of 1.24 kU(A)/L (sensitivity, 85.0%; specificity, 86.4%). A positive correlation was found between the serum levels of barley-sIgE and wheat-sIgE in the B-allergic group with clinical wheat allergy.CONCLUSION: Barley is an important allergen for children in Korea. This study showed the clinical characteristics of barley allergy and suggested optimal cut-off levels of barley-sIgE for clinical barley allergy. Clinically, cross-reactivity or co-sensitization is often observed between barley and wheat.


Subject(s)
Anaphylaxis , Asia , Beer , Child , Eating , Food Hypersensitivity , Hordeum , Humans , Hypersensitivity , Immunoglobulin E , Immunoglobulins , Korea , Medical Records , Pediatrics , Phenotype , Respiratory System , Retrospective Studies , Sensitivity and Specificity , Triticum , Wheat Hypersensitivity
13.
Article in English | WPRIM (Western Pacific) | ID: wprim-782262

ABSTRACT

BACKGROUND/OBJECTIVES: Vitamin D is a pleiotropic hormone that affects various body organ systems. We evaluated the prevalence of a vitamin D deficiency (VDD) and its potential role in the clinical condition of critically ill Korean children.SUBJECTS/METHODS: Patients under 18 years old with a 25(OH) vitamin D measurement on the first day of PICU admission were included from among the children admitted to the pediatric intensive care unit (PICU) of our tertiary children's hospital between October 2017 and January 2019.RESULTS: A total of 172 pediatric patients were enrolled. The mean 25(OH) vitamin D level was 17.5 ± 12.8 ng/mL. There was a 65.1% prevalence of VDD (25(OH) vitamin D level < 20 ng/mL). VDD was associated with age at PICU admission, gastrointestinal/hepatobiliary disorders, International Society of Thrombosis and Hemostasis disseminated intravascular coagulation (ISTH DIC) score, pediatric multiple organ dysfunction syndrome (pMODS) score and with several laboratory test findings including hemoglobin, platelet, C-reactive protein, serum albumin, total bilirubin, prothrombin time, and anti-thrombin III levels. Most of these parameters also showed significant linear correlations with the 25(OH) vitamin D level (P < 0.05). However, no statistically meaningful association was found between VDD and other clinical conditions such as the need for a mechanical ventilator, requirement for vasoactive drugs, duration of the PICU and hospital stays, or PICU mortality.CONCLUSION: There is a high prevalence of VDD in critically ill Korean children. There were significant associations between the 25(OH) vitamin D level and gastrointestinal/hepatobiliary disorders, the pMODS score and with coagulation related factors. Further large-scale studies with more specific subgroup analyses are required to more precisely assess the clinical implications of VDD in critically ill pediatric patients.


Subject(s)
Bilirubin , Blood Platelets , C-Reactive Protein , Child , Critical Illness , Disseminated Intravascular Coagulation , Hemostasis , Humans , Intensive Care Units , Length of Stay , Mortality , Multiple Organ Failure , Pediatrics , Prevalence , Prothrombin Time , Serum Albumin , Thrombosis , Ventilators, Mechanical , Vitamin D Deficiency , Vitamin D , Vitamins
14.
Article in English | WPRIM (Western Pacific) | ID: wprim-782185

ABSTRACT

PURPOSE: We aimed to investigate the disease phenotype of Korean pediatric Crohn's disease (CD) patients at diagnosis according to the Paris classification by comparison with patients from the European multicenter 5-years recruitment of children with newly developed IBD (EUROKIDS registry).METHODS: Korean children and adolescents who had been newly diagnosed with CD at the age of < 18 years during 2013–2016 were included in this multicenter retrospective study. Disease phenotype at diagnosis was classified according to the Paris classification, and compared with the published data from the EUROKIDS study.RESULTS: A total of 255 patients were included. The median diagnosis age was 14.7 years (range, 0.8–17.9 years). No significant difference was observed in male-to-female ratio with EUROKIDS (1.9:1 vs. 1.45:1, p=0.062). The proportion of children aged < 10 years was significantly lower in Koreans (7.1% vs. 19.6%, p < 0.001). Colonic disease was less prominent (10.0% vs. 27.3%, p < 0.001), while upper GI involvement was more prominent in Korean children (59.3% vs. 46.2%, p < 0.001). The proportion with perianal fistulizing disease at diagnosis was significantly higher in Korean patients (44.8% vs. 8.2%, p < 0.001). A separate analysis of Korean patients revealed that perianal fistulizing disease at diagnosis was positively associated with male sex and body mass index z-score (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.20–3.76, p=0.010; and OR=1.29, 95% CI=1.05–1.58, p=0.015, respectively).CONCLUSION: Approximately half of pediatric CD patients in Korea present with perianal fistulas and/or abscesses at diagnosis, which is a distinct feature of CD in Korean children and adolescents compared to their European counterparts. An underlying genetic difference between ethnicities may play a role in this expression of different phenotypes in pediatric CD.


Subject(s)
Abscess , Adolescent , Body Mass Index , Child , Classification , Colonic Diseases , Crohn Disease , Diagnosis , Europe , Fistula , Humans , Inflammatory Bowel Diseases , Korea , Male , Pediatrics , Phenotype , Retrospective Studies
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-782178

ABSTRACT

Gastric xanthoma is frequently an incidental finding on upper endoscopy in adults. Gastric xanthomas (GX) can be mistaken for malignancies and warrant prompt histologic diagnosis. The underlying etiology is not fully understood; however, it has been linked to Helicobacter pylori gastritis and gastric cancer. GX in the pediatric population is largely unreported in the literature. Because of the relative rarity, documentation with case reports are essential to provide as much data as possible to see if there is a correlation between GX and malignant potential in the pediatric population. Our group is reporting two cases, a 10-year-old male and a 7-year-old male, both who presented with chronic dysphagia, upper abdominal pain, nausea, vomiting, and loss of appetite. Upper endoscopies for both patients revealed small polypoid lesions located in the antrum with foamy histiocytes on histology, leading to the diagnosis of gastric xanthoma.


Subject(s)
Abdominal Pain , Adult , Appetite , Child , Deglutition Disorders , Diagnosis , Endoscopy , Gastritis , Helicobacter pylori , Histiocytes , Humans , Incidental Findings , Male , Nausea , Pediatrics , Stomach Neoplasms , Vomiting , Xanthomatosis
16.
Chonnam Medical Journal ; : 44-49, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-787275

ABSTRACT

The aim of this study was to investigate the usefulness of a clinical screening test [the Korean Infant and Child Developmental Test (KICDT)] compared to language specific tests: the sequenced language scale for infant (SELSI) and the Preschool Receptive-Expressive language Scale (PRES) in children with delayed language development. A retrospective chart review was conducted on 615 children who visited the Department of Pediatrics at Chonbuk National University Hospital from January 2013 to December 2016. All patients were evaluated with KICDT as a clinical screening test and SELSI or PRES as a language specific test. Language Developmental Quotients (LDQs) from the KICDT were compared with the Receptive Language Quotient (RLQ) and expressive language quotient (ELQ) from the SELSI or PRES. The sensitivity, specificity and predictive values of LDQ of KICDT were calculated by comparing with SELSI/PRES. Language DQs from the KICDT were significantly correlated with the RLQ (r=0.706), ELQ (r=0.768), and total language quotient (TLQ) (r=0.766) from the SELSI/PRES (p<0.05). In cross tabulation, the patients belonging to the retardation groups in both KICDT and SELSI/PRES were 417 (67.8%). Otherwise, patients belonging to the normal group in KICDT but not in SELSI/PRES were 151 (24.6%). Sensitivity and specificity of LDQ of KICDT relative to SELSI/PRES were 72.3% and 92.2% respectively (p<0.05). Our data suggests that clinical screening tests alone, not cumbersome language specific tests, can determine language developmental delays in children.


Subject(s)
Child Development , Child , Humans , Infant , Language Development , Language Development Disorders , Language Tests , Mass Screening , Pediatrics , Retrospective Studies , Sensitivity and Specificity
17.
Article in Portuguese | LILACS (Americas) | ID: biblio-1100239

ABSTRACT

OBJETIVO: Desenvolver e validar o Questionário de Conhecimento em Asma Pediátrica (Q-CAP), na língua portuguesa brasileira. MÉTODOS: o questionário foi desenvolvido com base em instrumentos internacionais reconhecidos. Especialistas analisaram o instrumento, juntamente com pais de crianças com asma. Foram realizados os testes de validade de construto e conteúdo, alfa de Cronbach, coeficiente de correlação intraclasse, correlação de Pearson, análise de Kappa e curva ROC. RESULTADOS: participaram do estudo 132 pais de crianças com asma, sendo 117 (88,6%) do sexo feminino, idade média de 35,9±9,1 anos, 78 (59,1%) com ensino médio completo, 73 (59,8%) pertencente a classe econômica C. A versão final do instrumento possuí 20 questões, com ponto de corte de ≥14 pontos. Os escores totais obtiveram conceito "A" nos testes de validade/constructo e valor de 0,69 no alfa de Cronbach. Na avaliação da correlação do coeficiente intraclasse o questionário possui níveis dentro dos aceitáveis (ICC=0,69; IC95%=0,61~0,77; p<0,001). A sensibilidade e especificidade apresentaram área de 0,93 (IC95%: 0,84~1,0; p=0,002) e valores de 80% e 97,1%, respectivamente. Após a aplicação da versão final do Q-CAP, apenas 5 (3,8%) dos pais demonstraram níveis satisfatórios de conhecimento em asma. CONCLUSÃO: o Q-CAP demonstrou ser confiável, claro e com adequados índices de reprodutibilidade e consistência interna. Sua aplicação é fácil e abrange os aspectos culturais brasileiros essenciais, além de grande precisão em mensurar o nível de conhecimento sobre asma.


AIMS: To develop and validate the Knowledge Questionnaire in Pediatric Asthma, in the brazilian Portuguese language. METHODS: The questionnaire was developed based on recognized international instruments. Experts have examined the instrument, along with parents of children with asthma. The tests of construct validity and contents, Cronbach's alpha, intraclass correlation coefficient, Pearson Correlation, analysis of Kappa and ROC curve. RESULTS: Participated in this study 132 parents of children with asthma, and 117 (88.6%) female, average age of 35.9 ± 9.1 years, 78 (59.1%) with full high school, 73 (59.8%) in the economy class C. The final version of the instrument possessing 20 questions, with cut-off of ≥ 14 points. The total scores obtained "A" concept validity tests/construct and value of 0.69 on Cronbach's alpha. In the evaluation of correlation intraclass coefficient the questionnaire has within the acceptable levels (ICC = 0.69; 95% CI = 0.61 ~ 0.77; p < 0.001). The sensitivity and specificity have lodged area of 0.93 (95% CI: 0.84 ~ 1.0; p = 0.002) and values of 80% and 97.1%, respectively. After applying the final version of the questionnaire of knowledge in Pediatric Asthma, only 5 (3.8%) the parents showed satisfactory levels of knowledge in asthma. CONCLUSION: The Knowledge questionnaire in Pediatric Asthma has proven to be reliable, clear and with suitable levels of reproducibility and internal consistency. Your application is easy and covers the cultural aspects, as well as Brazilian great accuracy in measuring the level of knowledge about asthma.


Subject(s)
Asthma , Pediatrics , Health Education , Medicine
18.
Acta otorrinolaringol. cir. cabeza cuello ; 48(e-Boletín): 79-92, 2020.
Article in Spanish | LILACS (Americas) | ID: biblio-1095913

ABSTRACT

La pandemia causada por el SARS-CoV-2 (COVID-19) (1) ha desatado una crisis de salud pública global sin precedentes en nuestra historia reciente. Teniendo en cuenta que la población pediátrica, si bien no ha sido afectada con la severidad con que ha ocurrido con los adultos, es considerado un grupo de riesgo por su posibilidad de transmitir y propagar el SARS-CoV-2. En el siguiente documento sugerimos pautas tomadas de diferentes paneles de expertos para la realización de consulta externa, así como procedimientos quirúrgicos y no quirúrgicos durante esta pandemia. Es de recalcar que nos enfrentamos a una situación que cambia rápidamente, razón por la cual se harán actualizaciones periódicas de las recomendaciones acá pautadas en publicaciones subsecuentes, según la etapa en la que estemos entrando.


The pandemic caused by the SARS-CoV-2 (COVID-19) has developed a global public health crisis with no precedents in our recent history. The pediatric population has not been affected as much as the adult population although children are considered a risk group given the fact that they could spread the SARS-CoV-2. In the following document recommendations taken from various expert panels are given to otolaryngologist to take in consideration when organizing an outpatient clinic, performing surgical and non surgical procedures during this pandemic. It's important to highlight this is a rapidly evolving situation therefore updates will be done according to the pandemic stage we face.


Subject(s)
Humans , Betacoronavirus , Otolaryngology , Pediatrics , Coronavirus , Personal Protective Equipment , Infections
19.
Article in Portuguese | LILACS (Americas) | ID: biblio-1117490

ABSTRACT

Objetivo: identificar fatores associados à prevalência dos diferentes tipos de dificuldades alimentares em crianças com idade entre 0 e 10 anos. Métodos: trata-se de um estudo observacional retrospectivo com dados de crianças de 0 a 10 anos diagnosticadas com alguma dificuldade alimentar, atendidas em um centro de referência localizado no município de São Paulo, SP, Brasil. A presença da dificuldade alimentar foi analisada de acordo com o diagnóstico multidisciplinar, o aparecimento da queixa, os dados sobre a gestação e a amamentação, o estilo parental, a presença de causas orgânicas e as complicações associadas. Os dados foram tabulados no programa Microsoft Excel e as análises estatísticas foram realizadas no programa IBM SPSS Statistics 21 através de frequências absolutas e relativas, média, desvio padrão, teste do qui-quadrado e Kruskall-Wallis com o teste de post-hoc de Dunn. Resultados: foram avaliados 166 pacientes com um predomínio do sexo masculino, em idade pré-escolar e nascidos a termo. O diagnóstico mais prevalente foi de seletividade alimentar, sem doenças orgânicas ou reações associadas. Os diagnósticos de dificuldade alimentar apresentaram associação estatisticamente significativa com idade, idade gestacional de nascimento, idade e fase da alimentação de aparecimento da queixa. Conclusões: os fatores que apresentaram associação com os diferentes tipos de dificuldade alimentar foram a idade, a idade gestacional de nascimento e a idade e fase da alimentação de aparecimento da queixa. O presente estudo permite iniciar um direcionamento mais específico de ações de orientação e de prevenção de dificuldade alimentar. Dessa forma, destaca-se a importância da realização de estudos desse cunho.


Aims: To identify factors associated with the prevalence of different types of feeding difficulties in children aged 0 to 10 years. Methods: This is a retrospective observational study with data from children aged 0-10 years diagnosed with some feeding difficulty, attended at a reference center located in the city of São Paulo, Brazil. The presence of feeding difficulty was analyzed according to the multidisciplinary diagnosis, appearing of the complaint, information about pregnancy and breastfeeding, parenting style, presence of organic causes and associated complications. Data were tabulated using Microsoft Excel software and statistical analyzes were performed using IBM SPSS Statistics 21 using absolute and relative frequencies, mean, standard deviation, chi-square test and Kruskall-Wallis test associated with Dunn post-hoc test. Results: 166 patients were analysed, with male, preschool age and full-term predominance. The most prevalent diagnosis was picky eating, with no associated organic diseases or reactions. Diagnoses of feeding difficulty were statistically significant associated with age, gestational age at birth, age and feeding phase of onset of the complaint. Conclusions: The factors that were associated with the different types of feeding difficulty were age, gestational age at birth, age and feeding phase of emergence of the complaint. The present study allows us to initiate a more specific direction of orientation actions and prevention of feeding difficulties, thus highlighting the importance of conducting studies of this nature.


Subject(s)
Infant Nutrition , Pediatrics , Child , Risk Factors , Diet , Feeding Behavior , Medicine
20.
Article in Portuguese | LILACS (Americas) | ID: biblio-1117457

ABSTRACT

Objetivo: o transporte de crianças gravemente doentes envolve particularidades que aumentam o risco de complicações. O objetivo foi investigar o impacto de complicações registradas durante o transporte na mortalidade geral e na taxa de alta hospitalar. Método: estudo realizado em duas etapas. A primeira foi um estudo transversal, no qual, através de entrevista padronizada, dirigida ao médico que admitiu essas crianças, foram identificadas potenciais complicações ocorridas durante o transporte. Três médicos independentes auditaram esses dados. A segunda etapa foi uma coorte prospectiva onde os pacientes divididos em dois grupos (com e sem complicações no transporte) foram seguidos prospectivamente. Resultados: 143 crianças foram incluídas no estudo. Pelo menos uma complicação durante o transporte foi observada em 74 delas (52%). A complicação mais prevalente foi relacionada a falhas no monitoramento e nos dispositivos (42%). A ocorrência de complicações no transporte foi associada a maior mortalidade hospitalar (Hazard ratio - HR): 5,60; intervalo de confiança de 95% (IC95%): 1,26 - 26,65; p=0,013) e a menor taxa de alta hospitalar (HR: 0,48; IC95%: 0,31 - 0,74; p = 0,0007). Após regressão de Cox para ajuste de fatores de confusão, a presença de complicações permaneceu associada à mortalidade hospitalar (HR: 6,74; IC95%: 1,40 - 32,34); p = 0,017), porém deixou de se associar com a taxa de alta hospitalar (HR: 0,76; IC95%: 0,49 - 1,16; p=0,213). Conclusão: presença de complicações durante o transporte pediátrico foi frequente na região metropolitana de Ribeirão Preto, São Paulo, Brasil. A ocorrência de complicações foi um preditor independente de mortalidade hospitalar.


Aims: Transport of critically ill children involves particularities that increase the risk of complications. The objective was to investigate the impact of these complications recorded during transport on overall mortality and hospital discharge rate. Method: Two-step study: the first was a cross-sectional study, in which, through standardized interviews with the doctor who admitted these children, potential complications during transport were identified. Three independent doctors audited this data. The second step was a prospective cohort, where patients divided into two groups (with and without transport complications) were followed prospectively. Results: One hundred and forty-three children were included in the study. At least one complication during transport was observed in 74 of them (52%). The most frequent complication was related to monitoring and device failures (42%). The occurrence of transport complications was associated with higher hospital mortality (Hazard ratio (HR): 5.60; 95% confidence interval (95%CI: 1.26 - 26.65; p = 0.013) and the lowest hospital discharge rate (HR: 0.48; 95%CI: 0.31 - 0.74; p = 0.0007). After Cox regression to adjust for confounding factors, the presence of complications remained associated with hospital mortality (HR: 6.74; 95%CI: 1.40 - 32.34; p = 0.017), but no remained associated with hospital discharge rate (HR: 0.76; 95%CI: 0.49 - 1.16; p = 0.213). Conclusion: The presence of complications during pediatric transport was frequent in metropolitan region of Ribeirão Preto, São Paulo, Brazil. The occurrence of complications was an independent predictor for hospital mortality.


Subject(s)
Intensive Care Units, Pediatric , Pediatrics , Medicine
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