Brazilian Thoracic Association Consensus on Sleep-disordered Breathing / Consenso em Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia

ABSTRACT Sleep is essential for the proper functioning of all individuals. Sleep-disordered breathing can occur at any age and is a common reason for medical visits. The objective of this consensus is to update knowledge about the main causes of sleep-disordered breathing in adult and pediatric populations, with an emphasis on obstructive sleep apnea. Obstructive sleep apnea is an extremely prevalent but often underdiagnosed disease. It is often accompanied by comorbidities, notably cardiovascular, metabolic, and neurocognitive disorders, which have a significant impact on quality of life and mortality rates. Therefore, to create this consensus, the Sleep-Disordered Breathing Department of the Brazilian Thoracic Association brought together 14 experts with recognized, proven experience in sleep-disordered breathing.

RESUMO O sono é essencial para o adequado funcionamento de todos os indivíduos. Os distúrbios respiratórios do sono ocorrem em todas as faixas etárias, constituindo motivo frequente de consulta médica. O objetivo deste consenso foi atualizar os conhecimentos sobre os principais distúrbios respiratórios do sono tanto na população adulta quanto na pediátrica, com ênfase na apneia obstrutiva do sono. A apneia obstrutiva do sono é uma doença extremamente prevalente, porém frequentemente subdiagnosticada. Associa-se frequentemente a uma série de comorbidades, notadamente cardiovasculares, metabólicas e neurocognitivas, que impactam significativamente na qualidade de vida e na mortalidade. Por conta disso, o Departamento de Distúrbios Respiratórios do Sono da Sociedade Brasileira de Pneumologia e Tisiologia reuniu 14 especialistas com reconhecida e comprovada experiência em distúrbios respiratórios do sono para a elaboração deste documento.

2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy / Recomendações para oxigenoterapia domiciliar prolongada da Sociedade Brasileira de Pneumologia e Tisiologia (2022)

ABSTRACT Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years later, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.

RESUMO Algumas doenças respiratórias crônicas podem evoluir com hipoxemia e, nessas situações, a oxigenoterapia domiciliar prolongada (ODP) está indicada como opção terapêutica com o objetivo principal de melhorar a qualidade e a expectativa de vida desses pacientes. O oxigênio domiciliar é usado há mais de 70 anos, e a ODP tem como base dois estudos da década de oitenta que demonstraram que o uso de oxigênio melhora a sobrevida de pacientes com DPOC. Existem evidências de que a ODP tem outros efeitos benéficos como melhora da função cognitiva e da capacidade de exercício e redução de hospitalizações. A ODP está indicada para outras doenças respiratórias que cursam com hipoxemia, segundo os mesmos critérios estabelecidos para a DPOC. Tem sido observado aumento no uso da ODP provavelmente pela maior expectativa de vida, maior prevalência de doenças respiratórias crônicas e maior disponibilidade de ODP no sistema de saúde. O primeiro consenso sobre ODP da Sociedade Brasileira de Pneumologia e Tisiologia foi publicado em 2000; após 22 anos, apresentamos esta versão atualizada. Este documento é uma revisão não sistemática da literatura, realizada por pneumologistas que avaliaram evidências científicas e diretrizes internacionais sobre ODP nas diversas doenças que cursam com hipoxemia e em situações específicas (exercício, sono e viagens aéreas). Estas recomendações, tendo em vista a prática clínica, oferecem diversos quadros com informações sobre indicações, fontes de oxigênio, acessórios e estratégias para melhor eficiência, efetividade e uso seguro da ODP, assim como um modelo para sua prescrição.

Videolaparoscopic prostatectomy in porcine model for training residents

ABSTRACT Introduction: Surgical training models prepare the resident for a more ethical surgical practice as well as providing a less steep learning curve. In urology, there are well-known models of pyeloplasty simulation, urethro-vesical anastomosis and nephrectomy, which have helped in the training of urology residents (1-3). Learning laparoscopic prostatectomy is a difficult surgery and requires advanced surgical skill from the surgeon (4), requires operate without a direct view of the surgical field in a two-dimensional space and with longer instruments (5). Laparoscopic prostatectomy step by step makes the surgeon's learning curve less difficult, lead to less intraoperative complications, such as blood loss, while also enabling shorter operative time and less positive surgical margins (6). The objective of surgical models is to simulate surgical procedures in a reliable way thus preparing the surgeon for his daily practice, surgical simulations in animal models have been described to compensate for inadequate clinical exposure (7). The canine model of prostate cancer has many similarities with humans. Despite trying to develop a model that is as credible as possible, there are ethical issues in several countries, such as Brazil, that do not allow the use of live dogs for scientific experimentation and there is a difficulty in not standardizing the animals used (8, 9). The swine surgical training model is widely known, accepted and used as a valuable tool in the teaching of new surgeons (10). The porcine video laparoscopic prostatectomy model allows the urologist in training to exercise the skills required in a real surgical situation, practicing them in a single session (10). We will present an experimental model in pigs for training urology residents in laparoscopic radical prostatectomy with current techniques (11-13). The limitations found are that the prostate has no limits as well defined as in humans, the urethra is long and coiled, the fat surrounding the pelvic organs is scarce and there is no postoperative follow-up for evaluating functionality after the procedure, as well as the effectiveness of the surgery with surgical margins. However, it is similar in surgical model presented, it is reproducible and can provide a realistic simulation environment to the beginner surgeon. Material and Methods: In this paper, according to the institutional protocol approved by the institutional ethics and research committee FMUSP n° 964/2017 and protocol was in accordance with current international regulations for the use of animals in Research: Reporting In Vivo Experiments (ARRIVE) guide. Ten male pigs weighing 20 to 22kg were used. The animals were anesthetized with a combination of Telazol (5mg/kg), Xylazine (1.5mg/kg), Cetamine (22mg/kg) and Atropine (0.04mg/kg) for orotracheal intubation followed by Isoflurane (2%). Animals were euthanized at the end of the procedure with a lethal dose of KCl (2mEq/kg). The trocar insertion points were marked using the epigastric vessels and umbilical region as reference points. Initially, urethral catheterization was performed using a hydrophilic Nitinol guidewire, followed by a perineal incision to dissect the tortuous urethra of the porcine model. A malleable urethral catheter 8Fr was inserted into their bladder. The animal was placed in the Trendelenburg position inserted and 12mm trocars were inserted in its umbilical region, utilizing 10mm in the surgeon's dominant hand, 5mm in his non-dominant hand of the surgeon, and 5mm in the first assistant's trocar. The surgeon replicates the steps performed in a laparoscopic radical prostatectomy in humans, including the bladder catheterization, dissection of the anterior bladder plane, the vesicular and prostatic dissection, the suture of the dorsal venous plexus, a prostatectomy, an urethral vesical anast omosis, as well as the waterproof test, even including the performing of surgical steps using current concepts of anterior urethral suspension as the reconstruction of the posterior plane of the rhabdosphincter. Results: All steps of surgery could be reproduced in all ten porcine cases. No significant bleeding was observed and the surgical time was gradually reduced fifty percent from case one to last cases. Conclusions: The porcine model allowed the surgeon to replicate all the steps usually performed in a laparoscopic radical prostatectomy. The junior surgeons are better prepared to such difficult surgery. However, further studies will be necessary to prove the impact of the animal model presented in urological clinical practice.

Using the No-Apnea score to screen for obstructive sleep apnea in adults referred to a sleep laboratory: comparative study of the performance of the instrument by gender / Triagem de apneia obstrutiva do sono através do escore No-Apnea em indivíduos adultos encaminhados para um laboratório de sono: estudo comparativo do desempenho do instrumento relacionado ao gênero

ABSTRACT Objective: To evaluate the performance of the No-Apnea score, a simplified screening instrument for obstructive sleep apnea (OSA), by gender. Methods: This was a cross-sectional study including adults undergoing full polysomnography. The No-Apnea model comprises two items (neck circumference and age) with a total score of 0 to 9. The severity of OSA was categorized, on the basis of the apnea-hypopnea index, as any (≥ 5 events/h), moderate-to-severe (≥ 15 events/h), or severe (≥ 30 events/h). The performance of the No-Apnea instrument was assessed by determining the area under the (ROC) curve (AUC) and by constructing contingency tables. Results: We evaluated a total of 6,606 adults (53.8% men). For categorizing the level of OSA severity, the No-Apnea score had a sensitivity of 83.9-93.0% and a specificity of 57.3-35.2%. At all OSA severity levels, the No-Apnea score exhibited higher sensitivity and lower specificity in men than in women. The No-Apnea score proved to be an appropriate screening model for patients in general or when separated by gender or severity of OSA (AUC > 0.7 for all). The discriminatory power of the No-Apnea score to predict any, moderate-to-severe, and severe OSA was similar between genders (p = 0.109, p = 0.698, and p = 0.094, respectively). Conclusions: In a sample of adults referred to the sleep laboratory, there was no significant difference between men and women in terms of the discriminatory power of the No-Apnea instrument in for screening for OSA severity.

RESUMO Objetivo: Avaliar o desempenho do escore No-Apnea, um instrumento simplificado para a triagem da apneia obstrutiva do sono (AOS), relacionado ao gênero. Métodos: Estudo transversal incluindo indivíduos adultos submetidos à polissonografia completa. O No-Apnea é um modelo contendo dois itens (circunferência do pescoço e idade) com uma pontuação total de 0 a 9. A gravidade da AOS foi baseada no índice de apneia-hipopneia ≥ 5 eventos/h (qualquer AOS), ≥ 15 eventos/h (AOS moderada/grave) e ≥ 30 eventos/h (AOS grave). O desempenho do No-Apnea foi avaliado pela área sob a curva (ASC) ROC e tabelas de contingência. Resultados: No total, 6.606 adultos (53,8% homens) foram avaliados. No geral, para a triagem dos diferentes níveis de gravidade de AOS, o No-Apnea teve sensibilidade variando de 83,9% a 93,0% e especificidade variando de 57,3% a 35,2%. Em todos os níveis de gravidade da AOS, o No-Apnea exibiu maior sensibilidade e menor especificidade nos homens que nas mulheres. O No-Apnea mostrou ser um adequado modelo de triagem para os pacientes em geral ou quando separados por gênero ou gravidade da AOS (ASC > 0,7 para todos). A capacidade discriminatória do No-Apnea em predizer qualquer AOS, AOS moderada/grave e AOS grave foi semelhante entre os sexos (p = 0,109, p = 0,698 e p = 0,094, respectivamente). Conclusões: Em uma amostra de indivíduos adultos encaminhados para laboratório do sono, o No-Apnea apresentou discriminação similar para a triagem de AOS de acordo com sua gravidade em mulheres e homens.

Asociación del ángulo de fase con parámetros de evaluación del estado nutricional en pacientes en hemodiálisis / Association of the phase angle with nutritional status assessment parameters in hemodialysis patients

RESUMEN La desnutrición energético-proteica es altamente prevalente en pacientes en tratamiento con diálisis, siendo un importante marcador de riesgo para morbimortalidad. Entre los diversos parámetros disponibles para evaluación de la condición nutricional, la medida del Ángulo de Fase (AF) se ha señalado como marcador útil para evaluar a pacientes en hemodiálisis (HD). Objetivo: Evaluar la asociación del AF con parámetros de evaluación del estado nutricional en pacientes en HD. Métodos: Se realizó un estudio transversal entre febrero y julio de 2016 en dos unidades de hemodiálisis, de Recife, Nordeste brasileño. Resultados: Se evaluó a 101 pacientes, con edades de 51,7±16,8 años e IMC de 24,3±4,5 kg/m². El promedio del AF fue 5,6±1,7° y se correlacionó inversamente con la edad (r= −0,222; p= 0,024) y con el % grasa (r= −0,219; p= 0,026) y directamente con la altura (r= 0,286; p= 0,003), con el índice de masa muscular esquelética (r= 0,269; p= 0,006), con la fuerza de agarre palmar (r= 0,627;p <0,001), velocidad de marcha (r= 0,263; p= 0,008), masa libre de grasa (r= 0,303; p= 0,002) y creatininemia (r= 0,278; p= 0,004). Conclusiones: El AF presentó asociación con algunos parámetros de evaluación nutricional, que puede ser una medida útil adicional para reflejar la condición nutricional y evaluar la sarcopenia en pacientes en HD.

ABSTRACT Energy-protein malnutrition is highly prevalent in dialysis patients, being an important marker of risk for morbidity and mortality. Among the various parameters available for assessing nutritional status, the phase angle (PA) measurement has been indicated as a useful marker for evaluating patients on hemodialysis (HD). Objective: To evaluate the association of PA with parameters of nutritional status in patients on HD. Methods: We performed a cross-sectional, observational study from February to July, 2016, in two hemodialysis units, in the city of Recife, Northeastern Brazil. Results: A total of 101 patients were evaluated, with a mean age of 51.7±16.8 years and mean BMI of 24.3±4.5kg/m². The mean PA was 5.6±1.7°. PA was inversely correlated with age (r= −0.222; p= 0.024), fat% (r= −0.219; p= 0.026) and positively with height (r= 0.267; p= 0.003), velocity speed (r= 0.267; p= 0.003), skeletal muscle mass index (r= 0.269; p= 0.006), fat free mass (r= 0.303; p= 0.002) and serum creatinine (r= 0.278; p= 0.004). Conclusions: PA was associated with some parameters of nutritional status. Thus, it may be an additional useful measure to reflect nutritional status and to evaluate sarcopenia in patients on HD.

Lung Cancer in Never-Smokers: Epidemiological, Clinical, and Survival Patterns based on Gender / Câncer de Pulmão em Indivíduos não Fumantes: Padrões Epidemiológicos, Clínicos e de Sobrevida baseados no Gênero / Cáncer de Pulmón en Individuos no Fumadores: Patrones Epidemiológicos, Clínicos y de Supervivencia basados en el Género

Introduction: Tobacco smoke is the leading risk factor for the development of lung cancer (LC). However, several countries have recently reported increases in LC in never-smokers. Objective: The study aimed to verify epidemiological and survival characteristics in never-smoker LC patients. Method: The study was based on a historical cohort of never-smokers with LC diagnosed from 2000 to 2009. Overall survival was compared using log-rank test, and Cox regression analysis was used to identify independent prognostic factors. Results: A total of 254 never-smoker LC patients were studied (median age 65.5 years; 66.5% women). The most common histological type was adenocarcinoma (65.7% in women and 60.0% in men), and the majority of the patients had advanced stages (III-IV) (79.6% in women and 92.8% in men). 9.9% of the patients were treated with surgery (13.1% of women and 3.6% of men). The overall survival rates at one, three, and five years were 37.2%, 14.2%, and 9.5%, respectively. Median overall survival was 8.3 months. Women showed better survival than men (9.6 vs. 6.9 months; p=0.023). Non-surgical treatment (p<0.001), performance status 2-4 (p=0.038), and stages III and IV (p<0.001) were associated with worse overall survival. Conclusions: The majority of LC cases in never-smokers were advanced-stage adenocarcinoma, submitted to non-surgical treatment. Women showed better survival than men. Based on the low overall survival, the data emphasize the importance of early diagnosis of LC in never-smoker patients.

Introducción: El tabaquismo es el factor de riesgo predominante para el de cáncer de pulmón (CP). Sin embargo, un aumento reciente de CP en no fumadores es prominente en algunos países. Objetivo: El objetivo de este estudio fue verificar las características epidemiológicas y de sobrevida en no fumadores con CP. Método: Cohorte histórica de no fumadores con CP diagnosticados de 2000-2009. La supervivencia global fue comparada usando análisis de log-rank y la regresión de Cox para identificar factores pronósticos independientes. Resultados: Una muestra totalizando 254 pacientes no fumadores con CP fue estudiada (mediana de edad: 65,5 años, 66,5% de mujeres). El tipo histológico más común correspondió a adenocarcinoma (65,7% en las mujeres y el 60,0% en los hombres) y la mayoría en estadio avanzado (III-IV) (79,6% en las mujeres y el 92,8% en los hombres). Un total de 9,9% de pacientes fueron tratados con cirugía (13,1% en mujeres y 3,6% en hombres). Las tasas de supervivencia global de 1, 3 y 5 años fueron, respectivamente, el 37,2%, el 14,2% y el 9,5%. La supervivencia mediana global correspondió a 8,3 meses. Fue observada una mejor sobrevida en mujeres que em hombres (9,6 frente a 6,9 meses, p=0,023). El tratamiento no quirúrgico (p <0,001), el estado de equilibrio del estado 2-4 (p=0,038) y los estadios III-IV (p <0,001) se encontraron asociados con una peor sobrevida global. Conclusiones: Se encontró una mayor ocurrencia de adenocarcinoma, estadificación avanzada y tratamiento no quirúrgico. Las mujeres mostraron una sobrevida mejor que los hombres. En función de la baja sobrevida global, estos datos refuerzan la importancia del diagnóstico precoz del CP en no fumadores.

Introdução: O tabagismo é o fator de risco predominante para o desenvolvimento do câncer de pulmão (CP). Contudo, um aumento recente de CP em não fumantes é proeminente em alguns países. Objetivo:O objetivo deste estudo foi verificar as características epidemiológicas e de sobrevida em não fumantes com CP. Método: Coorte histórica de não fumantes com CP diagnosticados de 2000 a 2009. A sobrevivência global foi comparada usando o teste Log-rank e a análise de regressão de Cox foi usada para identificar fatores prognósticos independentes. Resultados: Um total de 254 pacientes com LC não fumantes foram estudados (mediana de idade: 65,5 anos, 66,5% de mulheres). O tipo histológico mais comum foi o adenocarcinoma (65,7% nas mulheres e 60,0% nos homens) e a maioria tinha estadiamento avançado (III-IV) (79,6% nas mulheres e 92,8% nos homens). Um total de 9,9% dos pacientes foi tratado com cirurgia (13,1% em mulheres e 3,6% em homens). As taxas de sobrevida global de 1, 3 e 5 anos foram, respectivamente: 37,2%, 14,2% e 9,5%. A sobrevida global mediana foi de 8,3 meses. As mulheres tiveram melhor sobrevida do que os homens (9,6 vs. 6,9 meses, p=0,023). O tratamento não cirúrgico (p<0,001), o performance status 2-4 (p=0,038) e os estádios III-IV (p<0,001) foram associados com uma sobrevida global pior. Conclusão: Encontrou-se uma maior ocorrência de adenocarcinoma, estadiamento avançado e tratamento não cirúrgico. As mulheres tiveram uma sobrevida maior do que os homens. Em razão da baixa sobrevida global, esses dados reforçam a importância do diagnóstico precoce do CP em não fumantes.

La actividad física, el ejercicio y el deporte en niños y adolescentes / Physical activity, work out and sports in children and adolescents

Cuando se quiere resumir la actividad física, que en general hoy realizan los niños y jóvenes, se debe mencionar la tendencia a vivir el día con más horas dentro de estructuras urbanas, con poco verde o espacios reducidos. Expuestos a miles de juegos electrónicos, programas de televisión, otros dispositivos electró-nicos; tabletas o teléfonos inteligentes con los que acceden a redes sociales. Los niños y jóvenes pasan mucho más tiempo sentados que de pie o en actividades físicas al aire libre, co-miendo alimentos con alto contenido en calorías, acompañados con bebidas azucaradas. Algunos de ellos en su tiempo libre sentados en transporte por horas, recibiendo tutorías o clases de música, o de idiomas, dependiendo de su capacidad económi-ca. Las extensas jornadas laborales de sus padres no permite una actividad física compartida en familia (1). Aunque esto podría ge-neralizarse con algún grado de acierto, no podemos desconocer muchos otros que aun buscan realizar actividad física, ejercicio o deportes alentados por el gobierno, escuelas, sus familiares o amigos. Esto es consistente con el aumento en los últimos 10 años de la prevalencia de obesidad, sobrepeso desencadenando un desarrollo temprano de diabetes, altos costos sanitarios y dis-minución en la calidad de vida en este grupo de edad (1).

Validation of the STOP-Bang questionnaire as a means of screening for obstructive sleep apnea in adults in Brazil / Validação do questionário STOP-Bang para a identificação de apneia obstrutiva do sono em adultos no Brasil

ABSTRACT Objective: To validate the Portuguese-language version of the STOP-Bang (acronym for Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire, culturally adapted for use in Brazil, as a means of screening for obstructive sleep apnea (OSA) in adults. Methods: In this validation study, we enrolled patients ≥ 18 years of age, recruited between May of 2015 and November of 2016. All patients completed the STOP-Bang questionnaire and underwent overnight polysomnography. To evaluate the performance of the questionnaire, we used contingency tables and areas under the (receiver operating characteristic) curve (AUCs). Results: We included 456 patients. The mean age was 43.7 ± 12.5 years, and 291 (63.8%) of the patients were male. On the basis of the apnea-hypopnea index (AHI), we categorized OSA as mild/moderate/severe (any OSA; AHI ≥ 5 events/h), moderate/severe (AHI ≥ 15 events/h), or severe (AHI ≥ 30 events/h). The overall prevalence of OSA was 78.3%, compared with 52.0%, and 28.5% for moderate/severe and severe OSA, respectively. The most common score on the STOP-Bang questionnaire was 4 points (n = 106), followed by 3 points (n = 85) and 5 points (n = 82). An increase in the score was paralleled by a reduction in sensitivity with a corresponding increase in specificity for all AHI cut-off points. The AUCs obtained for the identification of any, moderate/severe, and severe OSA were: 0.743, 0.731, and 0.779, respectively. For any OSA, the score on the questionnaire (cut-off, ≥ 3 points) presented sensitivity, specificity, and accuracy of 83.5%, 45.5%, and 75.2%, respectively. Conclusions: The STOP-Bang questionnaire performed adequately for OSA screening, indicating that it could be used as an effective screening tool for the disorder.

RESUMO Objetivo: Realizar a validação da versão brasileira do questionário STOP-Bang (acrônimo em inglês para Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) para a identificação de apneia obstrutiva do sono (AOS) em adultos. Métodos: Neste estudo de validação, foram incluídos pacientes com idade ≥ 18 anos, recrutados entre maio de 2015 e novembro de 2016. Todos os pacientes completaram o questionário STOP-Bang e foram submetidos a polissonografia de noite inteira. O índice de apneias e hipopneias (IAH) foi calculado. Foram utilizadas tabelas de contingência e a área sob a curva (ASC) ROC para avaliar o desempenho do questionário. Resultados: Foram incluídos 456 pacientes. A média de idade foi de 43,7 ± 12,5 anos, e 291 (63,8%) dos pacientes eram homens. Com base no IAH, a AOS foi classificada em leve/moderada/grave (AOS, independentemente da gravidade; IAH ≥ 5 eventos/h), cuja prevalência foi de 78,3%; moderada/grave (IAH ≥ 15 eventos/h), cuja prevalência foi de 52,0%; e grave (IAH ≥ 30 eventos/h), cuja prevalência foi de 28,5%. A pontuação mais frequentemente obtida no STOP-Bang foi 4 (n = 106), seguida de 3 (n = 85) e 5 (n = 82). O aumento da pontuação obtida no STOP-Bang (pontuação máxima: 8) resultou em redução da sensibilidade e aumento correspondente da especificidade em todos os pontos de corte do IAH (≥ 5, ≥ 15 e ≥ 30 eventos/h). A ASC para a identificação de AOS, AOS moderada/grave e AOS grave foi de 0,743, 0,731 e 0,779, respectivamente. Para a identificação de AOS, a pontuação no STOP-Bang (valor de corte ≥ 3) apresentou sensibilidade de 83,5%, especificidade de 45,5% e acurácia de 75,2%. Conclusões: O questionário STOP-Bang mostrou-se adequado para identificar AOS e pode ser uma ferramenta eficaz para o diagnóstico do transtorno.

The game variants in Europe. Trends and perspectives during youth competitive stages

AIMS: The aim of this study was to verify how European countries manage the type of game variants and their frequency during different age groups of youth competition. METHODS: Data were collected from the official rules of youth football championships. To identify countries homogenous groups according to their game variants, Two Step Cluster Analysis procedure was used while a nonparametric Kruskal-Wallis test was used to compare the game variants distribution in each Cluster. In order to correlate the game variants with age groups, a Chi-Square independence test and a Spearman ordinal correlation coefficient were used. The results showed there were five clusters with significant differences in their game variants distribution (X2 kw (4) = 22.149; p<0.001; n = 30) and a significant correlation between age group and game variant (χ2(63) = 477.724; p<0.001; n = 30). Specifically, the most used game variants in each age group were the five-a-side (F5) in Under-8; the nine-a-side (F9) in Under-12; the seven-a-side (F7) in Under-9 and Under10; and the eleven-a-side (F11) in and above Under-13. CONCLUSION: These results may contribute to understand the different country perspectives about the competitive game variants of youth football within the European space and its relation with diverse learning philosophies and pathways.(AU)

Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography / Fatores preditivos para apneia obstrutiva do sono em pacientes em avaliação pré-operatória de cirurgia bariátrica e encaminhados para polissonografia em um laboratório do sono

Objective: To identify the main predictive factors for obtaining a diagnosis of obstructive sleep apnea (OSA) in patients awaiting bariatric surgery.Methods: Retrospective study of consecutive patients undergoing pre-operative evaluation for bariatric surgery and referred for in-laboratory polysomnography. Eight variables were evaluated: sex, age, neck circumference (NC), BMI, Epworth Sleepiness Scale (ESS) score, snoring, observed apnea, and hypertension. We employed ROC curve analysis to determine the best cut-off value for each variable and multiple linear regression to identify independent predictors of OSA severity.Results: We evaluated 1,089 patients, of whom 781 (71.7%) were female. The overall prevalence of OSA-defined as an apnea/hypopnea index (AHI) ≥ 5.0 events/h-was 74.8%. The best cut-off values for NC, BMI, age, and ESS score were 42 cm, 42 kg/m2, 37 years, and 10 points, respectively. All eight variables were found to be independent predictors of a diagnosis of OSA in general, and all but one were found to be independent predictors of a diagnosis of moderate/severe OSA (AHI ≥ 15.0 events/h), the exception being hypertension. We devised a 6-item model, designated the NO-OSAS model(NC, Obesity, Observed apnea, Snoring, Age, and Sex), with a cut-off value of ≥ 3 for identifying high-risk patients. For a diagnosis of moderate/severe OSA, the model showed 70.8% accuracy, 82.8% sensitivity, and 57.9% specificity.Conclusions: In our sample of patients awaiting bariatric surgery, there was a high prevalence of OSA. At a cut-off value of ≥ 3, the proposed 6-item model showed good accuracy for a diagnosis of moderate/severe OSA.

Objetivo: Identificar os principais fatores preditivos para o diagnóstico de apneia obstrutiva do sono (AOS) em pacientes encaminhados para cirurgia bariátrica.Métodos: Estudo retrospectivo de pacientes consecutivos submetidos a avaliação pré-operatória de cirurgia bariátrica e referenciados para a realização de polissonografia em um laboratório do sono. Oito variáveis foram avaliadas: gênero, idade, circunferência do pescoço (CP), IMC, escore da escala de sonolência de Epworth (ESE), ronco, apneia observada e hipertensão. Utilizamos a análise de curvas ROC para determinar o melhor ponto de corte para cada variável e regressão linear múltipla para identificar preditores independentes de gravidade de AOS.Resultados: Foram avaliados 1.089 pacientes, dos quais 781 (71,7%) eram mulheres. A prevalência geral de AOS - definida como índice de apneia-hipopneia (IAH) ≥ 5,0 eventos/h - foi de 74,8%. Os melhores pontos de corte para CP, IMC, idade e escore da ESE foram 42 cm, 42 kg/m2, 37 anos e 10 pontos, respectivamente. Todas as oito variáveis foram preditoras independentes para o diagnóstico de AOS em geral e de AOS moderada/grave (IAH ≥ 15,0 eventos/h), exceto hipertensão para o diagnóstico de AOS moderada/grave. Elaboramos um modelo de seis itens, denominado NO-OSAS (acrônimo formado pelos seguintes itens em inglês: CP, obesidade, apneia observada, ronco, idade e gênero), com um ponto de corte ≥ 3 para identificar pacientes de alto risco. Para o diagnóstico de AOS moderada/grave, o modelo mostrou acurácia de 70,8%, sensibilidade de 82,8% e especificidade de 57,9%.Conclusões: Nesta amostra de pacientes encaminhados para cirurgia bariátrica, houve uma alta prevalência de AOS. O modelo proposto de seis itens, com um ponto de corte ≥ 3, apresentou boa acurácia para o diagnóstico de AOS moderada/grave.

Índices de confiabilidade da análise do ângulo poplíteo através da biofotogrametria / Reliability indexes of popliteal angle analysis through photogrammetry / Índices de fiabilidad del análisis del ángulo poplíteo mediante fotogrametría ensaio clínico

Introdução: A avaliação e a mensuração objetiva da amplitude articular são de fundamental importância para o diagnóstico, planejamento e acompanhamento de um tratamento. Com o avanço da tecnologia, a biofotogrametria começa a ser utilizada com maior frequência no meio fisioterapêutico, mensurando a quantidade de movimento articular. O ângulo poplíteo foi escolhido por ser uma medida indireta da flexibilidade da musculatura ísquiossural. A retração dos isquiossurais pode resultar em problemas posturais significativos e produzir uma inclinação posterior contínua da pelve, afetando a marcha e o gesto esportivo, sendo também uma das causas de dores musculares ou articulares. Objetivos: Verificar as confiabilidades intra e inter-examinador da análise de ângulo poplíteo através a fotogrametria computadorizada, utilizando o software para avaliação postural (SAPo), buscando estabelecer a repetibilidade e a reprodutibilidade do método. Métodos: Foram avaliados 23 indivíduos (46 joelhos). Os voluntários foram posicionados em decúbito dorsal, com quadril e joelho do membro inferior avaliado fletidos a 90 graus, mantendo o membro contralateral em extensão. A seguir, o joelho do membro testado era estendido passivamente, até o ponto no qual se percebia primeira resistência dos músculos ao alongamento. Neste ponto, foi feito o registro do ângulo poplíteo. A análise estatística da confiabilidade inter e intra-examinador foi averiguada pelos resultados do coeficiente de correlação intra-classe (ICC) dos tipos 1,1 e 3,1 no teste de correlação de Pearson, considerando um nível de significância de p<0,05. Resultados: O método de avaliação do ângulo poplíteo pela biofotogrametria apresentou ...

Introduction: The assessment and objective measurement of joint range of motion are of fundamental importance for the diagnosis, planning and monitoring treatment. With the advancement of technology, photogrammetry is beginning to be used with greater frequency in the physical therapy practice, measuring the amount of joint motion. The popliteal angle was chosen because it provides an indirect measure of flexibility of the hamstring muscles. The retraction of the hamstrings can result in significant postural problems and produce a continuous posterior tilt of the pelvis, affecting the gait and sports movements, as well as causing muscle or joint pain. Objectives: To confirm the reliability intra- and inter-examiner analysis of popliteal angle through computerized photogrammetry using the Postural Assessment Software (SAPO), to establish the repeatability and reproducibility of the method. Methods: Twenty-three patients (46 knees) were evaluated. Volunteers were positioned supine with hip and knee of the evaluated leg flexed at 90 degrees, keeping the contralateral limb in extension. Next, the knee of the tested limb was passively extended until the point at which the first resistance to stretching was perceived. At this point, the popliteal angle was recorded. Statistical analysis of inter- and intra-examiner reliability was determined by the results of the coefficient of intra-class correlation (ICC) of types 1.1 and 3.1 in the Pearson correlation test, considering a significance level of p<0.05. Results: The measurement of the popliteal angle by photogrammetry showed strong intra-examiner reliability (ICC=0.786) and very strong inter-examiner reliability (ICC=0.920). Conclusion: The photogrammetry is an appropriate method for the evaluation of the popliteal angle since the coefficient of intra-class correlation and intra and inter- examiners reached strong and very strong levels, respectively, confirming the reproducibility ...

Introducción: La evaluación y la medición objetiva de la amplitud articular son de fundamental importancia para el diagnóstico, planificación y acompañamiento de un tratamiento. Con el avance de la tecnología, la fotogrametría está empezando a ser utilizada con mayor frecuencia en la práctica de fisioterapia para mensurar la cuantidad de movimiento articular. El ángulo poplíteo fue elegido porque proporciona una medida indirecta de la flexibilidad de la musculatura isquiotibial. La retracción de los isquiotibiales puede resultar en problemas de postura significativos y producir una inclinación posterior continua de la pelvis, afectando la marcha y el gesto deportivo, siendo también una de las causas de dolores musculares o articulares. Objetivos: Verificar la fiabilidad intra e inter-examinador de la análisis de ángulo poplíteo mediante fotogrametría computarizada, utilizando el software de evaluación postural (SAPo) para establecer la repetibilidad y la reproducibilidad del método. Métodos: Fueron evaluados 23 individuos (46 rodillas). Los voluntarios fueron posicionados en decúbito dorsal, con la cadera y la rodilla del miembro inferior evaluado flexionados a 90 grados, manteniendo el miembro contralateral en extensión. A continuación, la rodilla del miembro testado se extendió pasivamente hasta el punto en que se percibió la primera resistencia al estiramiento. En este punto, fue hecho el registro del ángulo poplíteo. El análisis estadístico de la fiabilidad inter e intra-examinador fue determinado por los resultados del coeficiente de correlación intra-clase (ICC) de los tipos 1.1 y 3.1 en la prueba de correlación de Pearson, considerando un nivel de significación de p < 0,05. Resultados: La medición del ángulo poplíteo por fotogrametría ...

Experimental model of Achilles tendon injury in rats

PURPOSE: To describe an effective experimental model to study the Achilles tendon healing. METHODS: Forty male Rattus norvegicus albinus, Wistar lineage adult male weighing 250 to 300g were used for this experiment and thirty were surgically submitted to bilateral partial transverse section of the Achilles tendon. The right tendon was treated with radio waves (RF) whereas the left tendon served as control. On the third postoperative day, the rats were divided into four experimental groups consisting of ten rats each which were treated with monopolar RF adjusted to 650 kHz and 2w, for two minutes twice a week and a group of normal animals without any intervention, until they were sacrificed on the 7th, 14th and 28th days, respectively. Tendons were weighed and collagen quantification was evaluated by hydroxyprolin content. RESULTS: Significant reduction in collagen content on day 7, 14 and 28 was related to control experiment to normal tendon (7 days, p<0.01; 14 e 28 days, p<0.05). CONCLUSION: The experimental model has been effective and available to be used to study Achilles tendon healing. .

Alterações estomatológicas em crianças de creches municipais da cidade de João Pessoa ­ PB / Prevalence of stomatologic alterations in well-nourished and malnourished children in João Pessoa city, PB

Este trabalho objetivou avaliar a prevalência das alterações estomatológicas, em crianças nutridas e desnutridas, com idades entre 25 e 72 meses, matriculadas em creches municipais da cidade de João Pessoa­PB. A amostra foi composta por 200 crianças, as quais foram examinadas sob fonte de luz artificial (fotóforo). Para avaliação do estado nutricional, utilizou-se o indicador peso/idade (P/I), empregando-se, como padrão de referência, a escala NCHS (National Center For Health Statistics), sendo as crianças classificadas, conforme o percentil, em desnutridas, em risco, eutróficas e com excesso de peso. Os dados foram submetidos ao teste estatístico do qui-quadrado. Constatou-se que 72% (n=144) das crianças eram eutróficas; 12,5% (n=25) estavam em risco; 11% (n=22), desnutridas e 4,5% (n=9) com excesso de peso. A prevalência das alterações estomatológicas foi 73% (n=146), afetando 76% (n=109) dos eutróficos, 59% (n=13) dos desnutridos, 80% (n=20) daqueles em risco e 44% (n= 4) dos com excesso de peso, não sendo estas diferenças significativas (p > 0,05). Os grânulos de Fordyce foram as alterações estomatológicas mais prevalentes, nas crianças desnutridas (30,8%), eutróficas (46,8%) e com excesso de peso (50%), enquanto naquelas em situação de risco a pigmentação melânica da gengiva inserida foi mais frequente. Conclui-se que os grânulos de Fordyce foram as alterações estomatológicas mais elevadas e, a desnutrição não influenciou o aparecimento das alterações estomatológicas, uma vez que as lesões bucais diagnosticadas consistem em variações da normalidade ou são decorrentes de traumas mecânicos, além de terem sido observadas em todos os grupos de estados nutricionais.

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve

Introduction Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Materials and Methods Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. Results By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. Conclusions This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to ...

Infrared Thermometer: an accurate tool for temperature measurement during renal surgery

Purpose To evaluate infrared thermometer (IRT) accuracy compared to standard digital thermometer in measuring kidney temperature during arterial clamping with and without renal cooling. Materials and Methods 20 pigs weighting 20Kg underwent selective right renal arterial clamping, 10 with (Group 1 - Cold Ischemia with ice slush) and 10 without renal cooling (Group 2 - Warm Ischemia). Arterial clamping was performed without venous clamping. Renal temperature was serially measured following clamping of the main renal artery with the IRT and a digital contact thermometer (DT): immediate after clamping (T0), after 2 (T2), 5 (T5) and 10 minutes (T10). Temperature values were expressed in mean, standard deviation and range for each thermometer. We used the T student test to compare means and considered p < 0.05 to be statistically significant. Results In Group 1, mean DT surface temperature decrease was 12.6 ± 4.1°C (5-19°C) while deep DT temperature decrease was 15.8 ± 1.5°C (15-18°C). For the IRT, mean temperature decrease was 9.1 ± 3.8°C (3-14°C). There was no statistically significant difference between thermometers. In Group 2, surface temperature decrease for DT was 2.7 ± 1.8°C (0-4°C) and mean deep temperature decrease was 0.5 ± 1.0°C (0-3°C). For IRT, mean temperature decrease was 3.1 ± 1.9°C (0-6°C). No statistically significant difference between thermometers was found at any time point. conclusions IRT proved to be an accurate non-invasive precise device for renal temperature monitoring during kidney surgery. External ice slush cooling confirmed to be fast and effective at cooling the pig model. IRT = Infrared thermometer DT = Digital contact thermometer D:S = Distance-to-spot ratio .

Can the learning of laparoscopic skills be quantified by the measurements of skill parameters performed in a virtual reality simulator?

Purpose To ensure patient safety and surgical efficiency, much emphasis has been placed on the training of laparoscopic skills using virtual reality simulators. The purpose of this study was to determine whether laparoscopic skills can be objectively quantified by measuring specific skill parameters during training in a virtual reality surgical simulator (VRSS). Materials and Methods Ten medical students (with no laparoscopic experience) and ten urology residents (PGY3-5 with limited laparoscopic experience) were recruited to participate in a ten-week training course in basic laparoscopic skills (camera, cutting, peg transfer and clipping skills) on a VRSS. Data were collected from the training sessions. The time that individuals took to complete each task and the errors that they made were analyzed independently. Results The mean time that individuals took to complete tasks was significantly different between the groups (p < 0.05), with the residents being faster than the medical students. The residents' group also completed the tasks with fewer errors. The majority of the subjects in both groups exhibited a significant improvement in their task completion time and error rate. Conclusion The findings in this study demonstrate that laparoscopic skills can be objectively measured in a VRSS based on quantified skill parameters, including the time spent to complete skill tasks and the associated error rate. We conclude that a VRSS is a feasible tool for training and assessing basic laparoscopic skills. .

Panorama do ensino da terapia pulpar em dentes decíduos nos cursos de graduação em odontologia / An overview of teaching of pulp therapy in primary teeth in undergraduate dental courses

Objetivo: Verificar as abordagens terapêuticas endodônticas em dentes decíduos adotadas nas disciplinas de Odontopediatria dos cursos de graduação em Odontologia no Brasil. Método: Foi realizado um estudo transversal, no qual foram enviados questionários, por correio eletrônico, aos coordenadores das disciplinas de Odontopediatria dos cursos de graduação em Odontologia (N = 162), com questões referentes às condutas terapêuticas adotadas nas pulpotomias e pulpectomias de dentes decíduos. Para análise dos dados, foram obtidas distribuições absolutas e percentuais, assim como técnicas de estatística descritiva. Resultados: Dos 162 questionários enviados, 83 (51,2%) retornaram. Para a realização da técnica da pulpotomia, o formocresol diluído foi o medicamento mais indicado (42,2%), o óxido de zinco e eugenol foi o material mais indicado como proteção do remanescente pulpar (54,2%) enquanto a resina composta foi o material restaurador escolhido para emprego definitivo em dentes anteriores (86,7%) e posteriores (77,1%). Para a realização da técnica da pulpectomia, a solução irrigadora mais usada foi o hipoclorito de sódio a 0,5% associado a outras substâncias (32,5%), a pasta Guedes-Pinto foi a substância mais usada como curativo de demora nos casos de biopulpectomia (24,1%) e o formocresol diluído nas necropulpectomias (28,9%). Para obturação dos canais radiculares, a pasta Guedes-Pinto foi o material de escolha (55,6%). A guta-percha associada ao cimento de ionômero de vidro foi o material mais indicado (33,7%) como sub-base e base da cavidade após obturação dos canais radiculares. O emprego do isolamento absoluto para terapia endodôntica é ensinado por 55 (66,2%) das instituições. Conclusão: A análise dos dados mostrou um consenso entre as condutas terapêuticas pulpares adotadas pelas instituições das diversas regiões, percebendo-se a tendência na redução do uso de medicamentos que agridem ao tecido pulpar e aumento do uso de substâncias biocompatíveis.

Objective: To verify the endodontic therapeutic approaches in primary teeth adopted in the Pediatric Dentistry discipline of undergraduate dental courses in Brazil. Method: A cross-sectional study was performed in which questionnaires were emailed to the coordinators of the Pediatric Dentistry discipline of Brazilian undergraduate dental courses (N = 162), with questions referring to the therapeutic approach adopted in pulpotomies and pulpectomies in primary teeth. For analysis of data, the absolute and percent distributions were obtained and descriptive statistics was used. Results: From the 162 questionnaires sent by email, 83 (51.2%) were returned. In the pulpotomy technique, diluted formocresol was the most frequently indicated medication (42.2%), zinc oxide and eugenol was the most frequently indicated pulp capping material (54.2%), and composite resin was the definitive restorative material of choice for anterior (86.7%) and posterior (77.1%) teeth. For the pulpectomy technique, 0.5% sodium hypochlorite was the most used irrigating solution combined with other substances (32.5%), the Guedes-Pinto paste was the most frequently used intracanal dressing for cases of biopulpectomy (24.1%) and diluted formocresol for cases of necropulpectomy (28.9%). The Guedes-Pinto paste was material of choice for root canal filling (55.6%). Gutta-percha combined with glass ionomer cement was the most indicated material (33.7%) as sub-base and base to cover the cavity floor after root canal filling. The use of rubber dam isolation for endodontic therapy is taught in 55 (66.2%) of the evaluated institutions. Conclusion: The analysis of the results showed a consensus among the pulp therapy approaches adopted by dental schools of diverse regions, revealing a tendency of reducing the use of harmful medications to the pulp tissue, and increasing the use of biocompatible substances.

Rabdomiosarcoma retroperitoneal en el adulto / Retroperitoneal rhabdomyosarcoma in the adult

El rabdomiosarcoma es un tumor maligno de los tejidos blandos que representa, aproximadamente, 4 a 8 % de los tumores sólidos en los niños. Generalmente, se origina en la cabeza y el cuello, y el sistema genitourinario. El rabdomiosarcoma retroperitoneal rara vez se ha reportado en la literatura científica, y el rabdomiosarcoma embrionario de origen epiploico en los adultos es aún más raro. Este tumor maligno de tejidos blandos es más común en los niños. El número de casos por millón de habitantes entre 1994 y 2005, fue de 8,3 (hombres) y 3,7 (mujeres); la mayoría de los casos son esporádicos. Según el tipo histológico, son tumores embrionarios, alveolares o pleomórficos. El rabdomiosarcoma embrionario se llama así por su parecido con el músculo esquelético inmaduro y representa el 60 % de los casos de este tumor en los pacientes menores de 20 años de edad. El propósito de este artículo fue revisar la literatura científica y presentar un caso clínico de rabdomiosarcoma retroperitoneal en un paciente adulto de la Clínica Universitaria Colombia.

Rhabdomyosarcoma is a malignant soft tissue tumor accounting for approximately 4-8% of all solid tumors in children. It generally originates in the head and neck and in the genitourinary system. Retroperitoneal rhabdomyosarcoma has been rarely reported in the literature, and the embryonary rhabdomyosarcoma of omental origin in the adult is even rarer. This soft tissue malignancy is more common in children. The number of cases per million inhabitants was 8.3 (males) and 3.7 (females) in the period between the years 1994 and 2005; most cases are sporadic rhabdomyosarcomas. According to the histologic type, these neoplasms are embryonal, alveolar, and pleomorphic. The embryonal rhabdomyosarcoma is named so for its resemblance to the immature skeletal muscle, and represents 60% of all rhabdomyosarcomas in patients under 20 years of age. The purpose of this article is the review of the scientific literature and the report of a case of retroperitoneal rhabdomyosarcoma in an adult managed at Clínica Universitaria Colombiana, Bogotá, Colombia.

Prevalência baixa de adenovírus em crianças com diarreia em Belo Horizonte-MG / Low prevalence of adenoviruses in children with acute diarrhea in Belo Horizonte-MG

INTRODUÇÃO: Diversos microrganismos são reconhecidos como agentes de diarreia aguda, entre eles, os adenovírus, cuja associação com a doença apresenta variações geográficas e é pouco conhecida no Brasil. OBJETIVOS: Investigar a presença de adenovírus em fezes de crianças com diarreia aguda e sem diarreia, em Belo Horizonte-MG, e estudar os fatores epidemiológicos associados à adenovirose intestinal. MATERIAL E MÉTODOS: O teste imunocromatográfico qualitativo (kit VIKIA® Rota-Adeno, bioMérieux) foi utilizado para pesquisa de antígenos de adenovírus em amostras fecais obtidas de 268 crianças com diarreia aguda e 124 sem diarreia, em 2005 e 2006, no Hospital Infantil João Paulo II, Belo Horizonte-MG. Dados laboratoriais, clínicos e epidemiológicos foram registrados em banco de dados (SPSS Statistical package, IBM). RESULTADOS: Adenovírus foi detectado nas fezes de 16 crianças (4,1%): 12 (4,5%) com diarreia e quatro (3,2%) sem diarreia. A virose foi mais comum em meninas e a distribuição etária da infecção foi homogênea. Entre as 16 crianças com infecção pelo vírus, 11 (68,8%) tinham até 12 meses de idade. Entretanto, diferença significativa não foi observada para os parâmetros analisados. Distribuição sazonal da infecção por adenovírus não foi detectada. CONCLUSÃO: Nossos dados demonstram que a prevalência da adenovirose é baixa na população pediátrica no nosso meio.

INTRODUCTION: Several microorganisms, among them enteric adenovirus, are widely recognized as etiological agents of acute diarrhea. The association between adenovirus and the disease varies among geographical regions and is poorly known in Brazil. OBJECTIVES: To investigate the presence of adenovirus in stool samples from children with and without diarrhea in Belo Horizonte-MG. To study factors associated with enteric adenovirus infection. MATERIAL AND METHOD: A qualitative immunochromatographic assay (kit VIKIA® Rota-Adeno, bioMérieux) was performed to detect adenovirus antigens in stool samples from 268 children with acute diarrhea and 124 without diarrhea at Hospital Infantil João Paulo II from January/2005 to December/2006. Clinical, laboratory, and epidemiologic data were recorded in SPSS database (SPSS Statistical package, IBM). RESULTS: Adenovirus was detected in 16 samples (4.1%): 12 of them (4.5%) were from children with acute diarrhea and 4 of them (3.2%) from children without diarrhea. The viral infection was more prevalent among girls and the age distribution was homogenous. Among the 16 children infected by adenovirus,11 (68.8%) were younger than 12 months old. However, no significant statistical difference was observed within the analyzed parameters. There was no seasonal distribution of adenovirus infection. CONCLUSION: Our data demonstrate that the prevalence of enteric adenovirus infection is low among children with diarrhea in Belo Horizonte-MG.

Acid-base abnormalities in dogs with diabetic ketoacidosis: a prospective study of 60 cases / Distúrbios ácido-base em cães com cetoacidose diabética: estudo prospectivo de 60 casos

Diabetic ketoacidosis (DKA) is considered a typical high anion gap metabolic acidosis due to the retention of ketoanions. The objective of this study was to describe the acid-base disturbances of dogs with DKA and further characterize them, according to their frequency, adequacy of the secondary physiologic response, and occurrence of mixed disturbances. Sixty dogs with DKA were enrolled in the study. Arterial blood pH and gas tensions, plasma electrolytes, serum b-hydroxybutyrate (b-OHB), glucose, albumin and urea concentrations were determined for all dogs included in the study. All dogs were evaluated individually and systematically by the traditional approach to the diagnosis of acid-base disorders. Most of the dogs had a high anion gap acidosis, with appropriated respiratory response (n = 18; 30%) or concurrent respiratory alkalosis (n = 14; 23%). Hyperchloremic acidosis with moderated to marked increases in b-OHB was observed in 18 dogs (30%) and 7 of these patients had concurrent respiratory alkalosis. Hyperchloremic acidosis with mild increase in b-OHB was observed in 6 dogs (10%). Four dogs (7%) had a high anion gap acidosis with mild increase in b-OHB and respiratory alkalosis. Most of dogs with DKA had a high anion gap acidosis, but mixed acid-base disorders were common, chiefly high anion gap acidosis and concurrent respiratory alkalosis, and hyperchloremic acidosis with moderated to marked increases in serum b-OHB.

A cetoacidose diabética (CAD) é considerada um quadro típico de acidose metabólica e aumento do anion gap, devido à retenção de cetoânions. O objetivo deste estudo foi descrever os distúrbios ácido-base de cães com CAD e ainda caracterizá-los, de acordo com sua frequência, adequação da resposta secundária fisiológica e ocorrência de distúrbios mistos. Sessenta cães com CAD foram incluídos no estudo. O pH e hemogasometria arteriais, eletrólitos plasmáticos, glicose, b-hidroxibutirato (b-OHB), albumina e ureia séricos foram determinados para todos os cães incluídos no estudo. Todos os cães foram avaliados individualmente e de forma sistemática pela abordagem tradicional para o diagnóstico de distúrbios ácido-básicos. A maioria dos cães tinha uma acidose metabólica com aumento do anion gap, com resposta respiratória apropriada (n = 18; 30%) ou alcalose respiratória concomitante (n = 14; 23%). A acidose hiperclorêmica com aumento moderado a marcante do b-OHB sérico foi observada em 18 cães (30%) e sete desses pacientes tinham alcalose respiratória concomitante. A acidose hiperclorêmica com aumento discreto do b-OHB sérico foi observada em seis cães (10%). Quatro cães (7%) tinham acidose metabólica com aumento discreto do b-OHB e alcalose respiratória. A maioria dos cães com CAD tinha uma acidose metabólica com aumento do anion gap, mas distúrbios ácido-básicos mistos foram comuns, principalmente, acidose metabólica com aumento do anion gap e alcalose respiratória concomitante e acidose hiperclorêmica associada a um aumento de moderado a marcante do b-OHB sérico.