Homocysteine concentrations in overweight children and adolescents

SUMMARY OBJECTIVE: The aim of this study was to describe homocysteine concentrations in overweight and obese children and adolescents and relate them to blood pressure levels, renal function, and insulin resistance. METHODS: This is a cross-sectional and observational study with 64 overweight children and adolescents (mean age: 11.6±3.5 years) in outpatient follow-up. The following parameters were evaluated: body mass index z-score, waist-to-height circumference ratio, pubertal stage, blood pressure, serum homocysteine, glycemia, insulin, lipid profile, renal function, high-sensitivity C-reactive protein, microalbuminuria, and creatinuria. Statistical analysis: analysis of variance and logistic regression (dependent variable: homocysteine) (p<0.05). RESULTS: The mean body mass index z-score was 2.9±1.1. The mean homocysteine concentrations were 8.6±2.2 μmol/L (10th and 90th percentiles: 6.6 and 11.2 μmol/L, respectively), with no difference when compared with children with severe obesity and obesity/overweight (p=0.431). High values of waist-to-height ratio (93.8%), systolic blood pressure (18.8%), diastolic blood pressure (12.5%), glycemia (4.7%), low-density lipoprotein cholesterol (31.1%), triglycerides (35.9%), non-high-density lipoprotein cholesterol (34.4%), and microalbuminuria (21.9%) were obtained. The mean glomerular filtration rate was 122.9±24.6 mL/min/1.73 m². Homocysteine concentrations were not associated with any of the studied variables (R²=0.095). CONCLUSION: Homocysteine concentrations in overweight children and adolescents (mean 8.6±2.2 μmol/L) were not associated with body mass index z-score, blood pressure, renal function, and insulin resistance.

Crianças e adolescentes com deficiência: desafios na formação médica / Children and adolescents with disabilities: challenges in medical training

Resumo: Introdução: Amparar os direitos constitucionais das pessoas com deficiência inclui atender aos novos direcionamentos curriculares e exige um ensino superior que considere a diversidade em diversos contextos. Assim, os currículos de graduação de profissionais de saúde devem atender às necessidades multifacetadas das pessoas com deficiência de modo que transcendam o modelo biomédico e perpassem pela promoção da cultura inclusiva. As atitudes e os valores sobre a deficiência frequentemente influenciam o comportamento das pessoas, tornando imperativa a introdução desta temática. Objetivo: Este estudo teve como objetivo descrever a abordagem nos currículos e as concepções de professores sobre crianças e adolescentes com deficiência em cursos de Medicina. Método: Trata-se de um estudo exploratório, transversal e de abordagem qualitativa que incluiu a análise documental de documentos oficiais dos cursos e páginas oficiais das universidades publicados até o primeiro semestre de 2021, e entrevistas de professores participantes do curso. A análise de conteúdo foi a técnica utilizada para o material das entrevistas. Resultado: A análise documental apontou nos tópicos gerais um direcionamento para uma formação humanística, com respeito às diferenças. Entretanto, quando a temática é a deficiência, o enfoque foi centrado nas questões biológicas. Nas entrevistas, identificaram-se os seguintes eixos temáticos: 1. a importância do Sistema Único de Saúde como espaço de formação médica; 2. a contribuição das Diretrizes Curriculares Nacionais na orientação das atividades dos docentes e destaque a pontos relevantes; 3. desenvolvimento de atividades de ensino voltadas à criança e ao adolescente com deficiência, com base nas experiências dos docentes; 4. concepção sobre a pessoa com deficiência e formação docente; 5. formação docente para o desenvolvimento de atividades de ensino sobre a criança e o adolescente com deficiência e conhecimento sobre as políticas públicas da área. Conclusão: Foi identificada uma fragilidade na abordagem da temática, com inserções pontuais sobre o tema, geralmente na perspectiva da doença e a partir de oportunidades surgidas. Entre os docentes, identificaram-se a predominância do olhar biomédico, a ausência de formação para a temática e a frágil inserção desta na prática acadêmica. Entretanto, houve reconhecimento da importância do tema e seu potencial em integrar a matriz curricular de forma transversal.

Abstract: Introduction: supporting the constitutional rights of people with disabilities includes meeting new curricular guidelines and requires higher education that considers diversity in different contexts. Thus, the undergraduate curricula of health professionals must meet the multifaceted needs of people with disabilities in a way that transcends the biomedical model and permeates the promotion of an inclusive culture. Attitudes and values about disability often influence people's behavior, making it imperative to introduce this topic. Aim: the present study aim to describe an approach in the curricula and teachers' conceptions about children and adolescents with disabilities in medical courses. Method: this exploratory, cross-sectional study with a qualitative approach included the documental analysis of official documents of the courses and official pages of the universities, published until the first semester of 2021 and interviews of teachers participating in the course. The content analysis technique was used for the interview material. Results: the documental analysis pointed in the general topics a direction towards a humanistic formation, while respecting the differences; however, when the topic is the disability, the focus was centered on biological issues. During the interviews, the following topics were identified: 1) The importance of the Unified Health System as a space for medical training; 2) The contribution of the National Curriculum Guidelines in guiding the activities of teachers and highlighting relevant points; 3) Development of teaching activities aimed at children and adolescents with disabilities, based on the teachers' experiences; 4) Conception about the person with disabilities and teacher training; 5) Teacher training for the development of teaching activities about children and adolescents with disabilities and knowledge about public policies in the area. Conclusions: a weakness was identified in the approach to the subject, with specific insertions on the subject, usually from the perspective of the disease and from the opportunities that arise. Among the teachers, the predominance of the biomedical perspective was identified, as well as the lack of training on the subject and its fragile insertion in academic practice. However, the importance of the topic was recognized and its potential to integrate the curricular matrix in a cross-sectional way.

Serum amyloid A in children and adolescents: association with overweight and carotid intima-media thickness

ABSTRACT Objective To compare serum amyloid A concentrations between overweight and eutrophic children and adolescents and to relate it to lipid profiles, glucose tolerance, and carotid intima-media thickness. Methods One hundred children and adolescents (mean age: 10.8±3.16 years) were included and divided into two groups: overweight and non-overweight. The following were evaluated: Z-score body mass index, carotid intima-media thickness, lipid metabolism biomarkers (lipid profile and apolipoproteins A1 and B), inflammatory biomarkers (ultra-sensitive C-reactive protein and serum amyloid A), and glucose homeostasis model assessment of insulin resistance. Results The groups were homogeneous in age, sex, and pubertal stage. Higher levels of triglycerides, apolipoprotein B, homeostasis model assessment of insulin resistance, ultrasensitive C-reactive protein, serum amyloid A, and carotid intima-media thickness were observed in the overweight group. In the multivariate analysis, age (OR=1.73; 95%CI: 1.16-2.60, p=0.007), Z-score body mass index (OR=3.76; 95%CI: 1.64-8.59, p=0.002), apolipoprotein-B (OR=1.1; 95%CI: 1.01-1.2, p=0.030), and carotid intima-media thickness (OR=5.00; 95%CI: 1.38-18.04, p=0.014) were independently associated with serum amyloid A levels above the fourth quartile of the studied sample (>9.4mg/dL). Conclusion Overweight children and adolescents had higher serum amyloid A concentrations than eutrophic children. There was an independent association between higher concentrations of serum amyloid A and Z-score, body mass index, apolipoprotein B, and carotid intima-media thickness, indicating the importance of this inflammatory biomarker in identifying the early risk of atherosclerosis.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios of overweight children and adolescents

SUMMARY OBJECTIVE: This study aimed to compare neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio of overweight children and adolescents with the eutrophic ratios and to verify whether these ratios are associated with age, inflammation, Z-score of body mass index, and waist-to-height ratio. METHODS: This is a cross-sectional study involving 64 overweight and 106 eutrophic children and adolescents. Data on weight, height, and waist circumference (body mass index and waist-to-height ratio), blood count (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio), and high-sensitivity C-reactive protein were collected. RESULTS: The mean age of participants was 8.4±3.2 years. The ratios did not differ between the overweight and non-overweight groups. The platelet-to-lymphocyte ratio has shown a direct and independent association with body mass index (p=0.031) and waist-to-height ratio (p=0.018), a fact not observed for neutrophil-to-lymphocyte ratio. The ultrasensitive C-reactive protein level was higher in the obesity group (p=0.003). Both ratios had a direct and independent association with age. CONCLUSION: The ratios did not differ between the overweight and non-overweight groups. There was a direct and independent association of platelet-to-lymphocyte ratio with overweight, not observed in neutrophil-to-lymphocyte ratio. The ratios have significantly increased according to the age of the participants.

Centenarian caregivers: perception of burden, sociodemographic data and physical activity

This study aimed to understand centenarian caregivers' perception of care burden according to sociodemographic characteristics and physical activity level. This is a descriptive study that used a mixed data (quantitative and qualitative) approach. Sixty-seven caregivers of centenarians from municipalities in Santa Catarina participated in this study. Interviews were held for application of questions about sociodemographic data, transport-related and leisure-time physical activity, caregiver burden, and suggestions for improving care. The data were collected in the centenarian's home where the caregiver worked. Quantitative data were analyzed using descriptive and inferential statistics and qualitative data by content analysis. The results showed that 58.2% of the caregivers were overburdened. Of these, 92.3% were females, 56.4% were 60-75 years old, 48.7% had 7 to 11 years of schooling, 53.8% were married, 66.7% were children of centenarians, the caregiving duration ranged from 1 to 5 years in 35.9%, and 69.2% cared for the older adult 24 hours/day. There was a statistically significant difference (p = 0.01) between the level of leisure-time physical activity and caregiving burden, with 64.9% of insufficiently active caregivers tending to be overburdened with the care demand. The suggestions of caregivers for improving centenarian care included having help from health professionals and relatives for care, infrastructure, and financial resources. Most burdened caregivers are insufficiently active and need assistance in taking care of their own health.

Association between acanthosis nigricans and overweight with hypertension in children and adolescents from low-income families

SUMMARY OBJECTIVE: This study aimed to describe the prevalence of acanthosis nigricans and high blood pressure in children and adolescents from low-income families, and to verify the association of elevated blood pressure with nutritional status and the presence of acanthosis nigricans. METHODS: This is a cross-sectional and controlled study with 232 children and adolescents from an institution for low-income families. Pubertal stage, body mass index Z-score, waist-to-height circumference ratio (increased waist-to-height circumference ratio >0.5), the presence of acanthosis nigricans, and blood pressure were assessed. RESULTS: The prevalence of excess weight and the change in waist-to-height circumference ratio was 37.9%. Acanthosis nigricans and increased blood pressure occurred in 20.3 and 34.8%, respectively. The prevalence of acanthosis nigricans and hypertension was higher in individuals with excess weight (p<0.001; p<0.001) and with an increased waist-to-height circumference ratio (p=0.009; p<0.001). Logistic regression showed a significant and independent association of body mass index Z-score (OR 2.35; 95%CI 1.52-3.65; p<0.001) and the presence of acanthosis nigricans (OR 2.43; 95%CI 1.12-5.23; p=0.023) with elevated blood pressure. CONCLUSION: Acanthosis nigricans and elevated blood pressure occurred in one-fifth and one-third of the individuals in an institution for children from low-income families. Overweight and the presence of acanthosis nigricans increased the risk of high blood pressure more than twofold.

Childhood obesity: an ecological perspective

Abstract Objective: To describe the participation of the environment in the childhood obesity epidemic, since childhood obesity currently represents a great challenge, with high prevalence worldwide, including in Brazil. Data source: Survey of articles published in the last 10 years in PubMed, evaluating the interface between the environment and childhood obesity. Data synthesis: Recent studies show that the environment is very important in the etiopathogenesis of obesity and its comorbidities. Therefore, factors such as air pollution, exposure to chemical substances that interfere with the metabolism, excessive consumption of ultra-processed foods, changes in the intestinal microbiota, and sedentary lifestyle are associated with increased obesity, insulin resistance, type 2 diabetes, and changes in lipid metabolism. These factors have a greater impact on some stages of life, such as the first thousand days, as they affect the expression of genes that control the adipogenesis, energy expenditure, and the mechanisms for hunger/satiety control. Conclusions: Environmental aspects must be taken into account in the prevention and treatment of childhood obesity, both from the individual and the population point of view, with adequate and comprehensive public health policies.

Análise de um instrumento para monitoramento da atenção básica em saúde / Análisis de un instrumento para monitoreo de la atención básica de la salud / Analysis of an instrument for primary health care monitoring

Resumo Objetivo Analisar um instrumento para o monitoramento da atenção básica. Métodos Pesquisa quantitativa, descritiva e analítica, consistiu na aplicação do instrumento em 442 Unidades Básicas de Saúde - UBS do município de São Paulo, contando com a participação de gestores locais na sua elaboração; o instrumento foi composto por 47 quesitos que contemplaram indicadores de Estrutura, Processo e Resultado e foram organizados em seis blocos temáticos: I - recepção técnica acolhedora - RTA (acolhimento); II - trabalho da enfermagem; III - trabalho médico; IV - organização assistencial e integração da equipe; V - cobertura vacinal e de programas; VI- gestão e participação. Para análise estatística utilizou-se o programa SPSS 25.0. Resultados A média e a mediana de pontuação obtidas pelas 414 UBS avaliadas (total de 470 pontos possíveis) foram 356 e 380, respectivamente. Por meio de modelagem multivariada, nove quesitos de Estrutura e Processo se destacaram, quando analisados em relação aos quesitos de Resultado, apresentando associação estatística (p<0,05): RTA realizada em todos períodos da UBS; treinamento específico para atendimento na RTA; atuação clínica do enfermeiro; retaguarda médica sistematizada para RTA; equipe de saúde bucal completa; horário reservado para reunião da equipe; atendimento em grupo realizado sistematicamente; ações de promoção à saúde; acomodações físicas adequadas. Conclusão o instrumento apresentou capacidade para captar diferentes estágios da organização e de resultados das unidades participantes do estudo e, além de uma avaliação global, revelou questões críticas dos serviços relacionadas às mudanças pretendidas. Como ferramenta avaliativa para os serviços pode contribuir no monitoramento e no apoio à tomada de decisões tecno-gerenciais cotidianas.

Resumen Objetivo Analizar un instrumento para el monitoreo de la atención básica. Métodos Estudio cuantitativo, descriptivo y analítico, que consistió en la aplicación de un instrumento en 442 Unidades Básicas de Salud (UBS) del municipio de São Paulo y contó con la participación de administradores locales para su elaboración. El instrumento estuvo compuesto por 47 ítems que contemplaron indicadores de Estructura, Proceso y Resultado, y fueron organizados en seis bloques temáticos: I - recepción técnica acogedora RTA (acogida); II - trabajo de enfermería; III - trabajo médico; IV - organización asistencial e integración del equipo; V - cobertura de vacunación y programas; VI - gestión y participación. Para el análisis estadístico se utilizó el programa SPSS 25.0. Resultados El promedio de puntuación obtenido por las 414 UBS evaluadas fue 356 y la mediana de 380 (total de 470 puntos posibles). Por medio de la modelación multivariada, se destacaron nueve ítems de Estructura y Proceso, al ser analizados con relación a los ítems de Resultado, y presentaron asociación estadística (p<0,05): RTA realizada en todos los períodos de la UBS, capacitación específica para atención en la RTA, actuación clínica del enfermero, retaguardia médica sistematizada para RTA, equipo de salud bucal completa, horario reservado para reunión del equipo, asistencia en grupo realizada sistemáticamente, acciones de promoción de la salud, instalaciones físicas adecuadas. Conclusión El instrumento presentó capacidad para captar diferentes niveles de la organización y de resultados de las unidades participantes en el estudio y, además de una evaluación global, reveló cuestiones críticas de los servicios relacionadas con los cambios pretendidos. Como herramienta evaluadora de los servicios, puede contribuir para monitorear y respaldar la toma de decisiones tecno-administrativas cotidianas.

Abstract Objective To analyze an instrument for monitoring primary care. Methods Qualitative, descriptive, and analytic research that consisted in the application of the instrument in 442 Basic Health Units - PCC from São Paulo city with the participation of local managers in its elaboration; the instrument is composed of 47 aspects that contemplated indicators of Structure, Process, and Result and we organized them in six thematic blocks: I - welcoming technical reception - WTR (reception); II - nursing work; III - medical work; IV - assistance organization and team integration; V - vaccination and program coverage; VI - management and participation. For the statistical analysis, we utilized the SPSS 25.0 program. Results The average and median scores obtained by the 414 evaluated Primary Care Centers (total of 470 possible points) were 356 and 380, respectively. Through the multivariate modeling, nine aspects of Structure and Processes stood out, when analyzed concerning the aspects of the Result, presenting statistical association (p<0.05): WTR carried out in every period of Primary Care Centers; specific training for the care in WTR; nurse clinical performance; systematized medical rearguard for WTR; complete oral health team; reserved time for team meeting; group appointment carried out systematically; health promotion actions; adequate physical accommodations. Conclusion The instrument presented the capacity to capture different stages of the organization and the results of the participant units of this study, and, besides a global evaluation, it revealed critical questions of the services related to the intended changes. As an evaluative tool for the services, it may contribute to the monitoring and the support to the everyday techno-management decision making.

Relationship between body mass index and waist-to-height ratio in childhood

SUMMARY OBJECTIVE: To evaluate whether there is an association between the body mass index z-score and waist-to-height ratio of children and adolescents. METHODS: This was a cross-sectional study conducted in a school in Santo André, SP, between June and August 2019. Body mass index was measured for all participants, adopting the z-score cutoff of +2 recommended by the World Health Organization. The waist-to-height ratio was determined in children over two years of age and considered abnormal when ≥0.5. The qualitative variables are presented as absolute numbers and percentages. To compare qualitative data, we used the χ2 test or Fisher's exact test. Pearson's test was applied to assess the correlation between BMI and waist-to-height ratio. The level of significance adopted was 5%. RESULTS: The body mass index was calculated for 518 children and the waist-to-height ratio for 473 children. Regarding body mass index, 60.6% of the participants had normal weight, 3.1% were underweight, and 36.3% were overweight. overweight (24.7%) and obesity (22.7%) were more prevalent in adolescents. The waist-to-height ratio was abnormal in 50.5% of the sample. There was an increasing association between body mass index and waist-to-height ratio with age, according to the Pearson correlation coefficients for the age groups <5 years (r=0.459; p<0.001), 5 to 10 years (r=0.687; p<0.001) and >10 years (r=0.805; p<0.001). CONCLUSION: There was a significant correlation between body mass index and waist-to-height ratio. This association was higher in adolescents. The waist-to-height ratio is easy to apply and may be useful as a predictor of cardiometabolic risk.

Immune system: development and acquisition of immunological competence

Abstract Objectives: To describe the ontogeny of the immune system and the adaptive mechanisms of the immune system in the neonatal period, with an emphasis on transplacental antibody transport and breastfeeding. Source of data: Non-systematic literature review in the PubMed database. Summary of the findings: The last two decades have witnessed a great advance in the knowledge of the immune system since conception. Several investigation tools have provided insight on phenomena that were previously inadequately understood. Still expanding, the functional and molecular investigation of various aspects of the immune system will make it possible to understand how intra-uterus maternal-fetal exchanges, the maternal microbiota interacting with the fetus and newborn, and the acquisition of immunological competence occur in healthy and disease scenarios. Conclusions: In-depth knowledge of the development of the immune system and of the adaptive mechanisms that allow a safer transition to the extrauterine environment are fundamental components of optimizing maternal and young infant vaccination, as well as the strategies associated with full postnatal development, and the early diagnosis and treatment of innate errors of immunity.

Effects of raloxifene combined with low-dose conjugated estrogen on the endometrium in menopausal women at high risk for breast cancer

OBJECTIVES: To compare the effects of low-dose conjugated estrogen (CE), raloxifene, and the combination thereof on the endometrium of postmenopausal women. METHODS: Postmenopausal women between 45 and 60 years of age, with Gail score≥1.67 and no endometrial disorders, were randomly assigned to receive low-dose CE (0.3 mg), raloxifene (60 mg), or combined therapy for 1 year. Transvaginal ultrasound was performed at baseline and every 3 months; the Kupperman Index was assessed at baseline and every 6 months. Endometrial biopsies were performed if endometrial thickness (ET) was ≥5 mm or if vaginal bleeding occurred. The primary outcome was the occurrence of ET≥5 mm over the one-year period. RESULTS: Seventy-three women were randomly assigned and analyzed on an intent-to-treat basis. Eight, three, and four women in the CE, raloxifene, and combination groups, respectively, exhibited ET≥5 mm. No genital bleeding was reported in the combination group. Endometrial biopsy revealed atrophy or polyps in all groups, with one patient in the CE group exhibiting a proliferative endometrium without atypia. At 6 months, there was a progressive increase in mean ET in the CE group, but not in the other two groups, with statistically significant differences at 6, 9, and 12 months. Mean scores for vasomotor symptoms and Kupperman Index favored the CE and combination groups over raloxifene. CONCLUSION: Combined raloxifene and low-dose CE decreased the severity of menopausal symptoms to a similar extent as CE alone and had similar effects as raloxifene alone on the endometrium.

Effects of vitamin d supplementation during pregnancy on newborns and infants: an integrative review / Efeitos da suplementação de vitamina d durante a gestação no recém-nascido e lactente: uma revisão integrativa

ABSTRACT Objective: To identify the effects of vitamin D supplementation during pregnancy on newborns and infants. Data sources: The present study is an integrative review of literature based on clinical trials published in journals indexed in the PubMed and Web of Science databases. Two searches were carried out, starting with the association (and) of the health term "vitamin D" with "pregnancy". In the search for information, selection criteria were established, and there was no language limitation and year of publication. Data synthesis: The final selection resulted in 44 clinical trials, most of which were randomized and double blind, which were carried out in outpatient clinics, referral hospitals and universities, mainly in Europe. The samples studied were predominantly of newborns. In these 44 trials, 23 types of different doses of vitamin D during pregnancy, with different doses, regimens and times of use, and 14 different outcomes were studied in newborns (NB) and infants. Of the 44 studies performed, 35 showed statistically significant beneficial effects of vitamin D supplementation during pregnancy on newborns and infants compared to control groups. Conclusions: Vitamin D supplementation during pregnancy for at least three months before delivery has the potential of positively influencing calcium metabolism, physical growth and immune system development in newborns and infants. However, there is insufficient knowledge to define the optimal dose and to guarantee the absence of possible long-term adverse effects.

RESUMO Objetivo: Identificar os efeitos da suplementação de vitamina D durante a gestação no recém-nascido e lactente. Fontes de dados: Revisão integrativa da literatura baseada em ensaios clínicos publicados em revistas indexadas nas bases de dados PubMed e Web of Science. Foi realizada uma busca em cada base de dados, que partiu da associação (and) dos descritores de saúde vitamin D e pregnancy. Na busca pelas informações, foram estabelecidos critérios de seleção e não houve limitação de idioma nem de ano de publicação. Síntese de dados: A seleção final resultou em 44 ensaios clínicos - a maioria randomizada e duplo-cego -, que foram realizados em ambulatórios, hospitais de referência e universidades sobretudo da Europa. As amostras estudadas foram predominantemente de recém-nascidos. Nesses 44 ensaios, foram testadas 23 formas de suplementação de vitamina D na gestação, com diferentes doses, regimes e tempos de uso, e estudaram-se 14 desfechos diferentes nos recém-nascidos e lactentes. Dos 44 estudos, 35 demonstraram efeitos benéficos da suplementação de vitamina D durante a gestação nos recém-nascidos e lactentes de forma estatisticamente significante, quando comparados aos do grupo controle. Conclusões: A suplementação de vitamina D na gestação, por no mínimo três meses antes do parto, potencialmente influencia de forma positiva o metabolismo do cálcio, o crescimento físico e o desenvolvimento do sistema imunológico dos recém-nascidos e lactentes, entretanto não há conhecimento suficiente para a definição da dose ideal nem para garantir a inexistência de possíveis efeitos adversos em longo prazo.

Seroprevalence of zika virus in a cattle flock

The present research evaluated the seroprevalence of anti-zika virus (anti-ZIKV) antibodies by virus neutralization test (VNT) in 529 bovines from Andradina city, São Paulo state, Brazil. The reading was performed in an inverted optical microscope, considering reagents when the antibodies were capable to neutralize the ZIKV. Of the 529 samples, 53 (10.01%) were reagents. The animals were healthy at the time of collection. The samples were collected in February 2018, a favorable period for the multiplication of the vector and the highest risk of disease transmission. None of the animals showed anti-bovine viral diarrhea virus (anti-BVDV) antibodies, ruling out a possible cross-reaction, reinforcing the possible contact of the bovine with the ZIKV. In the herd, 88 pregnant females were evaluated; of these, 12 cows were reactive, with no history of reproductive problems or fetal malformations. This is the first research on the seroprevalence of ZIKV in cattle in Brazil, and studies should continue to evaluate cattle as a possible host of this arbovirus and its possible consequences for unique health and agribusiness.

Lipid profile of pediatric patients with chronic rheumatic diseases - a retrospective analysis

SUMMARY AIM To describe the prevalence of dyslipidemia in children and adolescents with autoimmune rheumatic diseases (ARDs), particularly juvenile idiopathic arthritis (JIA), juvenile systemic lupus erythematosus (jSLE), and juvenile dermatomyositis (JDM). METHODS Retrospective cross-sectional study conducted in the pediatric rheumatology outpatient clinic. We evaluated 186 children and adolescents between the ages of 5 and 19 years. The medical records were reviewed for the following data: demographic and clinical features, disease activity, and lipid profile (triglycerides (TG), total cholesterol (TC), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) and very low density lipoprotein (VLDL-C)). In addition, non-HDL cholesterol was calculated as TC minus HDL-C. The cut-off points proposed by the American Academy of Pediatrics were used to classify the lipid profile. RESULTS Dyslipidemia was observed in 128 patients (68.8%), the most common being decreased HDL-C (74 patients, 39.8%). In the JIA group there was an association between the systemic subtype and altered LDL-C and NHDL-C, which demonstrated a more atherogenic profile in this subtype (p=0.027 and p=0.017, respectively). Among patients with jSLE, the cumulative corticosteroid dose was associated with an increase in LDL-C (p=0.013) and with a decrease in HDL-C (p=0.022). CONCLUSION Dyslipidemia is common in children and adolescents with ARDs, especially JIA, jSLE, and JDM, and the main alteration in the lipid profile of these patients was decreased HDL-C.

RESUMO OBJETIVO Descrever a prevalência de dislipidemias em crianças e adolescentes com doenças reumáticas autoimunes (Drai), em particular artrite idiopática juvenil (AIJ), lúpus eritematoso sistêmico juvenil (Lesj) e dermatomiosite juvenil (DMJ). MÉTODOS Estudo transversal retrospectivo realizado no ambulatório de reumatologia pediátrica. Foram avaliados 186 crianças e adolescentes com idades entre 5 e 19 anos. Foram coletados dos prontuários dados demográficos, clínicos, atividade de doença e perfil lipídico (triglicérides (TG), colesterol total (CT) e frações LDL-c (low density lipoprotein); HDL-c (high density lipoprotein) e VLDL-c (very low density lipoprotein). Foi também calculada a fração não HDL do colesterol (CT-NHDL -c). Para classificação do perfil lipídico, foram adotados os pontos de corte propostos pela American Academy of Pediatrics. RESULTADOS A dislipidemia foi observada em 128 pacientes (68,8%), sendo a mais comum a diminuição do HDL-c em 74 (39,8%). No grupo AIJ houve uma associação entre o subtipo sistêmico com alteração de LDL-c e NHDL-c, mostrando um perfil mais aterogênico neste subtipo (p=0,027 e 0,017, respectivamente). Em relação aos pacientes com Lesj, podemos observar que a dose cumulativa de CTC teve associação com o aumento do LDL-c (p=0,013) e com a diminuição do HDL-c (p=0,022). CONCLUSÃO A dislipidemia é frequente em crianças e adolescentes com Drai, em especial, AIJ, Lesj e DMJ, e a principal alteração no perfil lipídico desses pacientes foi a diminuição do HDL-c.

Red blood cell prescription and recognition of transfusion reactions by pediatricians / Prescrição de hemácias e reconhecimento de reações transfusionais por pediatras

ABSTRACT Objective To assess the level of knowledge of emergency pediatricians on red blood cell transfusions and their reactions. Methods Written survey with emergency pediatricians from a pediatric hospital. Results Less than 20% of pediatricians showed appropriate knowledge on prescribing red blood cells and recognition of transfusion reactions. There was no significant statistical regarding time since graduation and blood transfusion classes in undergraduate studies or during medical residency. Conclusion Pediatricians have insufficient knowledge about red blood cell transfusions and recognition of transfusion reactions.

RESUMO Objetivo Avaliar o conhecimento de pediatras emergencistas sobre transfusão de concentrados de hemácias e reações transfusionais. Métodos Aplicação de formulário para pediatras emergencistas de um hospital pediátrico. Resultados Menos de 20% dos participantes demonstraram conhecimento adequado sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais. Não houve diferença estatística significativa quando avaliados o tempo de formação profissional e o fato de ter recebido aula de hemoterapia na graduação ou na residência médica. Conclusão Os pediatras têm conhecimento insuficiente sobre prescrição de concentrados de hemácias e reconhecimento de reações transfusionais.

Concentrações de vitamina D em lactentes sibilantes e crianças asmáticas: relação com a condição nutricional e o controle da doença / Vitamin D concentrations in wheezing infants and asthmatic children: relationship with nutritional status and disease control

Introdução: Deficiência de vitamina D e obesidade foram associadas a um pior controle da asma em países desenvolvidos, embora essa relação ainda não esteja devidamente estabelecida. Assim, o presente estudo visa avaliar a relação entre deficiência de vitamina D, controle da asma e a condição nutricional em crianças menores de 10 anos. Métodos: 46 crianças asmáticas menores de 10 anos foram recrutadas para esse estudo observacional transversal, realizado entre outubro de 2016 e julho de 2018. O controle da asma foi verificado de acordo com o GINA 2016. A condição nutricional foi considerada como eutrófica (Z escore -2 a +1) ou sobrepeso/obesidade (Z score > +1), de acordo com a classificação da Organização Mundial da Saúde. Valores de vitamina D < 20 ng/mL foram considerados deficiência. A análise laboratorial foi realizada pelo laboratório de análises clínicas da Faculdade de Medicina do ABC. Resultados: Não foi encontrada relação estatisticamente significante entre controle da asma e condição nutricional (p = 0,766), controle da asma e níveis de vitamina D (p = 0,880), ou níveis de vitamina D e condição nutricional (p = 0,610). Deficiência de vitamina D foi encontrada em 21,8% das crianças incluídas; 63,5% apresentavam asma não controlada; e 41,3% apresentavam sobrepeso/obesidade. Conclusões: O presente estudo não encontrou associação entre controle da asma, níveis de vitamina D e condição nutricional, questionando a importância dessa relação em crianças com menos de 10 anos.

Introduction: Vitamin D deficiency and obesity have been associated with poorer asthma control in developed countries, although this relationship has yet to be established. This study aimed to evaluate the relationship between vitamin D deficiency, asthma control, and nutritional status in children younger than 10 years. Methods: 46 asthmatic children younger than 10 years were recruited for a cross-sectional observational study conducted from October 2016 to June 2018. Asthma control was assessed according to the GINA 2016 guidelines. Children were classified as normal weight (Z score -2 to +1) or overweight/ obese (Z score > +1) according to the World Health Organization classification. Vitamin D levels < 20 ng/mL were considered deficient. The laboratory analysis was performed in the Clinical Analysis Laboratory of the ABC Medical School. The statistical analysis was performed with the chi-square test. Results: There was no statistically significant relationship between asthma control and nutritional status (p = 0.766), asthma control and vitamin D levels (p = 0.880), or vitamin D levels and nutritional status (p = 0.610). Vitamin D deficiency was present in 21.8% of children; 63.5% had uncontrolled asthma, and 41.3% were overweight/ obese. Conclusions: The present study found no association between asthma control, vitamin D levels, and nutritional status, questioning the importance of this relationship in children younger than 10 years.

Albuminuria and glomerular filtration rate in obese children and adolescents / Albuminúria e taxa de filtração glomerular em crianças e adolescentes obesos

Abstract Objective: To describe the frequency of albuminuria in overweight and obese children and adolescents and to relate it to the severity of obesity, pubertal staging, associated morbidities and the glomerular filtration rate. Method: Cross-sectional study including 64 overweight and obese children and adolescents between 5 and 19 years of age. Data collected: weight, height, waist circumference and systemic arterial pressure. Laboratory tests: lipid profile; glycemia and insulin, used to calculate the Homeostasis Model Assessment (HOMA-IR); C-reactive protein; glutamic-pyruvic transaminase and albuminuria in an isolated urine sample (cutoff <30 mg/g). Creatinine was used to calculate the estimated glomerular filtration rate (eGFR, mL/min/1.73 m2). Results: The mean age was 11.6 ± 3.4 years, 32 (50%) and 29 (45.3%) were male and prepubertal. Forty-six (71.9%) had severe obesity. The frequency and median (min/max) of the observed values for albuminuria (> 30 mg/g) were 14 (21.9%) and 9.4 mg/g (0.70, -300.7 mg/g). The mean eGFR was 122.9 ± 24.7 mL/min/1.73 m2. There was no significant correlation between body mass index, pubertal staging, insulin and HOMA-IR with albuminuria values and neither with eGFR. Children with albuminuria tended to have higher values of diastolic blood pressure (75.0 ± 12.2 vs. 68.1 ± 12.4, p = 0.071). Conclusion: Albuminuria, although frequent in children and adolescents with obesity, was not associated with other morbidities and the glomerular filtration rate in these patients.

Resumo Objetivo: Descrever a frequência de albuminúria em crianças e adolescentes com sobrepeso e obesidade e relacioná-la com a gravidade da obesidade, estadiamento puberal, morbidades associadas e com a taxa de filtração glomerular. Método: Estudo transversal incluindo 64 crianças e adolescentes com sobrepeso e obesidade entre 5 e 19 anos de idade. Dados coletados: peso, estatura, circunferência abdominal e pressão arterial sistêmica. Exames laboratoriais: perfil lipídico; glicemia e insulina, utilizados para cálculo do Homeostasis Model Assessment (HOMA-IR); proteína C reativa; transaminase glutâmico-pirúvica e albuminúria em amostra isolada de urina (ponto de corte < 30 mg/g). A creatinina foi utilizada para o cálculo da taxa de filtração glomerular estimada (eTFG, mL/min/1,73m2). Resultados: A média de idade foi 11,6±3,4 anos, 32 (50%) e 29 (45,3%) eram do gênero masculino e pré-púberes. Quarenta e seis (71,9%) apresentavam obesidade grave. A frequência e a mediana (min/max) dos valores observados para albuminúria (> 30 mg/g) foram 14 (21,9%) e 9,4 mg/g (0,70; -300,7 mg/g). A média da eTFG foi 122,9±24,7 mL/min/1,73 m2. Não houve correlação significante entre o índice de massa corporal, estadiamento puberal, insulina e HOMA-IR com os valores de albuminúria e nem com a eTFG. Crianças com albuminúria tiveram tendência a valores mais elevados de pressão arterial diastólica (75,0±12,2 vs 68,1±12,4, p = 0,071). Conclusão: A albuminúria, apesar de frequente em crianças e adolescentes com obesidade, não se associou com outras morbidades e nem com a taxa de filtração glomerular nesses pacientes.

Fatores associados ao excesso de peso e baixa estatura em escolares nascidos com baixo peso / Factors associated with excess weight and stunting in schoolchildren born with low birth weight

Resumo O objetivo deste artigo é avaliar a condição nutricional de crianças com baixo peso ao nascer (BPN) e possíveis associações com variáveis independentes maternas, sexo e antecedentes neonatais Estudo transversal com 544 escolares com BPN (5 a 10 anos de idade) da região metropolitana de São Paulo. Variáveis: dados neonatais das declarações de nascidos vivos (peso ao nascer e idade gestacional), informações sobre a gestação e a condição nutricional atual das mães. A avaliação da condição nutricional dos escolares foi realizada por meio da obtenção dos dados de peso e estatura utilizados cálculo do escore z da estatura/idade (ZEI) e índice de massa corporal (ZIMC). Observou-se baixa estatura; sobrepeso e obesidade em 6,2%, 8,6% e 12,3% das crianças avaliadas, respectivamente. A presença de baixa estatura nos escolares associou-se com estatura materna < 150 cm (OR = 6,94; IC95% 2,34-20,6). O sobrepeso/obesidade nas crianças com BPN associou-se de forma independente com o sobrepeso/obesidade da mãe (OR = 2,40; IC95% 1,44-4,01) e o sexo masculino (OR = 1,77; IC95% 1,06-2,95). Um quinto dos escolares com BPN apresentaram excesso de peso, que se associou à condição nutricional materna atual e ao gênero masculino; a baixa estatura associou-se à estatura materna.

Abstract The scope of this study is to assess the nutritional status of low birth weight (LBW) children and the possible associations with independent maternal variables, gender and neonatal history. It involved a cross-sectional study with 544 LBW schoolchildren (five to ten years of age) in the metropolitan area of São Paulo. Variables: the neonatal data of liveborn infant declarations and the current weight and height of the mothers were collected. The weight and stature used to calculate the height/age z (HAZ) score and the body mass index (BMI) of children were evaluated. Among the LBW children 6.2% were of short stature, 12.3% overweight and 8.6% obese. There was an association between short stature in LBW schoolchildren and short maternal stature < 150 cm (OR = 6.94; 95 % CI 2.34-20.6). Excess weight/obesity in LBW children was independently associated with overweight/obesity of the mother (OR = 2.40; 95% CI 1.44-4.01), and the male gender (OR = 1.77; 95% CI 1.06-2.95). A fifth of schoolchildren with low birth weight were overweight, which was associated with current maternal nutritional status and the male gender and stunting was associated with maternal stature.

Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital / Avaliação da prescrição de concentrado de plaquetas em pacientes pediátricos em hospital terciário

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

RESUMO Objetivo: Verificar a adequação na prescrição de concentrado de plaquetas por pediatras em diferentes setores da pediatria de um hospital geral. Métodos: Estudo transversal avaliando 218/227 fichas de requisição de concentrado de plaquetas de crianças e adolescentes (zero a 13 anos), de janeiro de 2007 a abril de 2015 pelos pediatras do pronto-socorro, enfermaria e unidade de terapia intensiva. Excluíram-se as requisições em portadores de doenças hematológicas e aquelas sem o número de plaquetas. Resultados: Crianças com menos de 12 meses receberam 98 prescrições de concentrado de plaquetas (45,2%). A maioria das transfusões foi profiláticas (165; 79%). Em relação ao local da transfusão, 39 (18%) foram no pronto-socorro, 27 (12,4%) na enfermaria e 151 (69,6%) na unidade de terapia intensiva. O gatilho, o volume prescrito e o subtipo de concentrado de plaquetas foram adequados em 59 (28,2%), 116 (53,5%) e 209 (96,3%) das transfusões, respectivamente. Prescrições para pacientes com hemorragia apresentaram adequação em 42 (95,5%) transfusões, enquanto para crianças sem hemorragia houve adequação em 17 (10,3%) vezes. A inadequação mais comum em relação ao volume foi a prescrição acima da recomendação (95; 43,8%). Foram prescritos oito concentrados de plaquetas sem indicação de solicitação de subtipos. Conclusão: Os resultados obtidos nesse estudo mostraram que a prescrição de transfusão de concentrado de plaquetas foi mais adequada em crianças com hemorragia ativa em comparação com a transfusão profilática. Houve tendência à prescrição de volumes elevados e de subtipos de plaquetas, o que não se justifica segundo os protocolos atuais. O ensino da medicina transfusional deve ser mais valorizado na graduação e na residência médica.

Relações alimentares iniciais, uma investigação clínica Pediatria e psicanálise nutrindo vínculos: psychoanalysis and pediatrics nourishing links / Early feeding relationships, a clinical investigation: pediatría y psicoanálisis nutriendo vínculos / Relaciones alimentares tempranas, una investigación clínica: l'établissement de liens entre pédiatrie et psychanalyse / Les relations alimentaires initiales, une recherche clinique

Na interface psicanálise/pediatria e clínica/investigação, este artigo apresenta considerações acerca das dificuldades alimentares infantis em sua transitoriedade ou tendência à cristalização como possíveis indicadores de resiliência ou vulnerabilidade nas relações iniciais pais-bebê. Além de oferecerem um panorama da qualidade do vínculo, tais dificuldades podem evocar intensas ansiedades dos cuidadores, criando um círculo vicioso de recusa, evitações mútuas, intensidade projetiva e desinvestimento na subjetivação que pode permear a dimensão mais ampla do desenvolvimento psíquico do bebê. Resultados de estudo clínico detalhado e material ilustrativo, são consideradas em seu processo de captação psicanalítica e propostas como categorias para identificação de vulnerabilidade emocional na relação pais-bebê e encaminhamento de famílias em necessidade de intervenção terapêutica, o mais cedo possível, por parte de profissionais de saúde em contexto pediátrico.

Within the interface psychoanalysis/pediatrics and clinical work/research, this paper presents considerations about early feeding difficulties in its transience or crystallization trends as possible signs of resilience or vulnerability within parent-infant relationship. In addition to providing an overview of the relationship quality, these difficulties can evoke intense anxieties of caretakers, creating a vicious circle of mutual avoidance, refusal, projective intensity and disinvestment in the subjectivities which can permeate the wider dimension of the baby's psychic development. Results of a detailed clinical study with illustrative material are considered in its initial investigation phase and proposed as categories for identification of emotional vulnerability within parent-infant relationship and early referral of families in need of therapeutic intervention by health professionals in pediatric context.

En la interfaz psicoanálisis/pediatría y clínica/investigación, este trabajo presenta consideraciones acerca de las dificultades de alimentación infantiles en su fugacidad o cristalización de tendencias como posibles indicadores de resiliencia o vulnerabilidad inicial en las relaciones padres-bebé. Además de proporcionar una visión general de la calidad del enlace, estas dificultades pueden evocar intensas angustias en los cuidadores, creando un círculo vicioso de evitación mutua, negación, intensidad proyectiva y desinvestidura en la subjetivación que puede impregnar la dimensión más amplia del desarrollo psíquico del bebé. Resultados de un estudio clínico detallado, con material ilustrativo, son considerados en su proceso psicoanalítico inicial y propuestos como categorías para identificación de vulnerabilidad emocional en la relación padres-bebé y encaminamiento de familias a intervención terapéutica, tan pronto como sea posible, por parte de profesionales de la salud en contexto pediátrico.

Dans l'articulation entre psychanalyse/pédiatrie et recherche/clinique, cet article présente des considérations sur les difficultés alimentaires infantiles transitoires ou avec des tendances de cristallisation. Ces difficultés indiquent des potentiels de résilience ou de vulnérabilité dans les premières relations parents-bébé. Ce cadre offre un panorama de la qualité du lien de la relation, bien qu'il peut évoquer des angoisses intenses par les soignants, ce qui peut créer un cercle vicieux de d'évitement mutuelle dans la relation. La cristallisation des aspects transitoires peut jouer un rôle important dans une dimension plus large du développement psychique du bébé. Les résultats détaillés et les illustrations cliniques de l'étude sont proposés comme des catégories pour l'identification de la vulnérabilité émotionnelle de la relation parents-bébé. En plus, ces catégories peuvent être utilisés par les professionnels de la santé pour adresser les familles à une intervention thérapeutique le plus tôt possible.