Association between rectal diameter and response to treatment with parasacral transcutaneous electrical nerve stimulation and behavioral changes in children and adolescents with bladder and bowel dysfunction

ABSTRACT Purpose: Parasacral Transcutaneous Electrical Stimulation (TENS) is one of the treatments for children with Bladder and Bowel Dysfunction (BBD). Some studies showed that children with increased Rectal Diameter (RD) have more Functional Constipation (FC). However, RD prediction in maintenance of BBD after treatment was never evaluated. Our aim is to evaluate the association between RD and response to treatment in children and adolescents with BBD. Materials and Methods: This study evaluated patients from 5-17 years old with BBD. Dysfunctional Voiding Scoring System (DVSS), Rome IV criteria, and the Constipation Score were used. RD was measured using abdominal ultrasound before treatment according to the technique established by Klijn et al. and was considered enlarged when >3cm. No laxatives were used during treatment. Descriptive analysis and binary regression were performed and the area under the ROC curve was calculated. Results: Forty children were included (mean age 8.4±2.8 years, 52.5% male). Before treatment, RD was enlarged in 15 children (37.5%) (mean diameter 3.84±0.6cm), with FC persisting post-treatment in 11/15(73.3%). Those patients also required more laxatives following treatment and had more severe FC. Binary regression showed pretreatment RD to be an independent predictor of the persistence of FC post-treatment (OR=9.56; 95%CI:2.05-44.60). In ROC curve analysis, the sensitivity was 100% (95%CI: 0.49-1.0) and specificity 77.14% (95%CI:0.60-0.90) for rectal diameter >3 cm. The likelihood ratio was 4.38 (95%CI:2.40-8.0) for the persistence of BBD following treatment. Conclusion: RD appears to be relevant in the evaluation of children with BBD, not only as a diagnostic tool but also as a predictor of treatment outcome.

"Como será minha vida com sífilis?" Desafios do diagnóstico em homens à luz de Leininger / "How will my life with syphilis be?" Diagnosis challenges in men in the light of Leininger / ¿Cómo será mi vida con sífilis? Desafíos diagnósticos en los hombres a la luz de Leininger

Objetivo: compreender os fatores que interferem no diagnóstico da sífilis em homens à luz da Teoria da Diversidade e Universalidade do Cuidado Cultural. Método: estudo qualitativo, aprovado por Comitê de Ética em Pesquisa, realizado em Hospital Universitário no Rio de Janeiro, entre setembro de 2017 e março de 2018. Foram entrevistados 32 homens diagnosticados com sífilis adquirida, e a análise temática foi utilizada para o tratamento dos dados. Resultados: a maioria dos homens tinha história de contágio por outra Infecção Sexualmente Transmissível e foi diagnosticada no ambulatório de imunologia. O momento diagnóstico é encarado com surpresa, tem repercussões psicossociais e é influenciado por fatores culturais e sociais. Considerações finais: alguns fatores interferem positivamente e outros negativamente no diagnóstico da sífilis na população masculina. Para detectar essa infecção nos homens, deve-se conhecer o contexto sociocultural em que estão inseridos para, assim, implementar estratégias tanto diagnósticas quanto preventivas mais eficazes(AU)

Objective: to understand the factors that interfere with the diagnosis of syphilis in men in the light of the Theory of Diversity and Universality of Cultural Care. Method: qualitative study, approved by the Ethics and Research Committee, conducted at a University Hospital in Rio de Janeiro, during september 2017 to march 2018. Thirty-two men diagnosed with acquired syphilis were interviewed, and thematic analysis was used for data treatment. Results: most men had a history of contagion by another STI and were diagnosed at the immunology outpatient clinic. The moment of diagnosis is faced with surprise, has psychosocial repercussions and is influenced by cultural and social factors. Final considerations: some factors interfere positively and others negatively in the diagnosis of syphilis in the male population. To detect this infection in men, it is necessary to know the sociocultural context in which they live, in order to implement more effective diagnostic and preventive strategies(AU)

Objetivo: comprender los factores que interfieren en el diagnóstico de la sífilis en los hombres a la luz de la Teoría de la diversidad y universalidad del cuidado cultural. Método: estudio cualitativo, aprobado por el Comité de Ética en Investigación, realizado en un Hospital Universitario de Río de Janeiro, de septiembre de 2017 a marzo de 2018. Se entrevistó a 32 hombres diagnosticados de sífilis adquirida y se utilizó el análisis temático para el tratamiento de los datos. Resultados: la mayoría de los hombres tenía antecedentes de contagio por otra Infección Sexualmente Transmisible y el diagnóstico se hizo en el ambulatorio de inmunología. El momento del diagnóstico se afronta con sorpresa, tiene repercusiones psicosociales y está influenciado por factores culturales y sociales. Consideraciones finales: algunos factores interfieren positivamente y otros negativamente en el diagnóstico de la sífilis en la población masculina. Para detectar esta infección en los hombres, se debe conocer el contexto sociocultural en el que se insertan, para entonces poner en marcha estrategias de diagnóstico y de prevención más eficaces(AU)

Paternidade entre homens jovens: vivências, mudanças e possibilidades / Paternity on the younger men's: experiences, changes and possibilities / Paternidad entre hombres jovenes: experiências, câmbios y posibilidades

Objetivo: apresentar as percepções de homens jovens sobre a vivência da paternidade. Método: estudo qualitativo, realizado através de entrevista com 12 jovens de idade entre 18 e 24 anos, captados pela técnica de bola de neve e saturação teórica. O tratamento dos dados deu-se pela análise de conteúdo. Resultados: os jovens pais encontravam-se em cenário socioeconômico desfavorecido. A paternidade foi associada a isolamento e perdas, mas também à renovação e novas perspectivas. O provimento financeiro do filho foi um aspecto relacionado a exigências do modelo de masculinidade e paternidade vigentes, o que pode dificultar a vivência de outras formas de ser pai. Considerações finais: é necessária a implementação de políticas públicas que possibilitem aos rapazes gerenciarem sua vida reprodutiva de forma saudável e responsável, estabelecendo discussões quanto a gênero e masculinidade, para favorecer a vivência de uma paternidade menos calcada nas normas de masculinidade vigentes.

Objective: present the perceptions of young men about the experience of fatherhood. Method: qualitative study, carried out by interviews with 12 young people aged between 18 and 24 years, captured by the snowball technique and the theoretical saturation. Data processing was performed by content analysis. Results: the younger fathers were in a disadvantaged socioeconomic scenario. Fatherhood was associated with isolation and losses, but also with renovations and new perspectives. The financial provide of the child was one of the aspects related to the demands of the current model of masculinity and paternity, which can be difficult to experience in the other ways of being a father. Finalconsiderations: it is necessary to implement public policies that allow boys to manage their reproductive lives with health and responsibility, establishing discussions about gender and masculinity, to favor the experience of a fatherhood less grounded in the current norms of masculinity.

Objetivo: presentar las percepciones de hombres jóvenes sobre la experiencia de la paternidad. Método: estudio cualitativo, realizado a través de entrevistas a 12 jóvenes con edades comprendidas entre los 18 y los 24 años, captados por la técnica bola de nieve y saturación teórica. El tratamiento de los datos se realizó mediante análisis de contenido. Resultados: los padres jóvenes se encontraban en un escenario socioeconómico desfavorecido. La paternidad estaba asociada con aislamiento y pérdidas, pero también con la renovación y nuevas perspectivas. La provisión financiera del hijo fue un aspecto relacionado con las exigencias del modelo de masculinidad y paternidad actual, que puede dificultar la experiencia de otras formas de ser padre. Consideracionesfinales: es necesario implementar políticas públicas que permitan a los jóvenes gestionar su vida reproductiva de forma sana y responsable, estableciendo debates sobre el género y la masculinidad, para promover la experiencia de una paternidad menos basada en las normas de masculinidad actuales.

Empiema necessitatis por Campylobacter rectus. Identificación rápida por MALDI-TOF MS / Empyema necessitatis caused by Campylobacter rectus. Rapid identification by MALDI-TOF MS

Resumen El empiema necessitatis (EN) constituye una muy rara complicación de un empiema pleural en el cual la infección se extiende a los tejidos blandos adyacentes. La etiología por anaerobios es muy infrecuente y se da en el curso de infecciones crónicas. Se presenta el primer caso de empiema necessitatis por Campylobacter rectus. La identificación de este agente se efectuó por espectrometría de masas (MALDI-TOF MS) y su sensibilidad antimicrobiana se determinó por el método epsilométrico.

Abstract Empyema necessitatis (EN) is a very rare complication of a pleural empyema, in which the infection extends to adjacent soft tissues. Anaerobic bacteria are very rare etiologic agents of EN, which occurs in the course of chronic infections. We present the first case of empyema necessitatis caused by Campylobacter rectus. Bacterial identification was carried out by mass spectrometry (MALDI-TOF MS) and antimicrobial susceptibility was determined by the epsilometer method.

Parasacral transcutaneous electrical nerve stimulation in children with overactive bladder: comparison between sessions administered two and three times weekly

ABSTRACT Purpose: This study compares the results achieved following parasacral TENS administered using two different weekly schedules. Materials and Methods: Children of at least four years of age with a diagnosis of pure overactive bladder were included in this randomized clinical trial and treated with parasacral TENS (2 versus 3 sessions per week). All the participants also underwent standard urotherapy. Results: Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group. There were no statistically significant differences between the two groups with respect to sex; however, there was a difference in age. There were no significant differences regarding complete resolution of urinary symptoms, with 8 children (50%) in the twice-weekly group and 11 children (61%) in the three times weekly group having their symptoms completely resolved (p=0.73). There was a significant difference in the DVSS score in both groups following TENS treatment compared to baseline (p=0.0001 for both groups), but not between groups. Evaluation of the bladder diary showed no difference between the groups before or after treatment. Conclusion: For children with overactive bladder who are unable to undergo parasacral TENS treatment three times weekly, the method can be administered successfully at twice-weekly sessions.

Disfunção vésico-intestinal em mães e filhos: um estudo transversal de base populacional / Bladder and bowel dysfunction in mothers and children: a population-based cross-sectional study

ABSTRACT BACKGROUND: Recently it was shown an association between lower urinary tract symptoms in mothers and their children. However, the role of functional constipation in this binomial is unclear. OBJECTIVE: To evaluate bladder and bowel dysfunction between mothers and children. METHODS: A population-based cross-sectional study. Mothers and their children responded a self-administrated questionnaire composed by Rome IV criteria, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System and demographic questions. RESULTS: A total of 441 mother-child pairs was obtained. Children's mean age was 9.1±2.7 years, with 249 (56.5%) female. Mothers' mean age was 35.7±6.1 years. Isolated constipation was present at 35 (7.9%) children and 74 (16.8%) mothers. Isolated lower urinary tract symptoms were present in 139 (31.5%) children and 92 (20.9%) mothers and bladder bowel dysfunction occurred in 51 (11.6%) children and 78 (17.7%) mothers. There wasn't any association between isolated lower urinary tract symptoms in children and isolated lower urinary tract symptoms in mothers (P=0.31). In univariate analysis there were an association between bladder bowel dysfunction in children and bladder bowel dysfunction in mothers (OR=4.8 IC 95% 2.6-9.6, P<0.001) and isolated constipation in children and isolated constipation in mothers (OR=3.0 IC 95% 1.4-6.4, P=0.003). In multivariate analysis mothers with bladder bowel dysfunction was the only independent factor associated with bladder bowel dysfunction in children (OR=5.4 IC 95% 2.5-11.6, P<0.001). CONCLUSION: Mothers with bladder bowel dysfunction are more likely to have a child with bladder bowel dysfunction. Association between these two dysfunctions plays an important role in this familiar presentation.

RESUMO CONTEXTO: Recentemente foi demonstrada associação entre sintomas do trato urinário inferior entre mães e filhos. No entanto, o papel da constipação funcional neste binômio não é claro. OBJETIVO: Avaliar a disfunção vésico-intestinal entre mães e filhos. MÉTODOS: Estudo transversal de base populacional. As mães e os filhos responderam a um questionário de autorresposta, composto pelos critérios de Roma IV, International Consultation on Incontinence Questionnaire - Overactive Bladder, Dysfunctional Voiding Scoring System e perguntas sociodemográficas. RESULTADOS: Foram estudados 441 pares mãe-filho. A idade média dos filhos foi de 9,1±2,7 anos, sendo 249 (56,5%) do sexo feminino. A idade média das mães foi de 35,7±6,1 anos. A constipação sem sintomas do trato urinário inferior estava presente em 35 (7,9%) crianças e 74 (16,8%) mães. Sintomas do trato urinário inferior isolados estavam presentes em 139 (31,5%) crianças e 92 (20,9%) mães e a disfunção vésico-intestinal ocorreu em 51 (11,6%) crianças e 78 (17,7%) mães. Não houve associação entre sintomas isolados do trato urinário inferior em crianças e sintomas isolados do trato urinário inferior em mães (P=0,31). Na análise univariada, houve associação entre disfunção vésico-intestinal em crianças e disfunção vésico-intestinal em mães (OR=4,8 IC 95% 2,6-9,6; P<0,001) e constipação isolada em crianças e constipação isolada em mães (OR=3,0 IC 95 % 1,4-6,4; P=0,003). Na análise multivariada, mães com disfunção vésico-intestinal foi o único fator de associação independente para disfunção vésico-intestinal em crianças (OR=5,4 IC 95% 2,5-11,6; P<0,001). CONCLUSÃO: Mães com disfunção vésico-intestinal têm maior probabilidade de ter filhos com disfunção vésico-intestinal. A associação entre constipação e sintomas do trato urinário inferior desempenha um papel importante nesta apresentação familiar.

Clinical repercussions of Glanders (Burkholderia mallei infection) in a Brazilian child: a case report

Abstract Glanders is a relatively unknown zoonotic disease caused by Burkholderia mallei. This bacterium affect solipeds and humans, and can be used as a biological warfare. Glanders is characterized as an occupational disease. We report the case of an 11-year-old boy who was presented to an emergency department with chest pain and dyspnea. He evolved into septic shock, pneumonia, and multiple abscesses. B. mallei was found in the exudate culture. Human infection is rare and difficult to confirm. The knowledge on glanders is important for differential diagnosis from other serious illnesses causing pneumonia and multiple abscesses.

Concepção de mulheres sobre vivência com vírus da imunodeficiência humana e impossibilidade de amamentar / Concepción de mujeres sobre vivir con virus de la inmunodeficiencia humana e imposibilidad de amamantar / Womens conception about living with human immunodeficiency virus and impossibility of breastfeeding

Objetivos: discutir a concepção de mulheres sobre a vivência com o vírus da imunodeficiência humana e a impossibilidade de amamentar. Método: estudo descritivo, exploratório, com abordagem qualitativa, realizado com 12 mulheres em um hospital universitário no Rio de Janeiro, Brasil. A coleta de dados, por meio de entrevista individual e semiestruturada, ocorreu entre junho de 2017 e março de 2018. Os dados foram analisados mediante a utilização do referencial metodológico da análise de conteúdo. Resultados: a maioria das participantes foi diagnosticada no pré-natal e no parto. Elas reconheceram os benefícios da amamentação e seguiram a recomendação de não amamentar. Conclusão: as participantes reconheceram os benefícios da amamentação e, mesmo que tristes e frustradas diante da impossibilidade de amamentar, transcenderam esses sentimentos, por proteção ao filho, reafirmando o papel atribuído pela sociedade e pela cultura e as assimetrias de gênero relacionadas à reprodução e maternidade.

Objetivos: discutir la concepción de mujeres sobre vivir con el virus de la inmunodeficiencia humana y la imposibilidad de amamantar. Método: estudio exploratorio descriptivo, con enfoque cualitativo, con 12 mujeres en hospital universitario de Río de Janeiro, Brasil. Recopilación de datos a través de entrevistas individuales y semiestructuradas, entre junio de 2017 y marzo de 2018. Datos analizados por el marco metodológico del análisis de contenido. Resultados: la mayoría de los participantes fueron diagnosticados durante el prenatal y parto. Reconocieron los beneficios de la lactancia materna y siguieron la recomendación de no amamantar. Conclusión: los participantes reconocieron los beneficios de la lactancia materna y, aunque tristes y frustradas ante la imposibilidad de la lactancia materna, trascendieron estos sentimientos para proteger al niño, reafirmando el papel atribuido por la sociedad y la cultura y las asimetrías de género relacionadas con la reproducción y maternidad.

Objectives: to discuss women's conception about living with the human immunodeficiency virus and the impossibility of breastfeeding. Method: descriptive, exploratory study, with a qualitative approach, conducted with 12 women in a university hospital in Rio de Janeiro, Brazil. Data collection, through individual and semi-structured interviews, occurred between June 2017 and March 2018. The data were analyzed using the methodological framework of content analysis. Results: most participants were diagnosed during prenatal care and delivery. They recognized the benefits of breastfeeding and followed the recommendation not to breastfeed. Conclusion: the participants recognized the benefits of breastfeeding and, even if sad and frustrated at the impossibility of breastfeeding, transcended these feelings to protect their child, reaffirming the role attributed by society and culture and gender asymmetries related to reproduction and motherhood.

Association between stress and lower urinary tract symptoms in children and adolescents

ABSTRACT Introduction: Lower urinary tract dysfunction (LUTD) is a common clinical condition. Emotional and behavioral issues are increasing among children and adolescents, with stress indicating difficulties in personal and social functioning. This study evaluated whether urinary tract symptoms (LUTS) is associated with stress. Materials and Methods: A cross-sectional, analytical study with 6-14-year-old patients with LUTS and no anatomical/neurogenic urinary tract abnormalities was conducted using the Dysfunctional Voiding Scoring System, a psychological assessment and the Child Stress Scale. The overall stress score was analyzed in relation to the psychological assessment data. Answers to the seven specific DVSS urinary questions were compared with those for the four Child Stress Scale domains. Univariate and multivariate analyses were performed. The chi-square test and Pearson's correlation were used to determine associations. Significance was defined as p <0.05. Results: Most children were male (56%). Mean age was 9.0±2.25 years. Stress was detected in 20 out of 98 patients (20.4%; 95% CI: 13-30%). Of these, 90% were born from unplanned pregnancies and 67% were upset about their disorder. All the Child Stress Scale domains were significantly associated with urinary dysfunction, with dysuria being significantly associated with all four domains. In the multivariate analysis, dysuria was the only symptom that remained associated with stress. Associations with stress strengthened as the frequency of dysuria increased: physical reactions (p <0.01), emotional reactions (p <0.05), psychological reactions with a depressive component (p <0.01) and psychophysiological reactions (p <0.05). Conclusion: Stress levels are higher in children and adolescents with LUTS who have more severe symptoms. Dysuria was the symptom most associated with stress, both in the physical reactions domain, in the psychological reactions domains with or without a depressive component and in the psychophysiological reactions domain.

Cuidados odontológicos em pacientes diabéticos / Dental care in diabetic patients

A Diabetes Mellitus (DM) é uma doença metabólica que se particulariza pela hiperglicemia, isto é, o aumento na quantidade de glicose no sangue que pode provir da insuficiência da formação, secreção e ação da insulina produzida pelas células beta das ilhotas de Langerhans no pâncreas. Alguns dos sinais e sintomas mais encontrados em pacientes diabéticos são a poliúria, polidipsia, polifagia e perda de peso. A cavidade bucal também pode apresentar sinais e sintomas bucais muito característicos da diabetes. Abordar condutas odontológicas perante um paciente diabético, apontar aspectos relevantes de como proceder à frente ao atendimento odontológico e esclarecer informações sobre a doença por meio de uma revisão de literatura. Para realização deste trabalho foram realizadas buscas nos periódicos como a biblioteca eletrônica da Biblioteca Virtual em Saúde (BVS), SciELO, PubMed e Google Acadêmico para seleção de artigos publicados de 2003 à 2018.Se o paciente estiver com a doença controlada pode ser atendido igualmente a um paciente sistemicamente normal, e em caso de descontrole, o cirurgião dentista deve estar apto a analisar o risco benefício do tratamento odontológico e diagnosticar as situações de risco à saúde para então encaminhá-lo a um médico endocrinologista para confirmar o diagnóstico ou tratamento.

Diabetes Mellitus (DM) is a metabolic disease that is characterized by hyperglycemia, in other words, it's an increase in the amount of glucose in the blood that can result from the insufficiency of the formation, secretion, and action of the insulin produced by the beta cells of the islets of Langerhans in the pancreas. Some of the most common signs and symptoms found in diabetic patients are polyuria, polydipsia, polyphagia, and weight loss. The oral cavity may also exhibit signs and oral symptoms very characteristic of diabetes. This study aims to address dental conducts before a diabetic patient, to point out relevant aspects of how to proceed with dental care and to clarify information about the disease through a review of the literature. In order to carry out this work, we searched the electronic library of the Virtual Health Library (VHL), SciELO, PubMed and Google Scholar for the selection of articles published from 2003 to 2018That if the patient has the disease controlled, and in case of discontrol, the dental surgeon must be able to analyze the risk of benefit from dental treatment and diagnose the health risk situations and then refer him to an endocrinologist to confirm the diagnosis or treatment.

Relato da experiência da realização de pequenos procedimentos em dermatologia em Hospital Universitário / Report of the experience of small procedures in dermatology at University Hospital

Modelo do estudo: Cohort. Objetivos: Relatar a experiência do setor de Pequenos Procedimentos em Dermatologia do Hospital Universitário Gaffrée e Guinle, determinando os diagnósticos, tipos de tratamentos e resolutividade. Metodologia: Trata-se de estudo prospectivo, observacional, por meio da coleta de dados dos pacientes do Programa de Saúde da Família da Secretaria Municipal de Saúde do Rio de Janeiro encaminhados para a realização de pequenos procedimentos em dermatologia, durante um período de 31 semanas. Resultados: Foram atendidos 884 pacientes. As lesões benignas representaram 77,5% dos diagnósticos clínicos e as malignas 22,5%. Os diagnósticos mais frequentes foram de cisto (133) e carcinoma basocelular (128). Os procedimentos mais realizados foram a excisão e sutura simples (337) e a retirada de lesão por shaving mais eletrocoagulação (161). No total, 98,3% dos procedimentos foram de cirurgia dermatológica básica e 1,7% dos casos necessitaram de procedimentos avançados. Além disso, 90,8% dos pacientes foram operados no dia do primeiro atendimento e 3,7% precisaram ser encaminhados para outras especialidades cirúrgicas. Conclusão: Um serviço de cirurgia dermatológica estruturado para a realização de pequenos procedimentos, em caráter ambulatorial, permite prover atendimento resolutivo à grande maioria dos pacientes com essa necessidade. (AU)

Study design: Cohort study. Objectives: To report the experience of the Small Procedures Division, Dermatology Department, at Gaffrée and Guinle University Hospital, including a description of diagnoses, types of treatment, and efficacy. Methods: This is a prospective, observational study that consisted of data compilation of patients referred from the primary Family Health Program, Local Health Department, to an University Hospital for the performance of small dermatological procedures, encompassing a period of 31 weeks. Results: Overall, 884 patients underwent procedures. Benign lesions comprised 77.5% of the clinical diagnoses, while malignant lesions constituted 22.5%. The most frequent diagnoses were cyst (133) and basal cell carcinoma (128). The most commonly performed procedures were simple excision and suture (337) and lesion removal through shaving plus electrocoagulation (161). 98.3% of the procedures consisted of basic dermatological surgeries and 1.7% of the cases required advanced procedures. In addition, 90.8% of the patients were operated on the first day of care, on the other hand 3.7% were referred to other surgical specialties. Conclusion: A Dermatologic Surgery Department structured to perform small outpatient procedures provides efficacious care to the vast majority of referred patients (AU)

Risk factors for urinary tract infection in children with urinary urgency

ABSTRACT Purpose To identify which independent variable would be strong predictor of febrile urinary tract infection (UTI) in children and adolescents with overactive bladder. Materials and Methods A search was made of the institute's database for all patients diagnosed with overactive bladder over the preceding four years. Children and adolescents under 18 years of age with overactive bladder and no neurological or anatomical alterations of the lower urinary tract were included in the study. The independent variables were: sex, age, ethnicity (Brazilians of African descendence/others), the presence of urinary urgency, daytime incontinence, enuresis, frequent urination, infrequent voiding (≤3 voids/day), nocturia, holding maneuvers, straining to void, intermittent urinary flow, constipation and encopresis. An analysis was conducted to identify patients with febrile UTI and subsequently determine predictors of this condition. Univariate and multivariate analyses were performed. Results Overall, 326 patients (214 girls/112 boys) were evaluated. The mean age of the patients was 7.7±3.19 years (± standard deviation). The incidence of febrile UTI was 39.2%. Being female and infrequent voiding were factors significantly associated with febrile UTI, both in the univariate and multivariate analyses. Conclusions These results show that being female and infrequent voiding constituted significant risk factors for a diagnosis of febrile UTI in these children.

Intervenção de enfermagem no estresse do cuidador familiar do idoso com dependência: estudo piloto / Intervención de enfermería en el estrés del cuidador familiar del anciano con dependencia: estudio piloto / Nursing intervention for stress management in family caregivers of dependent older adults: a pilot study

Objetivo avaliar a eficácia de uma intervenção de enfermagem estruturada com base num programa psicoeducativo de gestão do estresse sobre estressores primários (sobrecarga), recursos (coping) e resultados (bem-estar emocional) do cuidador, e avaliação realizada pelos cuidadores e pelos enfermeiros sobre a ajuda da intervenção e sobre o material de apoio ao programa. Método estudo piloto com 13 cuidadores de idosos em Portugal durante 5 semanas. Realizaram-se entrevistas para avaliar a intervenção e o material de apoio. Resultados depois da intervenção, houve melhoria no coping, no bem-estar e na sobrecarga com diferença estatisticamente significativa na sobrecarga; dificuldades com a implementação da intervenção e uso do material de apoio. Conclusão os cuidadores familiares revelaram que a intervenção ajudou-os na aprendizagem de novas estratégias de coping. Por parte dos enfermeiros, a intervenção ajudou-os a conhecer as dificuldades do cuidador, facilitando a abordagem holística do cuidado centrado no cuidador e no idoso.

Objetivo evaluar la eficacia de una intervención de enfermería estructurada con base en un programa psicoeducativo de gestión del estrés sobre estresores primarios (sobrecarga), recursos (coping) y resultados (bienestar emocional) del cuidador, y evaluación realizada por cuidadores y enfermeros sobre la ayuda de la intervención y el material de apoyo al programa. Método estudio piloto con 13 cuidadores de ancianos en Portugal, durante cinco semanas. Se realizaron entrevistas para evaluar intervención y material de apoyo. Resultados después de la intervención, hubo mejora en el coping, bienestar y sobrecarga, con diferencia estadísticamente significativa en la sobrecarga; dificultades con la implementación de la intervención y uso del material de apoyo. Conclusión los cuidadores familiares revelaron que la intervención ayudó en el aprendizaje de nuevas estrategias de coping. Para los enfermeros, ayudó a conocer las dificultades del cuidador, facilitando el abordaje holístico de la atención centrada en el cuidador y anciano.

Objective assess the effectiveness of a structured nursing intervention for caregivers based on a psychoeducational stress management program in relation to primary stressors (overload), resources (coping) and results (emotional well-being), as well as an assessment by caregivers and care recipients as to the helpfulness of the intervention and the program's support material. Method a pilot study was conducted with 13 caregivers of older adults in Portugal during five weeks. Interviews were conducted to assess the intervention and support material. Results after the intervention, there was an improvement in coping, well-being and overload, with a statistically significant difference in overload; difficulties implementing the intervention and using the support material. Conclusion the family caregivers stated that the intervention helped them learn new coping strategies. On the part of the nurses, the intervention helped them understand the difficulties faced by caregivers, facilitating a holistic care approach based on the caregiver and elderly person.

Digestibilidade das dietas formuladas com diferentes níveis de L-glutamina e zinco para frangos de corte / Digestibility of the diets formulated with different levels of L- glutamine and zinc for broilers

Objetivou-se avaliar o efeito da adição de L-glutamina e zinco sobre os coeficientes de digestibilidade dos nutrientes e balanço de nitrogênio no período de 9 a 15 dias de idade. Foram utilizados 140 pintos, distribuídos em delineamento inteiramente casualizados, em esquema fatorial 2 (1 e 2% de L-glutamina) x 3 (0, 90 e 120 mg de zinco/kg de ração) e um tratamento controle, com cinco repetições com 4 aves cada. Não houve efeito da combinação de L-glutamina e zinco sobre o coeficiente de digestibilidade da matéria seca. Nos níveis 1 e 2% de L-glutamina, o zinco, influenciou de forma linear crescente e quadrática, respectivamente. O coeficiente de digestibilidade do extrato etéreo e todos os tratamentos testados apresentaram maiores valores quando comparados com o controle. O tratamento com 2% de L-glutamina combinado com 120 mg de zinco/kg de ração apresentou maior excreção de nitrogênio, menor coeficiente de digestibilidade da proteína e menor eficiência de utilização do nitrogênio. As dietas com a adição de 1 e 2% de L-glutamina associada com todos os níveis de zinco suplementar proporcionam o aumento do coeficiente de digestibilidade do extrato etéreo. O tratamento com a associação de 1% de L-glutamina com 90 e 120mg de zinco/kg e 2% de L-glutamina sem a adição zinco de propiciam a maior retenção de nitrogênio.

This study aimed to evaluate the effect of the addition of L-glutamine and zinc on nutrient digestibility and nitrogen balance in the period 9-15 days old. Were used 140 chicks, distributed in a completely randomized design in a factorial 2 (1 and 2% glutamine) x 3 (0.0, 90.0 and 120.0 mg zinc / kg diet) and control treatment, with five replications, with four birds each. No effect of the combination of L-glutamine and zinc on the coefficient of digestibility of dry matter. At levels 1 and 2% L-glutamine, zinc, influenced increasingly and quadratic linear form, respectively, ether extract digestibility, and all treatments showed higher values when compared to the control. The treatment with 2% L-glutamine combined with 120 mg of zinc/kg feed showed higher nitrogen excretion, lower coefficient of digestibility of protein and lower use efficiency of nitrogen. The diets with the addition of 1 and 2% L-glutamine associated with all levels of zinc further provide increased ether extract digestibility. The treatment with the combination of 1% L-glutamine with 90 and 120mg of zinc/kg and 2% L-glutamine, without the addition of zinc to provide greater retention of nitrogen

Enuresis and overactive bladder in children: what is the relationship between these two conditions?

ABSTRACT Objective: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). Material and Methods: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values <0.05 being considered significant. A multivariate analysis was conducted to identify independent predictive factors. Results: Enuresis was diagnosed in 141/200 children. The two groups were similar with respect to sex, age and skin color. No difference was found in relation to urinary infection, non-urge incontinence, urinary dysfunction, nocturia, encopresis or constipation. The two groups were significantly different with regard to some symptoms related to OAB such as urgency (p=0.001), urge incontinency (p=0.001) and holding maneuvers (p=0.033). Following multivariate analysis, only holding maneuvers (p=0.022) remained as an independent predictive factor. Conclusion: The only independent predictive factor for resolution of enuresis in children with OAB, as detected in the multivariate analysis, was holding maneuvers.

Urodynamic outcome of parasacral transcutaneous electrical neural stimulation for overactive bladder in children

ABSTRACTObjective:To evaluate the urodynamic changes immediately after the first session (acute effect) and after the last session of parasacral TENS in children with idiopathic OAB.Materials and methods:We performed urodynamic evaluation immediately before and after the first session of parasacral TENS and immediately after the last session (7 weeks later). Only children with idiopathic isolated OAB were included. Patients with dysfunctional voiding were not included.Results:18 children (4 boys and 14 girls, mean age of 8.7) were included in the first analysis (urodynamic study before and immediately after the first session) and 12 agreed to undergo the third urodynamic study. Urodynamic before and immediately after the first session: There was no change in the urodynamic parameters, namely low MCC, low bladder compliance, presence of IDC, the average number of IDC, or in the maximum detrusor pressure after the first exam. Urodynamic after the last session: The bladder capacity improved in most patients with low capacity (58% vs. 8%). Detrusor overactivity was observed in 11 (92%) before treatment and 8 (76%) after. There was not a significant reduction in the average number of inhibited contractions after TENS (p=0.560) or in the detrusor pressure during the inhibited contraction (p=0.205).Conclusion:There was no change in the urodynamic parameters immediately after the first session of stimulation. After the last session, the only urodynamic finding that showed improvement was bladder capacity.

Análisis descriptivo de las colisiones viales en Bahía Blanca en el período 2006-2010 / Descriptive analysis of road collisions in Bahia Blanca, 2006-2010

Las colisiones viales se consideran un grave problema de la salud pública en el mundo, tanto por el número de lesionados y fallecidos que ocasionan como por los recursos económicos que deben destinarse para su atención y recuperación. Las lesiones causadas constituyen un problema social, económico y de salud pública en el mundo, que afecta a todos los sectores de la sociedad. Objetivo: Describir las características de las colisiones viales que requirieron asistencia sanitaria en la ciudad de Bahía Blanca en el período 1 Enero del 2006 al 31 de Diciembre del 2010. Materiales y Métodos: Estudio descriptivo retrospectivo de corte transversal con datos de la base de datos del Hospital Municipal de Agudos ¼Dr. Leónidas Lucero¼ (HMALL), centro de derivación del 70% de colisiones viales. Población: pacientes ingresados al Hospital Municipal de Agudos ¼Dr. Leónidas Lucero¼ por haber sufrido una colisión vial en el periodo 1 Enero del 2006 al 31 de Diciembre del 2010. Resultados: Se registraron 8422 consultas por colisión vial. En promedio se interna el 17% (±2%) de las consultas por colisiones viales. El 63,55% (5364) fueron personas entre 15 y 34 años. La relación hombre-mujer es de 2:1. El costo de la colisión vial por moto implicó el 60,60% del costo por colisiones durante el período analizado ($3.554.206,88). La tasa de mortalidad encontrada en el período estudiado fue de aproximadamente 5 por cada 100.000 habitantes. Conclusiones: La mayor siniestralidad ocurre en población joven y circulando en motocicleta. Ese mismo vehículo ocasiona el mayor costo en atención sanitaria.

Road collisions are a serious public health problem in the world, both because of the number of injured individuals and casualties that they cause and because of the economic resources that should be allocated for their care and recovery. The injuries caused are a social, economic, and public health problem in the world affecting all sectors of society. Objective: The purpose of this work is to describe the characteristics of road collisions that required health care in the city of Bahía Blanca from January 1, 2006 to December 31, 2010. Materials and Methods: Cross-sectional retrospective descriptive study using data from the database of the Hospital Municipal de Agudos ¼Dr. Leónidas Lucero¼ (referral center for 70% of road collisions). Population: patients admitted at the Hospital Municipal de Agudos ¼Dr. Leónidas Lucero¼ who have suffered a road collision between January 1, 2006 and December 31, 2010. Results: 8,422 referrals related to road collisions were recorded. In average, 17% (±2%) of the referrals related to road collisions required hospitalization. 63.55% (5364) of individuals were between 15 and 34 years of age. The male-female ratio was 2:1. Conclusions: The cost of a motorbike road collisions implied 60.60% of the whole cost for collisions during the period analyzed in this study (ARS 3,554,206.88). The mortality rate for the period under study was approximately 5 every 100,000 inhabitants.

Colisiones viales en motocicleta en la ciudad de Bahía Blanca, 2009-2010 / Motorcycle traffic collisions in the city of Bahía Blanca, 2009-2010

INTRODUCCIÓN: Debido a las consecuencias generadas, las colisiones viales son un problema de salud pública. OBJETIVOS: Describir las características sociodemográficas y sanitarias de las personas involucradas en colisiones producidas con motocicletas. MÉTODOS: Se realizó un estudio descriptivo transversal retrospectivo. Se utilizaron datos de historias clínicas de pacientes que ingresaron al hospital por este motivo en 2009 y 2010. RESULTADOS: Los siniestros en moto significaron un 40% del total. Un 18% (n=369) de las personas derivadas al hospital resultaron internadas. En su mayoría, se trató de hombres con una media de 26,8 años de edad. Un 36% poseía cobertura social. El motivo de internación más frecuente y de mayor gravedad fue el traumatismo de cráneo (46%), con y sin pérdida de conocimiento. Los internados con alteraciones en la conciencia tuvieron mayor tiempo de hospitalización (p=0,001). Como lugar de residencia de las personas afectadas, se verificó un aglomerado urbano con dificultades socioeconómicas y en el transporte público de pasajeros. CONCLUSIONES: Debido a las consecuencias sobre una franja de población socioeconómica activa, las colisiones viales deben priorizarse en la agenda política. La utilización del casco debe ser fuertemente promovida. La mayor vulnerabilidad socioeconómica de las personas internadas aumenta la importancia de las intervenciones estatales. Es imprescindible generar estadísticas para evaluar las políticas públicas y compararlas con las de localidades similares.

INTRODUCTION: Due to their consequences, traffic collisions are a public health problem. OBJECTIVES: To describe socio-demographic and health characteristics of people involved in motorcycle collisions. METHODS: A descriptive, cross-sectional and retrospective study was conducted, using data from medical records of patients admitted to the hospital for this reason in 2009 and 2010. RESULTS: Motorcycle collisions represented 40% of the total. 18% (n=369) of the people sent to the hospital were admitted there. They were mainly men, with anaverage age of 26.77 years. 36% of the people had social coverage. The most common and severe reason for hospitalization was head trauma ( 46%), with and without loss of consciousness. Patients with alteration of consciousness had longer hospitalization (p=0.001). The place of residence of the affected people was an urban agglomeration, with socio-economic and public transport difficulties. CONCLUSIONS: Due to the consequences for an active socio-economic sector, traffic collisions should be considered as a priority in the political agenda. Helmet use should be strongly encouraged. Since people admitted to the hospitals are socially and economically more vulnerable, public interventions turn to be more important. It is essential to produce statistics in order to evaluate public policies and compare them with those of similar locations.

Medidas del crecimiento placentario y su relación con el peso de nacimiento y la edad gestacional. Revisión bibliográfica / Placental growth measures and their relation to birth weight and gestational age. Literature review

El peso de nacimiento es un indicador crudo de la nutrición fetal. Las funciones placentarias de transporte, metabolismo y endócrinas son los mayores determinantes de la nutrición fetal y homeostasis, pero la eficiencia placentaria está escasamente relacionada con el peso del órgano. El peso placentario y las principales medidas placentarias (PMP) (diámetros mayor y menor, espesor del disco, distancia de la inserción del cordón umbilical [CU], forma y longitud del CU) son rutinariamente recolectadas en los laboratorios de patología de todo el mundo y son útiles para capturar: a) su relación con la función placentaria, y, b) están convencionalmente consideradas de tener “períodos críticos” de desarrollo. El tamaño y la forma de la superficie placentaria son nuevos marcadores epidemiológicos para enfermedades crónicas no transmisibles, en especial la hipertensión arterial. En el presente estudio se presenta una revisión bibliográfica sobre la relación entre las principales medidas placentarias con la edad gestacional y el peso de nacimiento.