Report of the Korean Association of External Quality Assessment Service on Clinical Mycobacteriology (2017–2018)

Rapid and correct diagnosis is essential for national tuberculosis (TB) control. A greater national concern for quality control (QC) of Mycobacterium tuberculosis (MTB) testing is required to improve the proficiency of domestic clinical laboratories using diverse testing protocols in private and public sectors. External quality assessment (EQA) is an important program accompanying internal QC in clinical TB laboratories. In Korea, the EQA program initiated in 2005 by the Korean Association of External Quality Assessment Service (KEQAS) has made remarkable progress in the harmonization of private and public sectors with governmental support since 2011. An integrative TB EQA program led by the KEQAS with financial support from the Korea Centers for Disease Control and Prevention provides optimized EQA materials for both public and private sectors. In 2017, the KEQAS implemented ‘The Next-Generation Proficiency Testing Program’ equipped with a centralized control system of QC material production and electronic data management, which increased the scale of operating programs from 46 to 54 and recruited 1,700 participants. The TB program was also expanded to provide three times EQA for private laboratories from 2 times a year. For TB EQA programs implemented via the Clinical Microbiology Subcommittee of the KEQAS, survey materials were distributed by sectional orders for tests such as acid-fast bacilli (AFB) smears, AFB culturing and identification, antituberculous drug susceptibility screening, AFB molecular diagnosis, and rapid detection of rifampin and isoniazid resistance. All survey materials were produced by sophisticated manufacturing processes and thoroughly analyzed by various commercial kits, targeted DNA sequencing, and whole-genome sequencing in pre- and post-manufacturing phases for advancement in the EQA program.

Unilateral cleft lip repair: a comparison of treatment outcome with two surgical techniques using quantitative (anthropometry) assessment

OBJECTIVES: The unilateral cleft lip (UCL) repair technique has evolved extensively over the past century into its modern form and has been identified as an important determinant of treatment outcome. The aim of this study was to evaluate and compare treatment outcomes following repair of UCL using either the Tennison-Randall (triangular) technique or the Millard rotation-advancement technique. MATERIALS AND METHODS: This was a prospective randomized controlled study conducted at the Lagos University Teaching Hospital between January 2013 and July 2014. A total of 48 subjects with UCL presenting for primary surgery and who satisfied the inclusion criteria were recruited for the study. The subjects were randomly allocated into two surgical groups through balloting. Group A underwent cleft repair with the Tennison-Randall technique, while group B underwent cleft repair with the Millard rotation-advancement technique. Surgical outcome was assessed quantitatively according to anthropometric measurements, using a method described by Cutting and Dayan (2003). RESULTS: Our 48 enrolled subjects were evenly divided into the two surgery groups (n=24 for both group A and group B). Twenty-seven subjects were male (56.3%) and 21 were female (43.8%), making a sex ratio of 1.3:1. The Millard group showed a greater increase in postoperative horizontal length and vertical lip height and a greater reduction in nasal width and total nasal width. Meanwhile, the Tennison-Randall group showed better reduction of Cupid's-bow width and better philtral height. CONCLUSION: We did not find any significant differences in the surgical outcomes from the two techniques. The expertise of the surgeon and individual patient preferences are the main factors to consider when selecting the technique for unilateral cleft repair.

Oxigenoterapia en pediatría / Oxygen therapy in pediatrics

Cada año, cerca de 6 millones de niños mueren por enfermedades prevenibles o fácilmente tratadas. El 95% se produce en países subdesarrollados, siendo la neumonía la causa más prevalente muertes en menores de 5 años (18%). La hipoxemia es la causa de los decesos en estos individuos. La aplicación de O2 como medida terapéutica para tratar o prevenirla es una de las indicaciones más frecuente que debe realizar un clínico. Este escrito trata de integrar en forma muy resumida los conceptos básicos que involucran a la oxigeno terapia, cuándo aplicar O2, con que equipos y aditamentos más apropiados.

Around 6 million children died of preventable or easily treatable diseases each year. Ninety five per cent are produced in undeveloped countries, being pneumonia the leading cause of death of children of 5 years or less (18%) and hypoxemia is the cause of dead. Oxygen therapy to treat or prevent this, as a therapeutic measure, is one of the most commons indicationsthat must be performed by aclinician. The review summarized the basic concepts of oxygen administration, when and how, with which equipment, oxygen delivery devices, dangers and its precautions.

Prática e formação: psicólogos na peritagem em porte de arma de fogo / Practice and training: psychologists active in expertise of firearm usage licensing / Desafíos en la práctica y formación de los psicólogos activos con concesión de licencia de arma de fuego

Com o desenvolvimento e a crescente atualização da Avaliação Psicológica como área, prática e formação, os diferentes desafios enfrentados pelos psicólogos atuantes nesta temática têm sido discutidos. É pouco comum, contudo, a discussão das práticas e competências dos profissionais que atuam na Concessão de Porte de Arma de Fogo. Com o objetivo de conhecer estas atividades e este contexto de trabalho, foram entrevistados 14 psicólogos atuantes como peritos em concessão de porte de arma de fogo em um estado do Sudeste, sendo todos do sexo feminino, com idades entre 30 e 60 anos (M = 39,1 anos, DP = 7,1 anos). Os resultados apontam que a falta de formação voltada para a peritagem em porte de arma de fogo, bem como a formação deficitária em Avaliação Psicológica, podem conduzir a percepções negativas dentro deste contexto de atuação. A preocupação burocrática e documental que envolve esta avaliação, a falta de parâmetros para avaliação de perfil dos avaliados e o problema do descrédito do psicólogo como avaliador surgiram como temáticas adjacentes, suscitando a discussão do papel da formação na disseminação de melhores práticas profissionais...

Of study, practice, and training, the various challenges faced by psychologists working in this area have been discussed. However, discussion of the practice and skills of professionals working in the licensing of firearm usage is unusual. In order to improve understanding of these activities and this study, we interviewed 14 psychologists acting as experts in licensing the possession of firearms in a southeastern state of Brazil. All subjects were female aged 30–60 years (M = 39.1 years; SD = 7.1 years). The results indicate that a lack of training in expertise in possession of a firearm as well as a training deficit in Psychological Assessment may lead to negative perceptions within this context of action. Bureaucratic and documentary concerns surrounding this assessment, the lack of parameters to evaluate candidate profiles, and the problem of discredit of psychologists as evaluators emerged as key themes, leading to a discussion of the role of training in the dissemination of best practices...

Con el desarrollo y la creciente actualización de la evaluación psicológica como área, la práctica y la formación, se han analizado los diferentes retos que enfrentan los psicólogos que trabajan en este tema. No es habitual, sin embargo, la discusión de la práctica y las habilidades de los profesionales que trabajan en la Concesión de Licencia de Armas. Para conocer estas actividades y su contexto de trabajo, entrevistamos a 14 psicólogos que actúan como expertos en el otorgamiento de la posesión de un arma de fuego en un estado del sudeste, todas ellas mujeres, con edades comprendidas entre 30 y 60 años (M = 39,1 años, SD = 7,1 años). Los resultados indican que la falta de capacitación dirigida a expertos en posesión de un arma de fuego, así como el déficit de formación en evaluación psicológica puede llevar a percepciones negativas dentro de este marco de acción. La preocupación burocrática y el documental que rodea esta evaluación, la falta de parámetros para evaluar el perfil del problema y del psicólogo desacreditado, evaluado como evaluador, surgió como temática subyacente, planteando el debate sobre el papel de la formación en la difusión de las mejores prácticas...

Análise do consumo alimentar e das alterações bioquímicas de pacientes queimados internados em hospital de referência / Análisis de la ingesta y las alteraciones bioquímicas en pacientes quemados ingresados en un hospital de referencia / Analysis of dietary intake and biochemical alterations in burned patients admitted to hospital for reference

Objetivo: Analisar quantitativamente o consumo alimentar de macro e micronutrientes e identificar as alterações bioquímicas de pacientes queimados. Método: O estudo é descritivo, analítico/inferencial e transversal, realizado no Centro de Tratamento de Queimados de um hospital de referência, Ananindeua/Pará, de agosto a outubro de 2014, com amostra de 25 pacientes. As variáveis foram: número de prontuário, sexo, faixa etária, percentual de área queimada, tipo de queimadura, consumo alimentar de macro e micronutrientes e dados bioquímicos. Adotou-se a estatística descritiva (média e desvio-padrão) para os dados quantitativos; e a estatística inferencial por meio do teste t de Student para comparação entre as médias das variáveis, com nível de significância de 95% (p <0,05). Resultados: Houve maior prevalência no gênero masculino (60%); faixa etária entre 20 a 30 anos (44%); queimadura de origem térmica (76%). Comparando as médias dos valores da 1ª e 2ª avaliações bioquímicas, de acordo com o tipo de queimadura, observou-se alterações entre as duas avaliações. Porém, somente leucócitos, linfócitos e contagem total de linfócitos apresentaram significância estatística. A média de ingestão de carboidratos teve um percentual abaixo do valor recomendado, e de proteínas e lipídios acima do preconizado. Quanto aos micronutrientes, a ingestão de zinco, selênio, vitamina C e vitamina E ficou abaixo do recomendado; porém, a vitamina A estava de acordo com o valor referencial. Houve significância estatística (p <0,05) para todas as análises do consumo alimentar. Conclusão: As variáveis analisadas possibilitaram verificar as alterações bioquímicas e do consumo alimentar, permitindo, assim, possíveis estratégias de intervenções nutricionais.

Objective: To quantitatively analyze the macro and micronutrients food consumption and identify the biochemical changes of burn patients. Method: The study is descriptive, analytical/inferential and cross, held in Burn Treatment Centre for a referral hospital, Ananindeua/Pará, from August to October 2014, with a sample of 25 patients. The variables were: number of records, sex, age, percentage of burned area, type of burn, macro and micronutrient food intake and biochemical data. It adopted the descriptive statistics (mean and standard deviation) for quantitative data; and inferential statistics through the Student t test to compare the means of variables, with significance level of 95% (p<0.05). Results: There was a higher prevalence in males (60%); aged between 20-30 years (44%); burn type of thermal origin (76%). Comparing the mean values of the 1st and 2nd biochemical evaluations, according to the type of burn, there was a change between the two evaluations. But only leukocytes, lymphocytes and total lymphocyte count were statistically significant. The average carbohydrate intake had a percentage below the recommended amount, and proteins and lipids above the recommended. The micronutrients, zinc intake, selenium, vitamin C and vitamin E below the recommended; However, vitamin A was in accordance with the reference value. There were statistically significant (p<0.05) for all analyzes of food consumption. Conclusion: The variables analyzed allowed to check the biochemical and food consumption changes; thus allowing possible strategies of nutritional interventions.

Objetivo: Analizar cuantitativamente el consumo de macro y micronutrientes de alimentos e identificar los cambios bioquímicos de los pacientes quemados. Método: El estudio es descriptivo, analítico/inferencial y transversal, realizado en centro de tratamiento de un hospital de referencia, Ananindeua/Pará, de agosto/ octubre de 2014. Las variables fueron: número de registros, el sexo, la edad, el porcentaje de la superficie quemada, tipo de quemadura, la ingesta de macro y micronutrientes y datos bioquímicos. Realizada estadística descriptiva (media y desviación-estándar) para datos cuantitativos; y estadística inferencial, t de Student, para comparar las medias de las variables, con un nivel de significación del 95% (p<0,05). Resultados: Participaron 25 pacientes. Se observó mayor prevalência en los hombres (60%) e con edades comprendidas entre 20-30 años (44%); quemadura de origen térmica (76%). En la comparación de los valores medios de la 1ª y 2º evaluación bioquímica, según el tipo de quemadura, se observó un cambio entre las dos evaluaciones. Pero sólo los leucocitos, linfocitos y recuento total de linfocitos fueron estadísticamente significantes. El consumo promedio de carbohidratos tuvo un porcentaje abajo de la cantidad recomendada, y las proteínas y los lípidos arriba de lo recomendado. Los micronutrientes, la ingesta de zinc, selenio, vitamina C y vitamina E abajo de lo recomendado. Sin embargo, la vitamina A estaba de acuerdo con el valor de referencia. Todos los análisis de consumo de alimentos fueron estadísticamente significantes (p<0,05). Conclusión: Las variables analizadas permitieron comprobar cambios bioquímicos y de consumo de alimentos; permitiendo así posibles estrategias de intervenciones nutricionales.

Perfil epidemiológico e nutricional de adolescentes grávidas internadas em um hospital de referência do estado do Pará / Epidemiological profile and nutritional status of pregnant adolescents admitted to a reference hospital of the state of Pará

Objetivo: identificar o perfil epidemiológico e situação nutricional de gestantes adolescentes internadas em um hospital de referência do Estado do Pará. Método: foram entrevistadas 72 adolescentes entre agosto e novembro de 2013, após assinatura de assentimento dos pais ou da adolescente maior de 18 anos. Foram coletados dados socioeconômicos (idade, renda familiar e escolaridade), antropométricos (altura, peso, semana gestacional e IMC) e ingestão alimentar através do QFA. Utilizado o programa Bioestat 5.4 para análise dos dados estatísticos. Resultados: a média de idade das ado-lescentes foi de 17 anos, apresentando baixa escolaridade, baixa renda e IMC adequado. Quanto ao consumo alimentar, mostraram-se adequados os grupos do arroz, pães e massas, carnes, leite e derivados, e feijão. O consumo de frutas, verduras e legumes foi pouco frequente. Refrigerantes, salgados e sanduíches, salgadinhos tipo chips e pipoca, bebida alcoólica, bebidas artificiais e doces e açúcar de adição foram evidentes. Conclusão: as adolescentes apresentaram média de 17 anos, baixa escolaridade, baixa renda e IMC adequado, porém o consumo alimentar mostrou-se impróprio, com elevado consumo de refrigerantes, bebidas artificiais e doces, salgados, sanduíches, salgadinhos e pipocas industrializadas e baixo consumo de frutas, verduras e legumes. O consumo de leite e derivados, carnes, feijão e o grupo alimentar de arroz, pães e massas estavam adequados. Revela-se a importância do acompanhamento nutricional da gestante adoles-cente, para evitar complicações no binômio mãe/bebê e proporcionar hábitos alimentares que irão seguir por toda vida.

Objective: Identify the epidemiological profile and nutritional status of pregnant adolescents admitted to a reference hospital in the state of Pará. Method: study was conducted at a reference hospital in the state for high risk pregnan-cies, teenagers were interviewed between August and November’s 2013, after signing a consent of parents or the teen is itself, if greater than 18 years. Socioeconomic data (age, family income and education) and anthropometric datas (height, weight, BMI and gestational week) were collected and food intake was collected using the FFQ. The Bioestat 5.4 program was used to analysis of the statistics data. Results: The mean age of the adolescents was 17 years, had low education, low income and adequate BMI. In relation to food intake, showed-up appropriate groups of rice, bread and pasta, meat, dairy products and beans. The consumption of fruits and vegetables was unusual. Soft drinks, snacks and sandwiches, snacks like chips and popcorn, alcohol, artificial drinks and sweets, and added sugar were still evi-dent in the diet of pregnant adolescents. Conclusion: The adolescents had an average of 17 years, low education, low income and adequate BMI, but food consumption was found to be improper, with high consumption of soft drinks, artificial drinks and sweets, snacks, sandwiches, snacks and popcorn industrialized and low consumption of fruits and vegetables. The consumption of dairy products, meat, beans and the food group of rice, bread and pasta were adequate. Is revealed of nutritional monitoring of pregnant teenagers, to avoid complications in the binominal mother / baby and provide food habits that will follow for life.

Different equations for determining height among the elderly: the Bambuí cohort study of aging / Diferentes equações para determinação da estatura em idosos: estudo de coorte de idosos de Bambuí

The aim of this study was to compare measured height with estimates of height derived from equations using half arm-span measurements and assess how this affects the calculation of the body mass index (BMI) among elderly individuals. Direct height measurements of a subsample of elderly individuals from the baseline sample of the Bambuí Project were compared with estimates of height derived from equations proposed by Bassey and the WHO. The data was analyzed using the McNemar test, Lin concordance correlation coefficient (CCC) and Bland-Altman method (p < 0.05). Estimates of height using the WHO method showed a low CCC in relation to measured height. For BMI, the concordance was greater. However, with this method height was found to be underestimated so leading to the overestimation of BMI. The Bassey equation showed high concordance with measured height in elderly people over 80 years of age. With respect to BMI, the WHO method resulted in a much greater prevalence of overweight, whereas the estimates derived from the Bassey method did not differ from the results obtained from direct height measurement. Height estimates using the Bassey equation were similar to the results obtained from direct measurements, suggesting that this method is applicable.

O objetivo foi comparar a estatura mensurada com a obtida por equações baseando-se na semienvergadura do braço, e avaliar o impacto sobre o índice de massa corporal (IMC). Comparou-se a medida direta da estatura e a obtida pelas equações propostas por Bassey e pela Organização Mundial da Saúde (OMS), em subamostra de idosos da linha de base do Estudo de Coorte de Idosos de Bambuí. A análise constou de testes de McNemar, coeficientes de correlação de concordância de Lin (CCC) e método de Bland & Altman (p < 0,05). Pela fórmula da OMS verificou-se baixo CCC para altura mensurada e concordância superior para IMC. Constatou-se subestimação da altura e consequente superestimação do IMC. Na fórmula de Bassey foi encontrada forte concordância com a altura mensurada em idosos com mais de 80 anos. Para o IMC (OMS) observou-se prevalência bastante superior de sobrepeso. Já a prevalência de sobrepeso (Bassey) não diferiu daquela obtida pela medida direta. A estimativa da altura obtida pela fórmula de Bassey foi semelhante à medida direta, sugerindo aplicabilidade. Já a fórmula da OMS parece subestimar a altura.

Relationship between serum myostatin and gastric carcinoma-associated cachexia / 中华临床营养杂志

Objective To observe the changes of serum myostatin (MSTN) level in patients with gastric carcinoma-associated cachexia and to investigate the relationship between MSTN and tumor necrosis factor α (TNF-α) preliminarily.Methods Eighty patients with gastric cancer were divided into two groups based on their Patient-Generated Subjective Global Assessement (PG-SGA) scores:gastric carcinoma-associated cachexia group (GCC group,32 cases; PG-SGA stage C) and gastric carcinoma non-cachexia group (GCNC,48 cases; PG-SGA stage A + B).The serum MSTN and TNF-α levels were measured by enzyme linked immunosorbent assay,and relevant parameters including height,weight,albumin,hemoglobin,and C-reactive protein were also recorded before operation.Eighty healthy adults were chosen as the control group.Results The serum MSTN level in the GCC group [(1.36 ±0.50) μg/L] was significantly higher than that in the GCNC group [(0.91 ±0.49) μg/L; x2 =14.67,P =0.00],whereas the serum MSTN level in the GCNC group was significantly higher than that in the control group [(0.70 ± 0.37) μg/L; x2 =36.45,P =0.00].Serum MSTN level was not correlated with TNF-α in the GCC group (r=0.18,P=0.31),GCNC group (r=0.08,P=0.58),or control group (r=-0.16,P＝0.16).Conclusions Serum MSTN level is elevated in patients with gastric carcinoma-associated cachexia.However,it is not correlated with serum TNF-α.

Reliability and Validity of the Chinese Version of the Test of Everyday Attention (TEA) among Normal Chinese People / 中国康复理论与实践

@#Objective To explore the reliability and validity of the Chinese version of the Test of Everyday Attention (TEA) in normal Chinese people. Methods 117 normal volunteers (18～65 years old) were screened with the Montreal Cognition Assessment (MoCA), and the normal volunteers were administered to TEA (versions A), Trail Making Test B (TMT-B), Paced Auditory Serial Addition Task (PASAT), Stroop Color-Word Interference Test (SCWT), Continuous Performance Test (CPT). 20 normal volunteers were also given version B for testing of the test-retest reliability, time interval was 2 weeks between versions A and B. Results There was correlation between versions A and B in the major subtests (r>0.700, P<0.01) at a two-week interval. The varimax rotation principal-component analysis extracted 4 component factors, namely sustained attention, se lective attention, switching attention, and divided attention. The factors included various subtests of TEA and the other laboratory attentional test. Conclusion TEA has good reliability and validity.

FM listening evaluation for children: adaptação para a língua portuguesa / FM listening evaluation for children

INTRODUÇÃO: A inclusão do deficiente auditivo na escola é assegurada pelo poder público no Brasil por documentos oficiais e o sistema FM é um instrumento da tecnologia assistiva que o professor deve ter acesso. OBJETIVO: traduzir e adaptar para a Língua Portuguesa o questionário FM Listening Evaluation for children. MÉTODOS: A tradução e adaptação do questionário FM Listening Evaluation incluíram a tradução para o idioma português, adaptação lingüística e revisão das equivalências gramatical e idiomática e adaptação; também foi avaliada a reprodutibilidade intra-pesquisadores. O questionário foi aplicado nos professores e na fonoaudióloga de 12 crianças de sete a treze anos deficientes auditivas, usuárias de Aparelho de Amplificação Sonora Individual e adaptadas com sistema FM. RESULTADOS: A tradução e adaptação do questionário resultaram no novo inventário:AVALIAÇÃO DO SISTEMA FM, apresentando diferença significativa entre os resultados de ruído e: via auditiva e silêncio; - distância e: via auditiva e silêncio; - via auditiva e: ruído, distância e silêncio; - silêncio e: ruído, distância e via auditiva. Houve diferença significativa sem e com o Sistema FM, sendo que neste a pontuação foi sempre maior. Na comparação intrapesquisadores evidenciou-se diferença significativa entre: pontuação total com FM; via auditiva sem FM e ruído com FM. CONCLUSÃO: O questionário Avaliação do Sistema FM foi considerado um instrumento confiável para verificação e acompanhamento dos benefícios do Sistema FM podendo favorecer assim o processo de inclusão escolar do aluno deficiente auditivo.

INTRODUCTION: The inclusion of children with hearing impairments in schools is guaranteed by the Brazilian government by means of official legislation. The FM system is an assistive technology instrument to which regular teachers should have access. OBJECTIVE: To translate and adapt to Portuguese the FM Listening Evaluation questionnaire for children and assess its reliability. METHODS: The translation and adaptation to the FM Listening Evaluation included translation into Portuguese, linguistic adaptation and revision of the grammatical and idiomatic equivalences and adaptation; inter-researcher reproducibility was also evaluated. The questionnaire was administered to the teachers and speech-language pathologists of 12 children aged seven to thirteen years with hearing impairment; the children used hearing aids and had been adapted to the FM system. RESULTS: The translation and adaptation of the questionnaire resulted in new inventory: FM EVALUATION SYSTEM, presenting a significant difference between the results of noise and: hearing pathways and silence; - distance and: hearing pathways and silence; - hearing pathways and: noise, distance and silence; - silence and: noise, distance and hearing pathways. There was significant difference with and without the FM system, in which the score was always higher. Intra-examiner comparison revealed a significant difference between the total score with FM, via FM and hearing no noise with FM. CONCLUSION: The questionnaire Rating System FM was considered a reliable instrument for verifying and monitoring the benefits of FM system, in order to promote the process of educational inclusion for students with hearing impairments.

Desempenho de crianças com fenilcetonúria no Teste de Screening de Desenvolvimento Denver - II / Performance of children with phenylketonuria in the Developmental Screening Test - Denver II

TEMA: desempenho de crianças com PKU no Teste de Screening de Desenvolvimento Denver - II. Introdução: a fenilcetonúria é uma desordem autossômica recessiva resultante da mutação do gene localizado no cromossomo 12q22.24.1. OBJETIVO: caracterizar o desempenho de crianças com fenilcetonúria diagnosticadas e tratadas precocemente por meio do Teste de Screening de Desenvolvimento Denver II e dos níveis de fenilalanina sanguíneos. MÉTODO: participaram 20 crianças, dez com fenilcetonúria, diagnosticadas e tratadas desde o nascimento, de idade cronológica entre três a seis anos, e dez crianças do grupo típico, pareadas quanto ao sexo, idade e nível socioeconômico. Os níveis sanguíneos e as informações neurológicas, psicológicas e sociais foram obtidas no banco de dados do Programa de Triagem Neonatal para Erros Inatos do Metabolismo. A avaliação constou da aplicação do Teste de Screening de Desenvolvimento Denver-II. Utilizou-se estatística descritiva e aplicação do teste estatístico de Mann Whitney para a caracterização das habilidades. Para as medições dos níveis plasmáticos sanguíneos de fenilalanina considerou-se os valores abaixo de 2mg/dL, acima de 4mg/dL, os valores de referência entre 2 e 4mg/dL, de todos os exames realizados no decorrer da vida dos participantes, os valores mínimos e máximos e o valor obtido na época da avaliação fonoaudiológica. Resultado: A comparação entre os grupos foi estatisticamente significante nas áreas pessoal-social e de linguagem. CONCLUSÃO: crianças com fenilcetonúria diagnosticadas e tratadas precocemente apresentaram prejuízo nas áreas pessoal-social e de linguagem e, mesmo com o acompanhamento periódico, apresentaram dificuldades para manter os níveis de normalidade de fenilalanina, embora realizassem o tratamento recomendado.

BACKGROUND: phenylketonuria is an autosomal recessive disorder resulting from the mutation of a gene located in chromosome 12q22-24.1. AIM: to describe the performance of children with classic phenylketonuria, who were diagnosed and treated early, in the Development Screening Test Denver - II. METHOD: participants were 20 children with phenylketonuria, ranging in age from 3 and 6 years, and 10 children with typical language development, paired by gender, age and socioeconomic level to the research group. The plasmatic phenylalanine measure and the neurological, psychological and social information were gathered in the data base of the Neonatal Screening Programs for Metabolic disorder. Assessment consisted on the application of the Development Screening Test Denver II. A descriptive statistical analysis and the Mann Whitney test were used in order to characterize the tested skills. For the measurements of the plasmatic phenylalanine blood levels the values considered for analysis were: below 2mg/dL, above 4mg/dL, reference values between 2 and 4mg/dL, of all exams performed during the participants'lives; maximum and minimum values and values obtained on the day of the screening application. RESULTS: comparison between the groups indicated statistically significant differences for the personal-social and language areas. CONCLUSION:children who were diagnosed and treated early for phenylketonuria present deficits in the personal-social and language areas. Also, even when receiving follow-up and undergoing treatment, these children presented difficulties in maintaining normal plasmatic phenylalanine levels.

O bibliotecário e o compartilhamento de saberes e informação no contexto da avaliação de tecnologias de saúde / The librarian and sharing of knowledge and information in the assessment of health technologies

Esta pesquisa discute a participação do bibliotecário na formação de equipes multidisciplinares dos grupos de Avaliação de Tecnologias em Saúde (ATS), caracterizando sua atuação num novo campo que se abre para os bibliotecários em instituições de pesquisa. O objetivo geral baseia-se na criação de uma Biblioteca Digital (BD) com os parâmetros de qualidade da informação inerentes a ATS, a partir dos documentos gerados pelo Serviço de Comutação Bibliográfica (SCB) da Rede de Bibliotecas da FIOCRUZ, recomendando a inserção do bibliotecário na equipe multidisciplinar para ATS. A metodologia foi dividida em três partes: levantamento do estado da arte do conhecimento produzido na Saúde Coletiva, onde se insere a Avaliação de Tecnologias em Saúde, e da Ciência da Informação, pesquisa exploratória com uma abordagem qualitativa para coleta de dados junto ao grupo de pesquisadores de ATS de diversas instituições públicas e privadas e uma abordagem quantitativa para coleta de dados dos profissionais do SCB da Rede de Bibliotecas da Fiocruz e análise dos dados. Verificou-se que existe uma participação ativa do bibliotecário nas atividades de ATS, no que diz respeito, à formulação de estratégias de busca em base de dados, revisão de protocolos de busca, localização de publicações relevantes, auxílio para realização de revisões sistemática para os grupos de pesquisa. Pressupõe a criação de uma BD permitindo o compartilhamento de todos os documentos digitais gerados pelas bibliotecas. Com essa iniciativa pretende-se contribuir para impulsionar a produção do conhecimento científico e tecnológico na área da saúde e de ATS.

This research discusses the librarian's participation in the formation ofmultidisciplinary groups of Health Technology Assessment (HTA), characterizing its performance in a new field that opens to librarians in research institutions. The main objective is based on the creation of a Digital Library (DL) with quality parameters of information related to HTA, from documents created by the service of bibliographic Library Network Fiocruz, showing the necessity of the librarian in the multidisciplinarygroup to HTA. The methodology was divided into three parts: data collection of the art of knowledge produced in Collective Health, where the Evaluation of Health Technologies, and Information Science is, exploratory research with a qualitative approach to data collection with the group of HTA researchers from several private and public institutions and a qualitative approach to data collection of the Library Network Fiocruz professionals and data analysis. It was noted that there is an activeparticipation of the librarians in HTA activities, formulating database searchstrategies, reviewing search protocols, locating relevant publications, helping locating systematic reviews to the search groups. This preuposes creation of a DL sharing all the digital documents created by the libraries. This initiative aims to contribute to boosting the production of scientific and technological knowledge in the health and HTA.

A Preliminary Study on the Effect of "Low-dose" Glucocorticoid Therapy for Patients with Persistent Acute Respiratory Distress Syndrome / 대한구급학회지

BACKGROUND: The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS. METHODS: We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days' duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy. RESULTS: Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy. CONCLUSIONS: This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.

Clinical Variables Indicating Cervical Abscess in Adult Patients Diagnosed with Deep Neck Infection

PURPOSE: We evaluated a method to distinguish group A (abscess) from group B (cellulitis, pharyngitis, tonsillitis, epiglottis) through clinical variables in patients with a deep neck infection. METHODS: This was a retrospective chart review study consisting of the evaluation of CT scans or surgical diagnoses on adult patients (18 or more years of age). CT scans were reviewed by a radiologist. We evaluated several clinical variables in order to distinguish group A from group B. We also evaluated the ability of these clinical variables to distinguish group A from group B by a receiver operating characteristic curve. RESULTS: Sixty-three patients were enrolled in this study. Several clinical variables (swelling, odynophagia, tenderness, trismus, age>50years) differed between group A and group B. A AUC which was obtained by adding the number of variables (swelling, odynophagia, tenderness, trismus, age>50years) was 0.87 (p50, swelling, odynophagia, tenderness, trismus) were able to distinguish group A from group B.