Padrões alimentares de mulheres em idade reprodutiva: realidade na Zona da Mata nordestina / Eating patterns among women of reproductive age: reality in the Zona Mata, Northeastern Brazil

Objetivo: Verificar os padrões alimentares e os fatores associados de mulheres em idade reprodutiva. Métodos: Trata-se de estudo transversal realizado com 322 mulheres de 12 a 49 anos, residentes em Vitória de Santo Antão, Zona da Mata de Pernambuco, através de busca ativa nos domicílios. Os setores censitários foram sorteados de forma aleatória simples, abrangendo as unidades de saúde pertencentes à Estratégia de Saúde da Família. A partir do Questionário de Frequência Alimentar, identificaram-se os padrões alimentares, categorizados em baixo consumo, 1º e 2º tercil, e alto consumo, tercil superior. As variáveis independentes analisadas foram as sociodemográficas, de estilo de vida e de saúde. Resultados: Do grupo estudado, 59,3% tinham entre 20 e 39 anos e 60,9% apresentavam excesso de peso. Verificaram-se três padrões alimentares: Saudável, Comum Típico Brasileiro e Fast-food. As mulheres com idade ≥ 40 anos consumiam aproximadamente três vezes mais alimentos do padrão Saudável, quando comparadas àquelas com idade ≤ 19 anos. Em contraste, aquelas com idade ≥ 40 anos apresentaram menor probabilidade de consumir alimentos do padrão Fast-food do que as mais jovens (≤ 19 anos). Verificou-se ainda que mulheres com escolaridade superior a oito anos tinham maior probabilidade de consumir alimentos do padrão Fast-food quando comparadas aquelas com ≤ 4 anos de estudo. Conclusões: As mulheres mais jovens e as de maior escolaridade apresentaram um consumo elevado do padrão alimentar Fast-food, em comparação às mais velhas e de menor escolaridade, respectivamente. (AU)

Objective: To analyze eating patterns and associated factors in women of reproductive age. Methods: This is a cross-sectional study conducted with 322 women aged 12 to 49 years old, residing in Vitória de Santo Antão, Pernambuco's Zona da Mata, Brazil, through active household survey. Census sectors were drawn in a simple and random manner, covering the health units belonging to the Family Health Strategy. The Eating Frequency Questionnaire allowed identifying eating patterns, categorized into low consumption, 1st and 2nd terciles, and high consumption, higher tercile. The independent variables analyzed were sociodemographic, lifestyle and health. Results: Within the studied group, 59.3% of the women were aged between 20 and 39 years old, and 60.9% had excessive weight. Three eating patterns were observed: Healthy, Brazilian-Typical Common, and Fast-Food. Women aged ≥ 40 years old consumed approximately three times more food of the Healthy pattern compared to those aged ≤ 19 years old. On the other hand, those aged ≥ 40 were less likely to consume foods of the Fast-Food pattern than the younger ones were (≤ 19 years old). Moreover, women with more than eight years of education were more likely to consume foods of the Fast-Food pattern compared to those with ≤ 4 years of education. Conclusions: Younger and better educated women presented a high consumption of foods characterizing the Fast-Food eating pattern compared to older and less educated ones, respectively. (AU)

Risco e evolução do estado nutricional de adultos e idosos hospitalizados com distúrbios neurológicos / Risk and evolution of nutritional state of adults and elderly hospitalized with neurological disorders

INTRODUÇÃO: A triagem de risco associada à identificação do estado nutricional garante o diagnóstico precoce da desnutrição favorecendo o tratamento efetivo. A desnutrição em indivíduos hospitalizados é comum, afetando diretamente o risco nutricional, prognóstico da doença e aumentando o tempo de internação. OBJETIVO: Identificar o risco e a evolução do estado nutricional de adultos e idosos hospitalizados com distúrbios neurológicos. MÉTODOS: Estudo de caráter longitudinal e retrospectivo, desenvolvido na clínica neurológica de um hospital universitário do Recife-PE, de Janeiro a Agosto de 2018. A triagem nutricional pela Nutritional Risk Screening (NRS-2002) foi realizada em até 72 horas da admissão. Os pacientes foram avaliados na admissão e alta por meio das medidas antropométricas: peso, estatura e circunferência do braço. As análises estatísticas foram realizadas pelo Statistical Package for Social Sciences (SPSS) 21.0. RESULTADOS: Participaram do estudo 86 pacientes, o risco nutricional esteve presente em 53,5% da amostra. A média do tempo de internação foi de 22,3 +/- 14,4 dias. Houve uma associação estatisticamente significante entre a triagem de risco nutricional, o índice de massa corporal e a circunferência do braço, tanto na admissão quanto na alta. Foi evidenciada associação entre o risco nutricional e o período de internamento. DISCUSSÃO: É bem relatado na literatura que a hospitalização prolongada está associada a um maior risco de desnutrição. Fatores como a redução da ingestão alimentar associada ao aumento das necessidades energéticas e protéicas e falha na identificação do risco nutricional podem predispor ao aumento das taxas de desnutrição hospitalar. CONCLUSÃO: O risco nutricional foi presente em mais da metade da amostra estudada. Houve associação estatisticamente significante entre a triagem de risco nutricional, os parâmetros antropométricos e o período de permanência hospitalar. Quanto à evolução do estado nutricional, a maioria dos indivíduos adultos e idosos apresentou diagnóstico de eutrofia na admissão e alta

INTRODUCTION: Risk screening associated with the identification of nutritional states ensures the early diagnosis of malnutrition nutrition favoring effective treatment. Malnutrition in hospitalized individuals is common, directly affecting the nutritional risk, disease prognosis and increasing the length of stay. OBJECTIVE: Identifying the risk and the evolution of the nutritional states of hospitalized adults and elderly people with neurological disorders. METHODS: A longitudinal and retrospective study, developed at the neurological clinic of a university hospital in Recife, Brazil, from January to August 2018. Nutritional Screening by Nutritional Risk Screening (NRS 2002) was carried out within 72 hours of admission. Patients were assessed at admission and discharge by means of anthropometric measurements: weight, height and arm circumference. It was performed Statistical analyzes by the Statistical Package for Social Sciences (SPSS) 21.0. RESULTS: The study included 86 patients, the nutritional risk was present in 53.5% of the sample. The mean length of hospital stay was 22.3 +/- 14.4 days. There was a statistically significant association between nutritional risk screening, body mass index and arm circumference, both at admission and at discharge. It was evidenced an association between nutritional risk and hospitalization period. DISCUSSION:It is well reported in the literature that prolonged hospitalization is associated with an increased risk of malnutrition. Factors such as the reduction of food intake associated with increased energy and protein requirements and failure to identify the nutritional risk may predispose to increased hospital malnutrition rates. CONCLUSION: The nutritional risk was present in more than half of the sample studied. There was a statistically significant association between nutritional risk screening, anthropometric parameters and the length of hospital stay. Regarding the evolution of nutritional status, the majority of adult and elderly individuals presented a diagnosis of eutrophic on admission and discharge

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Successful Handling of Disseminated BCG Disease in a Child with Severe Combined Immunodeficiency.

In high-burden countries, Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccine is administered in newborn to prevent severe Mycobacterium tuberculosis infection. Because life-threatening disseminated BCG disease may occur in children with primary immunodeficiency, vaccination strategy against tuberculosis should be redefined in non-high-burden countries. We report the case of a patient with X-linked severe combined immunodeficiency (SCID) who developed disseminated BCG disease, highlighting the specific strategies adopted.

[Pediatric inflammatory bowel disease: is it still increasing?]. / Doença inflamatória intestinal pediátrica: uma patologia em crescendo?

INTRODUCTION: Crohn's disease (CD), Ulcerative Colitis (UC) and Indeterminate Colitis (IC), commonly known as Inflammatory Bowel Disease (IBD) represent a heterogeneous group of chronic diseases of unknown origin and varying course, diagnosed in pediatric age at 25 to 30% of cases. Epidemiological international studies studies show IBD incidence has increased exponentially in industrialized nations over the last 50 years. OBJECTIVES: Characterization of the pediatric population diagnosed with IBD, followed at medical consultation in Gastroenterology at Hospital de Dona Estefânia (HDE). MATERIAL AND METHODS: Descriptive and retrospective study by consulting the medical files of patients diagnosed with IBD followed between 1987 and 2009 (23 years). Clinical, radiological and histological criteria were used to define IBD. The following variables were studied: sex, family history, race, characterization of IBD, age at diagnosis, time from onset of symptoms to diagnosis and clinical presentation. Four different periods of time were compared: 1987-1992, 1993-1998, 1999-2004 and 2005-2009. RESULTS: 100 children were included (51 female), of which 59% are CD, 38% UC and 3% IC. Family history of IBD was present in 7 cases, with no sex difference between UC and CD. During the period of time between 2005-2009, it was registered the highest number of new cases (55 total, mean: 11 cases / year) and between 1987-1992 the lowest (9, 1.5 cases / year). Time from onset of symptoms to diagnosis was highly variable, ranging from 9 months (1987-1992) to 4 months (2005-2009). Children's age at the time of diagnosis varied from 14 months to 17 years, with a mean of 10.5 years. The most common symptoms at time of presentation were abdominal pain, diarrhea, and hematochezia. CONCLUSION: IBD are a heterogeneous group of diseases, not always easy to diagnose and difficult to classify as diagnostic criteria are not always uniform. The results show the number of IBD new cases has been rising during the last two decades, mainly CD, with no difference between gender. Time from onset of symptoms to diagnosis has been decreasing although age at time of diagnosis and clinical presentation has showed no difference in the last 20 years.

[Bacterial meningitis. A rare cause]. / Meningite bacteriana. Uma etiologia pouco frequente.

BACKGROUND: Meningitis is an uncommon clinical manifestation of invasive infection by Streptococcus pyogenes. CASE REPORT: A four years-old female child, previously healthy, started a history of high fever, associated to right otorrhea, prostration and vomiting. On admission she was haemodynamically stable but prostrated, with stiff neck and right otorrhea. Laboratory evaluation showed leukocytosis with neutrophilia, thrombocytosis and high C-reactive protein. The cerebrospinal fluid (CSF) examination suggested bacterial meningitis and treatment with ceftriaxone was started. After Streptococcus pyogenes grew in the CSF, clindamycin was added. She completed 15 days of antibiotics and was discharged clinically recovered. No neurological or hearing sequelae were observed. CONCLUSIONS: Although the incidence of group A streptococcal meningitis seems to be low, invasive infection by this agent is raising. Despite the excellent evolution of this case, a fatal outcome or neurological sequelae can arise, even in healthy children.

[Eating disorders in adolescents - what to look for?]. / Perturbações do comportamento alimentar em adolescentes - o que procurar?

BACKGROUND: Increase in the incidence and prevalence of Eating Disorders have made it increasingly important that Health Care Professionals be familiar with the early detection and appropriate management of this group of disorders. OBJECTIVES: To characterize an adolescent population followed in Adolescent Medicine office visit of Pediatric Department in Leiria's Hospital with Eating Disorders for type of disorder, presence of alert signs and symptoms and risk factors for an early detection of disease. METHODS: Retrospective analytic study conducted by consulting clinical processes and first office visit questionnaires of adolescent population followed for Eating Disorders, between August 2005 and April 2008. Criteria of Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition were considered to define Eating Disorder type. RESULTS: Twenty two adolescents were included, with 20 girls. Five adolescents met all Anorexia Nervosa criteria and two met all Bulimia Nervosa criteria. The other 15 were included in Eating Disorder Not Otherwise Specified. All samples showed intense fear of gaining weight and 20 adolescents a disturbed body image. All adolescents confessed having restrictive eating attitudes, half had compensatory behaviors and four assume having recurrent episodes of binge eating. Almost all revealed some type of somatic complaint and 19 showed psychological symptoms. One third of this population had personal history of obesity/overweight. Most adolescents presented weight lost when observed in the first office visit. Six adolescents showed body weight under 85% of that expected. One third of postmenarche adolescents suffered from secondary amenorrhea. Half of adolescents reported dysfunctional family and one quarter had separate parents; eight adolescents had family history of mental illness. CONCLUSION: Most adolescents were included in the diagnosis of Eating Disorder Not Otherwise Specified, according with other studies in this age. This fact implies that in practice the suspicion of an Eating Disorder in an adolescent should not be restricted to the meeting of other categories criteria. For an early detection, relevance should be given to aspects like a weight loss even without an abnormal body mass index, an inappropriate eating attitude, a dissatisfaction with body image, associated with a multiplicity of psychosomatic complaints, in a dysfunctional family environment.

[Perinatal transmission of hepatitis C virus - Santo André Hospital, Leiria 2002-2006]. / Transmissão perinatal do vírus da hepatite C - Hospital Santo André, Leiria 2002-2006.

BACKGROUND: Vertical transmission of hepatitis C virus (HCV) is the main route of infection in children, occurring in few cases (five percent). Current recommendations for HCV screening include first anti-HCV testing at age > 18 months, reducing false positives and false negatives. Positive results must be confirmed by the presence of HCV RNA on two different occasions. AIMS: To characterize the population of children born to HCV-positive mothers, to identify risk factors for perinatal HCV transmission and to improve the approach to HCV screening. METHODS: The study was conducted in two phases. An analytic retrospective study enrolling children born to HCV-positive mothers between January 2002 and December 2006 was done, followed by a transversal analysis in order to repeat anti-HCV testing, in cases that didn't meet current recommendations for HCV screening and in those without any HCV screening. RESULTS: Fifty-nine children born to HCV-positive mothers in a total of 12 985 births were included, corresponding to a prevalence of 0,45%. A high rate of inadequate pregnancy surveillance, prematurity and low birth weight, mainly in children born to addicted mothers was found. A child with HCV infection without any risk factor for perinatal transmission was found. Among children with negative anti-HCV at age 18 months, half had done anti-HCV prior to nine months of age, all were positive. Children discharged because of negative anti-HCV at nine months of age were called in a second phase of the study, for new anti-HCV at age > 18 months. All were negative. CONCLUSIONS: Perinatal HCV transmission rate was 2,9%. There was no identified risk factor for perinatal transmission in the single case of HCV infection. A high rate of prematurity, low birth weight and inadequate surveillance of pregnancy was found, with statistical significance to relation with mother addiction. Regarding anti-HCV at age < 18 months, a high rate of false positives but no false negative results were found. This study has enabled the detection and correction of mistakes in the approach to HCV screening.