Livros eletr��nicos da ��rea m��dica com ��nfase em Pediatria

O artigo indica livros eletr��nicos de acesso gratuito na Internet destinados �� especialidade pedi��trica.

Pancreatite aguda em pediatria: revis��o sistem��tica da literatura

OBJETIVO: Descrever os principais aspectos epidemiol��gicos, cl��nicos, diagn��sticos e do tratamento de crian��as com pancreatite aguda. FONTES DOS DADOS: Realizada revis��o sistem��tica das bases de dados MEDLINE e SciELO nos ��ltimos 5 anos sobre pancreatite aguda em crian��as, bem como consultadas refer��ncias relevantes dos textos obtidos. S��NTESE DOS DADOS: Os casos de pancreatite aguda em crian��as recebem crescente aten����o nos ��ltimos anos, sendo verificado um aumento na incid��ncia da doen��a em diversos estudos. As principais etiologias em crian��as envolvem doen��a biliar, pancreatite secund��ria a medicamentos, pancreatite heredit��ria recorrente e trauma, sendo at�� 30% dos casos sem etiologia definida. O diagn��stico baseia-se na combina����o de aspectos cl��nicos, laboratoriais com eleva����o das enzimas acinares e testes radiol��gicos. Tratamento de suporte inicial, com reposi����o vol��mica adequada e corre����o dos dist��rbios metab��licos, al��m de terap��utica nutricional espec��fica, s��o os pontos fundamentais no manejo dos quadros agudos. Complica����es a longo prazo s��o incomuns, e as taxas de mortalidade, inferiores ��s da popula����o adulta. CONCLUS��O: O diagn��stico precoce e o manejo apropriado podem contribuir para a melhor evolu����o da crian��a com pancreatite e prevenir as complica����es imediatas e tardias relacionadas �� doen��a. Mais estudos s��o necess��rios para melhor elucidar aspectos relacionados ao diagn��stico cl��nico e radiol��gico da pancreatite em crian��as, bem como aspectos da terap��utica nutricional nessa faixa et��ria.

Availability of processed foods in the perimeter of public schools in urban areas

Objective: To assess the availability of food in relation to their degree of industrial processing and the types of food stores in the perimeters of elementary schools. Method: This is a cross-sectional study. 82 food stores located within a 500 m radius buffer of three public schools located in three distinct regions with different socioeconomic levels in the municipality of Santos, state of Sao Paulo, Brazil, were assessed. All streets within a 500-meter radius of the schools were covered, geographic coordinates were recorded and information about the stores and food items available were collected by direct observation and interview with store managers. Available food items were classified in relation to their degree of industrial processing as ultra-processed foods and minimally processed foods. Kernel's density maps were used to assess the degree of agglomeration of stores near the schools. Results: The stores that offered mostly ultra-processed foods were significantly closer to schools than those who offered mostly minimally processed foods. There was a significant difference between the availability of processed food in different types of stores and between the three regions assessed. Conclusions: The data found by this work evidences that children who attend the three public schools assessed are exposed to an environment that encourages the consumption of ultra-processed foods through easier access of these products in the studied stores.

Epidemiological aspects of tuberculosis in children and adolescents in Rio de Janeiro

Objective: To describe the epidemiological aspects of childhood tuberculosis (TB) in a Brazilian reference hospital. Methods: This was a retrospective study (1999-2008) of 473 subjects (0-14 year olds) with confirmed TB, or with clinical improvement by the fourth month of treatment under the unit's care, including the review of medical records, monitoring reports and notifications by the TB unit. Results: Among 473 TB cases included in the study, positive tuberculin skin test was observed in 52%, history of contact with a patient with pulmonary tuberculosis in 66%, mostly intra-household, and with the father/stepfather most commonly involved; and disseminated TB in 22%. The result of HIV testing was obtained in 265 (56%) cases, being positive in 45 (17%). The diagnosis of TB was confirmed in 31% of cases, most frequently in children older than 5 years, with negative tuberculin skin test, and in disseminated forms. Of the 65 cultures positive for TB performed in the study, drug sensitivity testing to anti-TB drugs was done in 30 (46%) clinical samples, among which 10 (33%) were resistant to one or more anti-TB drugs, and 2 (0.8%) were multi-drug-resistant. Among patients with confirmed pulmonary TB, 31% did not meet the criteria for starting anti-TB treatment according to the scores of the Ministry of Health (<= 25 points). Conclusion: The high proportion of drug-resistant TB and co-infection with HIV identified in this study highlight the necessity to carry out additional studies in order to evaluate the impact of TB control activities on childhood TB.

Wheezing in infants: frequency, clinical characteristics and treatment

Objective: To estimate the frequency and describe the clinical characteristics and respective treatments of previous history of wheezing. Methods: Infants aged 6-23 months with upper respiratory tract complaints and reporting previous wheezing were followed-up retrospectively. Data were registered on a validated standardized form. Results: Out of 451 infants, 164 (36.4%; 95%CI: 31.9-41.0) had a report of prior history of wheezing, 148 (32.8%; 95%CI: 28.5-37.4) during the first year of life. The mean age at the first episode of wheezing was 5.3 +/- 3.9 months. Among those who had had their first episode before 12 months of age, 38.5% reported 3 to 6 episodes and 14.2% > 6 episodes. Mean age at first episode was lower for those with a >= 3 episodes in comparison with those with <= 2 episodes (3.2 +/- 2.7 vs. 5.7 +/- 2.5 months, p < 0.001). Conclusion: One third of the infants reported wheezing during the first year of life. The earlier the first episode occurs, the more frequently wheezing recurs.

Encefalite anti-receptor N-metil-D-aspartato na inf��ncia

OBJETIVO: Discutir o diagn��stico diferencial das encefalites al��m daquelas de etiologia infecciosa, e alertar os pediatras para a possibilidade do diagn��stico de encefalite anti-receptor N-metil-D-aspartato (rNMDA) na popula����o pedi��trica, destacando suas principais caracter��sticas cl��nicas. DESCRI����O: Tr��s pacientes apresentaram-se com uma s��ndrome neuropsiqui��trica inicial seguida de encefalopatia e transtornos de movimento. As caracter��sticas neuropsiqui��tricas iniciais se desenvolveram ao longo de dias ou semanas, com mudan��as comportamentais, ansiedade, confus��o mental e regress��o da fala. Em seguida, os pacientes evolu��ram com dist��rbios de movimento, caracterizados por coreoatetose ou distonia, acometendo a regi��o orofacial e os membros. Ap��s a exclus��o das principais causas de encefalite, foram identificados anticorpos anti-rNMDA no soro e no l��quido cefalorraquidiano. N��o foram detectadas neoplasias durante a investiga����o etiol��gica. Os pacientes foram submetidos a imunossupress��o, e dois deles tiveram uma recupera����o neurol��gica completa. Um deles ainda apresenta uma postura dist��nica leve em um dos membros. COMENT��RIOS: Os sinais cl��nicos de encefalite anti-rNMDA em crian��as s��o semelhantes aos anteriormente descritos em adultos. Tumores geralmente n��o s��o detectados nessa idade. O diagn��stico de encefalite anti-rNMDA deve ser abordado ap��s a exclus��o de outras causas de encefalite na inf��ncia, como as de origem infecciosa. Pediatras devem estar atentos a essa condi����o autoimune pass��vel de tratamento.

Bioelectrical impedance vector analysis (BIVA) in stable preterm newborns

Objective: To observe the behavior of the plotted vectors on the RXc (R - resistance - and Xc - reactance corrected for body height/length) graph through bioelectrical impedance analysis (BIVA) and phase angle (PA) values in stable premature infants, considering the hypothesis that preterm infants present vector behavior on BIVA suggestive of less total body water and soft tissues, compared to reference data for term infants. Methods: Cross-sectional study, including preterm neonates of both genders, in-patients admitted to an intermediate care unit at a tertiary care hospital. Data on delivery, diet and bioelectrical impedance (800 mA, 50 kHz) were collected. The graphs and vector analysis were performed with the BIVA software. Results: A total of 108 preterm infants were studied, separated according to age (< 7 days and >= 7 days). Most of the premature babies were without the normal range (above the 95% tolerance intervals) existing in literature for term newborn infants and there was a tendency to dispersion of the points in the upper right quadrant, RXc plan. The PA was 4.92 degrees (+/- 2.18) for newborns < 7 days and 4.34 degrees (+/- 2.37) for newborns >= 7 days. Conclusion: Premature infants behave similarly in terms of BIVA and most of them have less absolute body water, presenting less fat free mass and fat mass in absolute values, compared to term newborn infants.

Admissions due to pneumonia and biomass burning: a spatial approach

Objective: To identify spatial patterns in rates of admission for pneumonia among children and relate them to the number of fires reported in the state of Mato Grosso, Brazil. Methods: We conducted an ecological and exploratory study of data from the state of Mato Grosso for 2008 and 2009 on hospital admissions of children aged 0 to 4 years due to pneumonia and on fires in the same period. Admission rates were calculated and choropleth maps were plotted for rates and for fire outbreaks, Moran's I was calculated and the kernel estimator used to identify "hotspots." Data were analyzed using TerraView 3.3.1. Results: Fifteen thousand six hundred eighty-nine children were hospitalized (range zero to 2,315), and there were 161,785 fires (range 7 to 6,454). The average rate of admissions per 1,000 inhabitants was 2.89 (standard deviation [SD] = 5.18) and the number of fires per 1,000 inhabitants was 152.81 (SD = 199.91). Moran's I for the overall number of admissions was I = 0.02 (p = 0.26), the index for rate of admission was I = 0.02 (p = 0.21) and the index for the number of fires was I = 0.31 (p < 0.01). It proved possible to identify four municipalities with elevated rates of admissions for pneumonia. It was also possible to identify two regions with high admission densities. A clustering of fires was evident along what is known as the "arc of deforestation." Conclusions: This study identified municipalities in the state of Mato Grosso that require interventions to reduce rates of admission due to pneumonia and the number fires.

Practices of use of nasal intermittent positive pressure ventilation (NIPPV) in neonatology in northeastern Brazil

Objective: To investigate the use of nasal intermittent positive pressure ventilation (NIPPV) in level three neonatal intensive care units (NICU) in northeastern Brazil. Methods: This observational cross-sectional survey was conducted from March 2009 to January 2010 in all level three NICUs in northeastern Brazil that are registered in the Brazilian Registry of Health Establishments (Cadastro Nacional de Estabelecimentos de Saude, CNES) of the Ministry of Health. Questionnaires about the use of NIPPV were sent to the NICU directors in each institution. Statistical analysis was conducted using the software Epi-Info 6.04 and double data entry. A chi-square test was used to compare variables, and the level of statistical significance was set at p <= 0.05. Results: This study identified 93 level three NICUs in northeastern Brazil registered in CNES, and 87% answered the study questionnaire. Most classified themselves as private institutions (30.7%); 98.7% used NIPPV; 92.8 % adapted mechanical ventilators for NIPPV and used short binasal prongs as the interface (94.2%). Only 17.3% of the units had a protocol for the use of NIPPV. Mean positive inspiratory pressure and positive end-expiratory pressure were 20.0 cmH(2)O (standard deviation [SD]: 4.47) and 5.0 cmH(2)O (SD: 0.84). Conclusion: NICUs in northeastern Brazil use nasal intermittent positive pressure ventilation, but indications and ventilation settings are not the same in the different institutions.

Manifesta����es orais em crian��as HIV, em Mo��ambique

O objetivo foi comparar conhecimento de homens idosos ao de adultos jovens sobre Aids, considerando escolaridade. Estudo epidemiol��gico, descritivo e de corte transversal, em que foram analisadas informa����es de 30 idosos e 62 adultos jovens sobre conceito, transmiss��o, preven����o, diagn��stico e tratamento de Aids, investigadas por entrevista estruturada baseada em question��rio validado padronizado. Para an��lise de conting��ncia e de vari��ncia, empregaram-se distribui����es de frequ��ncias e testes de Qui quadrado ou exato de Fisher e teste t de Student ou Mann-Whitney em n��vel de signific��ncia de 0,05. Foram empregados o teste de Mantel-Haenszel, em n��vel de signific��ncia de 0,05, e os Odds Ratio com intervalos de confian��a a 95%, para influ��ncia da escolaridade. Constataram-se percep����o individual de boa sa��de maior em jovens (61,3% contra 43,3% dos idosos) e atividade sexual maior em idosos (80% contra 62,9% dos jovens). Apesar disso foi menos frequente idosos afirmarem conhecimento satisfat��rio sobre Aids (26,7% contra 80,6% dos jovens); hist��ria de teste de HIV (13,3% contra 24,2% dos jovens) e ter recebido orienta����o sobre Aids (36,7% dos idosos e 98,4% dos jovens). Os idosos tinham informa����o insuficiente sobre HIV/Aids comparados a adultos jovens, refor��ando a necessidade de maior aten����o �� popula����o idosa.

Global gene expression profiling of oral cavity cancers suggests molecular heterogeneity within anatomic subsites

Abstract Background Oral squamous cell carcinoma (OSCC) is a frequent neoplasm, which is usually aggressive and has unpredictable biological behavior and unfavorable prognosis. The comprehension of the molecular basis of this variability should lead to the development of targeted therapies as well as to improvements in specificity and sensitivity of diagnosis. Results Samples of primary OSCCs and their corresponding surgical margins were obtained from male patients during surgery and their gene expression profiles were screened using whole-genome microarray technology. Hierarchical clustering and Principal Components Analysis were used for data visualization and One-way Analysis of Variance was used to identify differentially expressed genes. Samples clustered mostly according to disease subsite, suggesting molecular heterogeneity within tumor stages. In order to corroborate our results, two publicly available datasets of microarray experiments were assessed. We found significant molecular differences between OSCC anatomic subsites concerning groups of genes presently or potentially important for drug development, including mRNA processing, cytoskeleton organization and biogenesis, metabolic process, cell cycle and apoptosis. Conclusion Our results corroborate literature data on molecular heterogeneity of OSCCs. Differences between disease subsites and among samples belonging to the same TNM class highlight the importance of gene expression-based classification and challenge the development of targeted therapies.

An��lise cr��tica das recomenda����es do uso das vacinas meningoc��cicas conjugadas

OBJETIVOS: Analisar a epidemiologia da doen��a meningoc��cica no Brasil e o impacto que as recentes evid��ncias acumuladas com a incorpora����o das vacinas meningoc��cicas C conjugadas nos programas de imuniza����o podem ter nas diferentes estrat��gias de uso dessas vacinas. FONTES DOS DADOS: Revis��o nas bases de dados MEDLINE, SciELO e LILACS no per��odo de 2000 a 2011. S��NTESE DOS DADOS: No Brasil, a doen��a meningoc��cica �� end��mica, com ocorr��ncia peri��dica de surtos. Os maiores coeficientes de incid��ncia ocorrem em lactentes, sendo o sorogrupo C respons��vel pela maioria dos casos, motivando a introdu����o da vacina meningoc��cica C conjugada no Programa Nacional de Imuniza����es, em 2010, para crian��as menores de 2 anos. A introdu����o das vacinas meningoc��cicas C conjugadas nos programas de imuniza����o na Europa, Canad�� e Austr��lia mostrou-se efetiva, com dram��tica redu����o na incid��ncia de doen��a causada pelo sorogrupo C, n��o apenas nos vacinados, mas tamb��m em n��o vacinados. A efetividade em longo prazo dessas vacinas mostrou-se dependente de uma combina����o de persist��ncia de anticorpos, mem��ria imunol��gica e prote����o indireta. Recentes evid��ncias indicando que a persist��ncia de anticorpos n��o �� duradoura em crian��as pequenas imunizadas e que a mem��ria imunol��gica n��o �� r��pida o suficiente para proteg��-las contra a doen��a enfatizam a import��ncia da prote����o indireta para manuten����o da popula����o protegida. CONCLUS��ES: A r��pida queda de t��tulos de anticorpos em crian��as vacinadas nos primeiros anos de vida sugere a necessidade de incorporarmos doses de refor��o antes da adolesc��ncia, especialmente em locais como o Brasil, onde ainda n��o contamos com o efeito da prote����o indireta da popula����o.

Fotoprote����o t��pica na inf��ncia e na adolesc��ncia

OBJETIVO: A exposi����o �� luz solar na inf��ncia ocorre, frequentemente, de forma mais intensa do que em muitos adultos. Dados da literatura comprovam de maneira inequ��voca a associa����o desse comportamento social com o risco de desenvolvimento do melanoma maligno e do c��ncer cut��neo n��o melanoma mesmo na vida adulta. Al��m disso, o fotoenvelhecimento cut��neo �� semeado j�� na inf��ncia com a exposi����o solar inadequada. Esta revis��o tem como objetivo orientar os pediatras nas medidas adequadas de fotoprote����o t��pica nas crian��as e adolescentes, o que ir�� alterar de maneira positiva o futuro desses pacientes. FONTES DOS DADOS: Realizou-se uma revis��o da literatura indexada na base de dados MEDLINE/PubMed entre os anos de 1999 e 2012 sobre fotoprote����o na inf��ncia, selecionando-se como fonte os artigos de revis��o mais relevantes, do ponto de vista de abrang��ncia do tema fotoprote����o em crian��as e adolescentes, fotoprote����o e vitamina D, fototerapia na neonatologia e impacto no c��ncer cut��neo, bronzeamento artificial e c��ncer cut��neo. S��NTESE DOS DADOS: Crian��as e adolescentes devem adotar medidas adequadas de fotoprote����o para diminuir o risco de c��ncer cut��neo melanoma e n��o melanoma. CONCLUS��ES: H�� dados na literatura que suportam a associa����o de h��bitos de exposi����o solar segura e uso de fotoprotetores t��picos em crian��as e adolescentes com a redu����o da ocorr��ncia do c��ncer cut��neo.

Erros de utiliza����o de assentos de seguran��a infantil por menores de 4 anos

OBJETIVO: Analisar erros de utiliza����o de assentos de seguran��a infantil por crian��as matriculadas em creches e fatores relacionados. M��TODOS: Estudo observacional transversal de coleta de dados prospectiva e eixo anal��tico retrospectivo. RESULTADOS: Um total de 42,7% das crian��as apresentava erros de utiliza����o. O modelo de regress��o log��stica evidenciou maiores chances de erros na presen��a de duas ou mais crian��as no ve��culo (odds ratio = 5,10, p = 0,007) e menores n��veis de escolaridade e renda dos pais (renda e escolaridade m��dias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). CONCLUS��O: Os dados s��o coerentes com publica����es internacionais.