Acidose metabólica crónica de causa renal e crescimento

Dissertação de Doutoramento em Medicina, área de especialização em Pediatria, apresentada à Faculdade de Medicina da Universidade do Port

Cardiovascular rhythmicity in overweight and obese children

Abstract Introduction: Obesity is thought to play a role in the disruption of cardiac rhythmicity in obese children, but this is mostly an unexplored field of investigation. We aimed to evaluate the impact of overweight and obesity on circadian and ultradian cardiovascular rhythmicity of prepubertal children, in comparison with normal weight counterparts. Methods: We performed a cross sectional study of 316 children, followed in the birth cohort Generation XXI (Portugal). Anthropometrics and 24-hour ambulatory blood pressure were measured and profiles were examined with Fourier analysis for circadian and ultradian blood pressure (BP) and heart rate (HR) rhythms. Results: Overweight/obese children presented more frequently a non-dipping BP pattern than normal weight counterparts (31.5% vs. 21.6%, p = 0.047). The prevalence of 24-hour mean arterial pressure (MAP) and 8-hour HR rhythmicity was significantly lower in obese children (79.3% vs. 88.0%, p = 0.038 and 33.3% vs. 45.2%, p = 0.031, respectively). The prevalence of the remaining MAP and HR rhythmicity was similar in both groups. No differences were found in the median values of amplitudes and acrophases of MAP and HR rhythms. Discussion: The alterations found in rhythmicity suggest that circadian and ultradian rhythmicity analysis might be sensitive in detecting early cardiovascular dysregulations, but future studies are needed to reinforce our findings and to better understand their long-term implications

Decreased renal function in overweight and obese prepubertal children

BACKGROUND: Obesity is a potentially modifiable risk factor for the development and progression of kidney disease, both in adults and children. We aim to study the association of obesity and renal function in children, by comparing estimated glomerular filtration rate (eGFR) in nonoverweight and overweight/obese children. Secondarily, we aim to evaluate the accuracy of equations on eGFR estimation when compared to 24-h urinary creatinine clearance (CrCl). METHODS: Cross-sectional study of 313 children aged 8-9 y, followed in the birth cohort Generation XXI (Portugal). Creatinine and cystatin C, GFR estimated by several formulas and CrCl were compared in 163 nonoverweight and 150 overweight/obese, according to World Health Organization growth reference. RESULTS: Overweight/obese children had significantly lower eGFR, estimated by all methods, except for CrCl and revised Schwartz formula. Despite all children having renal function in the normal range, eGFR decreased significantly with BMI z-score (differences ranging from -4.3 to -1.1 ml/min/1.73 m(2) per standard deviation of BMI). The Zappitelli combined formula presented the closest performance to CrCl, with higher correlation coefficients and higher accuracy values. CONCLUSION: Young prepubertal children with overweight/obesity already present significantly lower GFR estimations that likely represent some degree of renal impairment associated with the complex deleterious effects of adiposity

Sex-Specific Mediating Role of Insulin Resistance and Inflammation in the Effect of Adiposity on Blood Pressure of Prepubertal Children

Objective: To evaluate the association between obesity indices and blood pressure (BP) at 4 years of age, in each sex, and to quantify to which extent this association is mediated by inflammation and insulin resistance (IR). Materials and Methods: We studied 1250 4-year-old children selected from the population-based birth cohort Generation XXI. Associations between body mass index (BMI) z-score and waist-to-height ratio (WHtR), office BP, inflammation (high sensitivity C-reactive protein) and IR (HOMA-IR index) were assessed. Path Analysis, a modified multivariate regression approach, was applied to test causal models and quantify direct and indirect effects of predictors of systolic (SBP) and diastolic BP (DBP). Results: SBP and DBP increased significantly with BMI and WHtR in both sexes. There was a strong direct association (explaining 74.1-93.2% of the total association) of both measures of adiposity with SBP, in both sexes. This association was additionally indirectly mediated by IR, particularly regarding WHtR (20.5% in girls and 9.4% in boys). Mediation by inflammation did not reach statistical significance in either sex. Regarding DBP, the direct effect of adiposity was strong (>95% for BMI and WHtR in boys) and the mediation by IR was much smaller in boys than in girls. Discussion: The direct association between adiposity and BP in healthy 4-year-old children is strong and IR plays an important mediating role. The strength of effects of IR and inflammation suggests sex differences in the complex interplay between BP, adiposity and inflammation

A Essência da Pediatria

Contrariamente ao que sucedeu com outras especialidades,a pediatria e as suas áreas específicas não constituemuma especialidade cujo único enfoque seja oestudo das doenças de um órgão ou sistema. Dedica-seà criança e ao adolescente no seu todo, de forma holísticae integral

Evolução dos Cuidados de Saúde em Portugal e Seu Impacto na Mortalidade Infantil no Século XX: Date of submission: 24-06-2017 | Date of acceptance: 16-07-2017 | Published: 20-04-2018

A mortalidade infantil em Portugal diminuiu de uma forma espantosa ao longo do século XX, sendo objetivado uma queda de cerca de 90% da taxa de mortalidade infantil. Este indicador, um clássico em saúde pública, reflete não só as causas biológicas da morte infantil, mas também as causas de ordem social, económica e ambiental. É por isso curioso perceber o que se passou no último século que permitiu esta melhoria espantosa, tendo a evolução na área da medicina e as mudanças políticas e sociais sem dúvida um impacto decisivo.&nbsp

Síndrome hipertensiva hiponatrémica em criança de quatro anos

Resumo: A síndrome hipertensiva hiponatrémica (SHH) é uma forma rara de apresentação da doença renovascular em idade pediátrica. Descrevemos o caso de uma menina de quatro anos transferida para a Unidade de Cuidados Intensivos Pediátricos por quadro de cefaleias, prostração e convulsões generalizadas, sem febre. Apresentava hipertensão arterial (HTA) grave e alterações hidroelectrolíticas características, pelo que se fez o diagnóstico de SHH. O estudo etiológico realizado culminou no achado de estenose da artéria renal direita. A angioplastia, realizada como opção terapêutica, levou à reversão completa do quadro clínico em pouco tempo. A relevância deste caso reside na importância de uma avaliação de rotina da tensão arterial, que pode contribuir para o diagnóstico precoce e redução da morbilidade e mortalidade associadas ás formas de HTA grave na criança