Ketogenic diet nutritional impact in the infantile difficult epilepsy of difficult control

Introdução: A dieta cetogênica caracteriza-se por ser hiperlipídica, normoprotéica e hipoglicídica, levando ao estado de cetose. O mecanismo da dieta cetogênica ainda não está claro, porém, têm-se demonstrado uma forma terapêutica adequada nos casos de epilepsia refratária com crises do tipo Tônico-clônico, crises parciais, mioclônicas, e crises de ausência. A dieta produz um estado crônico cetose, com efeito, anticonvulsivante. Objetivos: Analisar a importância da dieta cetogênica utilizada em crianças e adolescentes com epilepsia de difícil controle e que não respondem a terapia medicamentosa. Metodologia: A dieta foi iniciada com a hospitalização de crianças em jejum durante 36 a 48 horas, até entrarem em cetose (4+); quatro importantes itens necessários para o cálculo da dieta foram acompanhados: peso ideal, calorias por Kg de peso, proporção da dieta cetogênica (gordura/proteínas/carboidratos) e ingestão hídrica. Resultados: 12 crianças entre 6 a 17 anos foram submetidas à dieta cetogênica, 4 delas, até o presente momento, apresentaram redução nas crises e melhora em aspectos psicológicos e motores e melhora entre 70 – 100% na qualidade de vida. Uma das crianças com a Síndrome de Lennox Gestaut após dez dias de dieta chegou ao ambulatório tendo um controle das crises e balbuciando as primeiras palavras. Um dos adolescentes, que usualmente passava a maior parte do dia dormindo por conta da medicação, atualmente apresenta vida regular normal, voltaram à escola e estão pintando. Não houve casos de má nutrição após a dieta cetogênica, colesterol sérico e triglicérides não sofreram aumento em seus níveis. Conclusão: Em relação ao custo, não foram encontrados obstáculos para introduzir a dieta cetogênica, já que partes não convencionais dos alimentos podem ser utilizadas, tornando as preparações mais acessíveis à família.Introduction: The Ketogenic Diet consists in a fat high, protein normal and carbohydrate low diet, leading to a ketosis state. The mechanism of the ketogenic diet is still not clear, however it has been showing to be a good form of therapeutic in refractory cases of tonic-clonic seizures, complex partial seizure, myoclonic seizures, and acinetic and absence crisis. The Ketogenic Diet produces a chronic ketosis state, and the ketosis and its anticonvulsive effects were available after the present understanding and conclusion concerning the real play of ketogenic bodies. This diet was called ketogenic diet upon the observation that epileptic patients have presented greater control of their convulsive crisis during the dietotherapic treatment. After fasting, the diet begins by restricting the quantity of carbohydrate and protein, which are adapted to the ideal weight of the child and enriching with high fat food, mainly mono and polyunsaturated.. It seems to be efficient in children and adolescent. In order to obtain a successful treatment, family members’ need all support, follow up and motivation they can get. Objective: The importance of Ketogenic Diet Used to help Children and Adolescents with hard control Epilepsy, who does not respond to pattern pharmacological therapy. Method: The diet begins by hospitalizing the child with a 36 to 48 hours fasting, so that the child gets to ketosis (4+). Four very important items to the precise calculation of the diet evaluated the patients: Ideal weight; Calories for kilogram; Ketogenic proportion (fat/protein/carbohydrate); Liquid ingestion. Results: Twelve children from 6 to 17 years old who were under the Ketogenic Diet were evaluated. Four of them, up to the present moment, had their crises reduced, improvements at the psychosocial and motor aspects and 70-100% the life quality. One of the children with Lennox Gestaut Syndrome has started to feel secure at ambulation and balanced affective emotional control, even stammering the first words. One of the adolescents, who used to spend most part of the day sleeping due to medication, takes a regular life nowadays, he is back to school and he is even painting. There were not cases of malnutrition after Ketogenic Diet beginning as well as increase of the cholesterol levels and triglycerides. Conclusion: Regarding cost effective, we have not found obstacles that could be considered barriers to proceed with the Ketogenic Diet, since we can use the unconventional parts of the food, making the treatment less expensive to the families.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundo de Auxílio aos Docentes e Alunos (FADA)BV UNIFESP: Teses e dissertaçõe

Car Seat Challenge Test in the Neonatal Intensive Care Unit

Background: In Portugal, there is a Guideline of the Directorate General of Health that requires that newborns with hospital discharge should be transported home in a proper and safe restraint system, aligned with AAP policy statements. In the Neonatal Intensive Care Unit (NICU) of Centro Hospitalar Universitário de S. João (Porto, Portugal), the Car Seat Challenge Test has been carried out since 2005, and there is not any study about its safety. Objective: This study aims to report the responses of preterm infants discharged home in 2015 and to develop a standardized procedure for its performance. Methods: This is a descriptive, retrospective, observational, non-experimental study. Data was collected from the NICU nursing records with a form designed for this purpose. Study variables were: gender, gestational age, birth weight, and comorbidities. Saturation of oxygen in arterial blood (SpO2) and heart rate (HR) values were measured at rest (in the crib), in the car seat chair at time 0, 5, 15, 30, 45 and 60 minutes. Results: During the year 2015, 86 preterm infants were discharged home, and all had values of SpO2 and HR within the reference range for this age group, during the Car Seat Challenge Test. The values decrease slightly from the measurement at 15 minutes for both SpO2 and HR. Infants with and without comorbidities had similar values of SpO2 (97-99.5%) and HR (135-155 beats per minute [bpm]), with a small decrease at 15 minutes. Infants with comorbidities did not regain saturation values after 30 minutes. Conclusion: The Car Seat Challenge Test has been performed systematically in the NICU since 2005. Data analyzed demonstrated it is safe. A standardized procedure was developed to provide harmonization of criteria

Frailty in the elderly living in the community with and without prior cerebrovascular disease

Objetivo: Determinar la prevalencia de fragilidad en ancianos que viven en la comunidad con y sin enfermedad cerebrovascular (ECV) y describir las principales características sociodemográficas y clínicas que presentan dichos pacientes. Material y método: Estudio descriptivo y transversal realizado entre enero y julio de 2016 en personas mayores residentes en 2 zonas concretas del Norte de Portugal. Los datos se han recogido mediante un cuestionario sociodemográfico y clínico. La existencia de ECV previa se evaluó a través de una valoración inicial y aplicación del Índice de comorbilidad de Charlson, y la fragilidad utilizando los criterios de la metodología fenotípica. Resultados: Se estudiaron 435 participantes, de edad>65 años (media=74,3 años), siendo en su mayoría mujeres (62,3%). El 6,9% de los ancianos tenía antecedentes de ECV. La prevalencia del síndrome de fragilidad fue de 60,0% en los ancianos con antecedentes de ECV y 20,5% en los restantes casos (p65 years (mean=74.3 years), mostly women (62.3%), were studied. Six point nine percent of the elderly people had a history of CVD. The prevalence of frailty syndrome was 60.0% in the elderly people with a history of CVD, and 20.5% in the other cases (P<.05). Statistically significant relationships (P<.05) were found between CVD and vision problems, fear of falling, hospitalisations in the last year, use of walking aids and perception of health status. Conclusion: Most of the elderly with a history of CVD were frail. According to the phenotypic theory, frailty is a state that precedes total dependence. The diagnosis and management of frailty may help to prevent adverse events that precipitate the institutionalisation of the elderly with CVD.info:eu-repo/semantics/publishedVersio

Interactions between children, teenagers and botos (Inia araguaiaensis and Inia geoffrensis) in markets and fairs of Eastern Amazon

The first author was granted by a scholarship of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). The second author and the fifth authors were granted scholarships from Coordenação de Aperfeicoamento de Pessoal de Nível Superior (CAPES, Brazil).In this study we present the first record of interactions (ludic behavior, swimming and induced feeding) involving river dolphins known as botos (Inia sp.) and children/adolescents (from eight to 17 years old) at markets and fairs at the river front of two localities of Pará State, Brazil. We registered the reports of the participants using semi-structured interviews while they were working at the markets or when they were in the water to interact with river dolphins. We registered dolphins and human behavior using the ad libitum method. Most of the children interacting with botos were boys - we observed only two girls swimming with the dolphins. All the fish species offered to river dolphins are commercial. Tourists were often involved in interactions in the Santarém region, but not as frequently in the city of Mocajuba. Nevertheless, in both places human populations were aware of the interactions of children/adolescents with botos. The interviewees did not show fear of botos, as is common in other localities of Pará State. Although some of them attributed mystical powers to those animals. The children demonstrated to know about river dolphins behavior and morphology, as well as the occurrence of other species of aquatic mammals in the surrounding areas. Despite the diversity of aquatic mammals in those areas, we noticed that the knowledge of children regarded mainly botos and tucuxis (another river dolphin species), probably because these are the most conspicuous aquatic mammal species in the region. Furthermore, according to the reports of the interviewees these interactions between dolphins and humans have been going on for a long time in both areas, more than 30 years. The presence of newborn calves along our field observations indicate that this behavior may be passed down through generations of botos. In short, our results expand the knowledge regarding interactions between humans and Inia sp. in the Amazon. Moreover, it is essential to intensify the systematic research effort in order to evaluate effects of direct interaction activities on river dolphins and humans alike. In addition, educational measures in Eastern Amazon may promote realistic and efficient plans for the conservation of this species.PostprintPeer reviewe

Calcified Cephalohematoma: an unusual case

Introduction: A cephalohematoma is characterized by a collection of serosanguineous fluid localized in the sub periosteum space, being the most common birth injury to the head. It occurs in up to 2.5% of all live births. Rarely a cephalohematoma persists and may calcify. We present a case that illustrates a calcified cephalohematoma that was reabsorbed. Case report: A two-month-old infant presented to the Pediatric Consultation at a first level hospital with a history of persistent right parietal mass, with no other symptoms He was born from instrument-assisted delivery with vacuum and about 72 hours after birth a right parietal tumefaction associated with cutaneous erythema was observed. At the physical examination on the first Pediatric Consultation, he presented with a 3-centimeter-long right parietal mass with hard consistency and no other alterations. Cranial X-rays were requested and showed images compatible with a calcified cephalohematoma, without apparent internal lamina alterations. A wait and see approach was conducted. At twelve-month-old, the mass had been completely reabsorbed and the child’s neurodevelopment was globally adequate. Currently, with four-years-old, the neurodevelopment remains adequate. Discussion and conclusion: Even though cephalohematoma is the most common birth injury to the head, in most cases it is reabsorbed in two to four weeks. Rarely a cephalohematoma persists and may calcify. An adequate medical history and physical examination are very important for a correct diagnosis. Cranium radiography is usually the first line imaging strategy and this patient radiographies were particularly evocative of the diagnosis. In this case a wait and see approach was conducted, the calcified cephalohematoma spontaneously reabsorbed, and the patient showed a good outcome

Terapia focada na compaixão online para a perturbação de ansiedade social na adolescência (CFT@TeenSAD): Dados preliminares de eficácia ao longo do tratamento

This work investigated the efficacy of Compassion Focused Therapy (CFT) on symptoms of social anxiety disorder (SAD) in adolescence, based on data collected throughout treatment. CFT has contributed to the psychological well-being of various populations, but limited evidence exists on its therapeutic gains for SAD in adolescence. Twenty-one adolescents (57.1% girls; 15-18 years old) presenting with SAD received online treatment. The CFT@TeenSAD intervention was organized into four modules: Our mind according to CFT, Developing the compassionate self and the skills of a compassionate mind, Practicing compassionate behavior, and Last remarks and continuing a compassionate journey. Before each session, adolescents reported on perceived change in symptom severity. At the end of each session, clinicians rated overtime change in that severity. Self-reports (F(1,540) = 32.271, p &lt; .0005, ηp2 = .63) and clinician’s reports (F(1,528) = 24.783, p &lt; .0005, ηp2 = .57) showed that improvement was significantly heightened during treatment, with significant changes across all four intervention modules. Trajectories of change were similar across gender. Though preliminary, findings point to online CFT being a promising approach to treat SAD in adolescent boys and girls, given that it contributes to continuous decrease in severity of social anxiety symptoms.Este trabalho investigou a eficácia da Terapia Focada na Compaixão (TFC) nos sintomas da perturbação de ansiedade social (PAS) na adolescência, com base em dados recolhidos ao longo da intervenção. A TFC contribuiu para o bem-estar psicológico em várias populações, mas é escassa a evidência sobre a sua eficácia no tratamento da PAS em adolescentes. Vinte e um adolescentes (57.1% raparigas; 15-18 anos) com PAS receberam tratamento online. A intervenção CFT@TeenSAD foi organizada em quatro módulos sequenciais: A mente de acordo com a TFC, Promoção do eu-compassivo e de competências para uma mente compassiva, Prática de comportamento compassivo, Últimas notas e continuar numa viagem compassiva. Antes de cada sessão, os adolescentes reportaram mudança percebida na gravidade dos sintomas e os clínicos fizeram essa avaliação no final de cada sessão. Tanto os adolescentes (F (1.540) = 32.271, p&lt;0.0005, ηp2 = 0.63) como os clínicos (F (1.528) = 24.783, p&lt; 0.0005, ηp2= 0.57) relataram melhoria continuada ao longo do tratamento, com mudança significativa ao longo dos quatro módulos. As trajetórias de mudança foram semelhantes para rapazes e raparigas. A TFC surge como uma abordagem promissora na PAS em adolescentes, contribuindo para a diminuição contínua da gravidade dos sintomas

Nível de conhecimento e atitudes preventivas entre universitários do curso de odontologia da UFMA em relação ao câncer bucal

O objetivo do presente trabalho foi avaliar o nível de conhecimento e as atitudes preventivas dos universitários do curso de Odontologia da UFMA, de diferentes períodos, em relação ao câncer bucal. Foram entrevistados 90 acadêmicos, que foram divididos em três grupos: o 1º ano (1 º e 2 º períodos), 3º ano (5 º e 6 º períodos) e 5º ano (9º e 10 º períodos). Após a coleta e tabulação dos dados foi realizada a estatística descritiva, sendo empregado o teste de Kruskal-Wallis, para verificar a diferença entre as resposta de cada grupo de estudo, considerando o nível de significância de 5%. Observou-se que os universitários do terceiro e do quinto ano apresentaram melhor desempenho que os alunos do primeiro ano; no entanto, quanto às atitudes preventivas, a maioria dos universitários não realiza o exame de câncer bucal na primeira consulta principalmente os do primeiro e do quinto ano, sendo ainda necessário o maior interesse dos concludentes em Odontologia frente à prevenção do câncer bucal

Results from the portuguese register

Objective Our aims were to evaluate the correlation between Juvenile Arthritis Disease Activity Score 27-joint reduced count (JADAS27) with erythrocyte sedimentation rate (ESR) and JADAS27 with C-reactive protein (CRP) scores and to test the agreement of both scores on classifying each disease activity state. We also aimed at verifying the correlation of the 2 scores across juvenile idiopathic arthritis (JIA) categories and to check the correlation between JADAS27-ESR and clinical JADAS27 (JADAS27 without ESR). Methods A nationwide cohort of patients with JIA registered in the Portuguese Register, Reuma.pt, was studied. JADAS27-CRP was adapted by replacing ESR with CRP level as the inflammatory marker. JADAS27-CRP was calculated similarly to JADAS27-ESR as the simple linear sum of its 4 components. Pearson's correlations and K statistics were used in the analyses. Results A total of 358 children had full data to calculate JADAS27; 65.4% were female and the mean ± SD disease duration was 11.8 ± 9.1 years. The correlation coefficient between JADAS27-ESR and JADAS27-CRP was 0.967 (P < 0.0001), although the correlation coefficient between ESR and CRP level was 0.335 (P < 0.0001). The strong correlation between JADAS27-ESR and JADAS27-CRP was maintained when compared within each JIA category. The agreement between JADAS27-ESR and JADAS27-CRP across the 4 activity states was very good, showing 91.1% of the observations in agreement; K = 0.867 (95% confidence interval 0.824-0.91). The correlation between JADAS27 with ESR and JADAS27 without ESR was high (r = 0.97, P < 0.0001). Conclusion JADAS27 based on CRP level correlated closely with JADAS27-ESR across all disease activity states and JIA categories, indicating that both measures can be used in clinical practice. Moreover, the correlation of JADAS27 with and without ESR was also high, suggesting that this tool might be useful even in the absence of laboratorial measures.publishersversionpublishe

Oficina de culinária: saberes e sabores dos alimentos

A metodologia de "Oficinas" vem sendo sistematizada e aplicada em áreas de saúde, educação e políticas sociais. O objetivo foi promover mudanças nos hábitos alimentares dos pacientes, tendo como conseqüência uma melhora na qualidade de vida. Conclui-se que as oficinas tiveram um impacto positivo na saúde e capacitaram os participantes a promoverem hábitos alimentares saudáveis no seu contexto familiar após depoimentos dos participantes

Influence of age and sex on bone development and athletic career longevity of Thoroughbred racehorses in Brazil – preliminary study

The impact of high-speed exercise on the musculoskeletal system of young racehorses has been extensively discussed because of concerns regarding animal health and welfare. This study investigated the correlation between age, degree of ossification of the distal radial epiphysis, sex, and career longevity of Thoroughbred racehorses in Brazil from 2012 to 2015. We performed a retrospective evaluation of 286 dorsopalmar radiographs of the left radiocarpal region of young horses and their racing performance. Distal radial epiphyseal closure was classified into three degrees: A, B, or C. Performance data included the number of races raced, athletic career length, and the number of races per month. The variables were subjected to regression analysis. At the time of radiographic examination, male horses were significantly older than females, and horses with epiphyseal closure degrees differed with age. Age at first race was 33.08±3.81 months, the average of races raced was 18.32±15.14 races, athletic career duration was 20.37±13.82 months, and the number of races raced per month was 0.93±0.46 races. Age influenced (P>0.001) the distal radial epiphyseal closure on racehorses, but sex did not (P=0.218 for males and P=0.275 for females). An inverse association was observed between age at the first race, the number of races raced per month, and athletic career duration. The frequency of race and the age at the first race influenced athletic career duration. Keywords: Athletic performance; distal radial epiphyseal closure; radiograph