Evaluation of food intake, weight and body composition in children with cerebral palsy / Avaliação da ingestão alimentar, peso e composição corporal em crianças com paralisia cerebral

Aim: We investigated food intake, weight and body composition evaluation in children with cerebral palsy.Method: A case-series study was conducted involving 53 children with mild to moderate motor impairment. Food intake was estimated and bioimpedance was used to determine body composition, with the calculation of the free fat mass index and fat mass index (FMI). The anthropometric profile was determined using z-scores of the following indices: height-for-age (zH/A), weight-for-age (zW/A) and body mass index-for-age (zBMI/A).Results: Height deficit was found in 7.5% of the children. Excess weight was found in 20.8% (zW/A) and 30.2% (zBMI/A). The prevalence of underweight was 7.5% (zW/A) and 5.7% (zBMI/A). Excess fat mass was found in 77.4%. No associations were found between excess fat mass or fat-free mass and excess weight or calorie intake. Height was positively correlated with age, mobility and zH/A. FMI was positively correlated with age and height. Lipid intake was positively correlated with age, height and FMI.Conclusion: The nutritional status and food intake of the children analyzed in the study was similar to that of children without neurological disease, possibly due to the lower degree of motor impairment

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Estudo do refluxo gastro-esofagico na infancia por meio da ultra-sonografia

Orientador: Gabriel HesselTese (mestrado - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: O objetivo desse trabalho foi determinar a acurácia da ultra-sonografia em identificar episódios de refluxo gastro-esofágico (RGE) e o valor da medida ultra -sonográfica do esôfago intra -abdominal em crianças portadoras da doença do refluxo gastro-esofágico (DRGE). Participaram do estudo 20 pacientes que foram submetidos a exames simultâneos de ultra-sonografia e registro do pH esofágico no período de 15 minutos após ingestão de suco de laranja. Foi observada a presença de episódios de RGE e efetuada a medida do esôfago intra abdominal. Os episódios de RGE visualizados à ultra-sonografia foram comparados com os episódios registrados à pHmetria quanto à presença e número por paciente, além de coincidência temporal. para essas comparações foram empregados os testes de Wilcoxon e de McNemar. As medidas do esôfago intra-abdominal foram comparadas com o índice de refluxo da pHmetria prolongada e com os resultados da avaliação endoscópica e histopatológica da mucosa esofágica. Para essas variáveis foi utilizado o teste de Fisher. episódios de RGE foram visualizados ao ultra-som e 24 episódios registrados pela pHmetria. Um paciente apresentou 23 episódios de RGE visualizados pelo ultra-som e apenas 4 na pHmetria e foi excluído da análise estatística global e estudado em separado. Foi encontrada coincidência temporal dos episódios de refluxo .em 100% do tempo de observação do ultra-som com o registro da pHmetria em 15 pacientes, em 75% do tempo em 2 pacientes, em 50% do tempo em 1 paciente e nenhuma coincidência em 2 pacientes. A coincidência temporal da pHmetria em relação ao ultra-som foi de 100% em 16 pacientes, 75% em-1 paciente, 50% em 1 paciente e nenhuma coincidência em 2 pacientes. A USG observou RGE em 10 pacientes, desses, 9 apresentaram RGE nos 15 minutos à pHmetria. A pHmetria (15 min) apresentou episódios de RGE em 10 pacientes, desses 9 apresentaram RGE ao ultra-som.- As medidas do esôfago intraabdominal estavam diminuídas em 7 crianças e nessas o índice de refluxo foi maior em comparação com o grupo de pacientes que apresentaram medidas normais do esôfago intra-abdominal. A endoscopia digestiva alta foi realizada em 15 pacientes, com o diagnóstico de esofagite por macroscopia em 7 e por microscopia em 10. Todos os pacientes com endoscopia digestiva e biópsia esofágica normais apresentavam esôfago intra-abdominal de tamanho normal e todos os pacientes com esôfago intra-abdominal diminuído e que fizeram endoscopia apresentavam diagnóstico de esofagite na avaliação macroscópica e microscópica. Conclusões: 1. Houve coincidência quanto à presença e número de episódios de RGE por paciente nos exames simultâneos de pHmetria e ultra-sonografia; 2. foi observada coincidência entre o período de observação do ultra-som e o registro da pHmetria e a mesma relação foi encontrada entre a pHmetria com o ultra som; 3. as crianças com medida do esôfago intra-abdominal diminuída para a idade apresentaram índice de refluxo maior do que as com esôfago normal; 4. o achado de um esôfago intra-abdominal diminuído ao ultra-som corresponde à presença de esofagite tanto à avaliação macroscópica quanto à biópsia da mucosa esofágicaAbstract: The aim of this study was to determine the accuracy of the ultrasound in order to identify the episodes of gastroesophageal reflux (GER) and the value of the ultrasound measurement of the esophageal abdominal segment (EAS) in children with gastroesophageal reflux disease (GERD). Twenty patients participated on this study who were submitted to simultaneous examination of ultrasound and esophagic pH records during a period of 15 minutes after the ingestion of orange juice. It was observed the presence of episodes of GER and it was also made the measurement of the EAS. The episodes of GER at the ultrasound were compared to the episodes recorded on the pH measurement about the presence and the number of patients and also the ,time coincidence. Wilcoxon and McNemar's tests were used to make these comparisons. The measurements of the EAS were compared to the reflux index of the prolonged pH measurement and with the results of the endoscopic and histopatologic evaluation of the esophageal mucosa. The Fisher's test was used to these changes. Fourty episodes of GER were seen at the ultrasound and 24 were recorded by the pH measurement. One patient has shown 23 episodes of reflux by the ultrasound and on1y 4 episodes by pH measurement and this patient was exc1uded from this study and was studied separately. A time coincidence was found on the episodes of the reflux of about 100% of the observation time of the ultrasound with the measurement record of pH in' 15 patients, 75% in 2 patients, 50% in one patient and no coincidence in 2 patients. The time coincidence of the pH measuremeÍ1t in relation to the ultrasound wa,s of about 100% in 16 patients, 75% in one patient, 50% in one patient ando no coincidence in 2 patients. The ultrasonography has observed GER in 10 patients; nine of these have shown GER during the period of 15 minutes in the .pH measurement. The pH measurement (15 minutes) has demonstrated episodes of GER in 10 pacients, nine of these haveshovm GER at the ultrasound. The measurement of the EAS were reduced in 7 children and in these, the reflux index was greater when compared -to the group of the patients who had presented normal measurements of the EAS. The upper digestive endoscopy was performed in 15 patients, giving the diagnosis of esophagitis by macroscopy in 7 patients and by microscopy in 10 patients. All the patients with normal digestive endoscopy and esophageal biopsy have shown EAS of normal size and all the patients with reduced EAS and that they had already urdergone endoscopy have shown a diagnosis of esophagitis at the macroscopy and microscopy evaluation. Conclusions: 1. There had been coincidence about the presence and number of episodes of GER by patients at the ultrasound ultrasonography, simultaneously examination of pH measurement and 2. A coincidence was observed between the observation period of the ultrasound and record of the pH measurement and also it was observed the same relationship between the pH measurement by the ultrasound. 3. The children which had the measurenient of the EAS reduced considering their ages have shown a greater reflux index than the others with normal esophagus. 4. The fmdings of a reduced esophageal abdominal segment by the ultrasound correspond with the presence of esophagitis in the macroscopy evaluation as well as at the microscopy evaluation of the esophageal mucosaMestradoMestre em Pediatri

Diarreia aguda: manejo baseado em evidências

Resumo Objetivos: Descrever as recomendações atuais sobre a melhor maneira de conduzir o paciente pediátrico com doença diarreica aguda. Fonte dos dados: PubMed, Scopus, Scholar Google. Síntese dos dados: Houve pouco avanço no uso dos sais de reidratação oral (SRO) nas últimas décadas apesar de ser amplamente divulgado por meio de diretrizes internacionais. Vários estudos vêm sendo feitos na tentativa de melhorar a eficácia do SRO. Hidratação venosa com solução salina isotônica, infundida de forma rápida, deve ser indicada em casos de desidratação grave. A nutrição deve ser assegurada logo após a resolução da desidratação e é primordial para a saúde intestinal e imunológica. Restrições alimentares usualmente não são benéficas e podem ser prejudiciais. As medicações sintomáticas têm indicação restrita e antibióticos são indicados em casos específicos, cólera e shiguelose moderada a grave. Conclusões: A hidratação e a nutrição continuam a ser as intervenções com melhor impacto sobre o curso da diarreia aguda