Retenção urinária aguda em pré‐escolar feminina com constipação intestinal

ResumoObjetivoRelatar um caso de criança que desenvolveu retenção urinária aguda associada à constipação intestinal.Descrição do casoMenina, seis anos, havia 24 horas apresentara incapacidade de liberação de esfíncter vesical. Foi atendida por duas vezes em um serviço de emergência nesse período. Na primeira consulta, 12 horas após o início do quadro, apresentava dor abdominal e retenção urinária aguda e foi feita sondagem de alívio com saída de 300mL de urina clara. Houve alívio imediato dos sintomas e, como o exame de urina tipo 1 não apresentou alterações, a paciente recebeu alta. No segundo atendimento, 12 horas após a primeira consulta, apresentava as mesmas queixas. Ao exame físico, observou‐se apenas bexiga palpável e distendida até a cicatriz umbilical, sem outras alterações. Nova sondagem vesical foi feita com saída de 450mL de urina clara, com alívio imediato dos sintomas. Nenhuma anormalidade foi observada no exame de urina tipo 1 e na urocultura. Durante a anamnese, foi levantada a hipótese diagnóstica de constipação intestinal. Foi feita radiografia simples de abdome, que identificou grande quantidade de fezes em todo o cólon (retenção fecal). Enema com solução glicerinada a 12% foi prescrito por três dias. Durante o seguimento a criança fez uso de laxativos e modificações na dieta que contribuíram para a resolução da constipação intestinal. Não houve repetição do quadro de retenção urinária aguda após seis meses de acompanhamento.ComentáriosA retenção urinária aguda em crianças é um fenômeno raro e a constipação intestinal deve ser considerada como uma das causas.AbstractObjectiveTo report a case of a preschool girl who developed acute urinary retention associated with constipation.Case descriptionA girl aged six years old presented a 24 hour history of inability to urinate. She was went twice to the emergency room during this period. In the first admission, 12 hours after the onset of the symptoms, she presented abdominal pain and acute urinary retention. After the drainage by urinary catheterization of 300mL of clear urine, she presented relief of the symptoms and, as urinalysis had no change, the patient was discharged home. Twelve hours after the first visit, she returned to the emergency room complaining about the same symptoms. At physical examination, there was only a palpable and distended bladder up to the umbilicus with no other abnormalities. Again, a urinary catheterization was performed, which drained 450mL of clear urine, with immediate relief of the symptoms. Urinalysis and urine culture had no abnormalities. During the anamnesis, the diagnosis of constipation was considered and a plain abdominal radiography was performed, which identified large amount of feces throughout the colon (fecal retention). An enema with a 12% glycerin solution was prescribed for three days. During follow‐up, the child used laxatives and dietary modifications, this contributed to the resolution of the constipation. There were no other episodes of urinary retention after 6 months of follow‐up.CommentsAcute urinary retention in children is a rare phenomenon and constipation should be considered as a cause

A successful experience of half a century of the University of São Paulo with the community

Extension is inseparable from university activities and a key link between academia and the community. The participation of the university in health care to the community may represent one of the most visible and at the same time sensitive aspects of university extension. The work of the University of São Paulo (USP) at the Community Social Medical Center “Vila Lobato” (CSMC "Vila Lobato") has been a successful experience of half a century in the community attended by this primary health care unit of Ribeirão Preto. Undergraduate students of both Medicine and Nutrition and Metabolism courses from Ribeirão Preto Medical School-USP (RPMS-USP) and also resident physicians from Clinics Hospital of RPMS-USP have provided health care to the local population. Undergraduate students from other schools from USP at Ribeirão Preto (dentistry, nursing and psychology) have also worked at the CSMC "Vila Lobato". Several research projects on health were carried out and many others has been developed in the unit, benefiting the community. This experience of half a century of USP with the CSMC “Vila Lobato” is a successful model in extension and it not only should be recognized in a genuine way in the academic institutions but also stimulated.A extensão constitui-se em parte indissociável das atividades universitárias e elo fundamental da interface da academia com a comunidade. A participação da universidade na assistência à saúde da comunidade talvez represente uma das faces mais visíveis e, ao mesmo tempo, sensíveis da extensão universitária. A atuação da Universidade de São Paulo (USP) no Centro Médico Social Comunitário “Vila Lobato” (CMSC “Vila Lobato”) tem se constituído em uma experiência exitosa de meio século junto à comunidade servida por esta unidade básica de saúde de Ribeirão Preto. Alunos de graduação do curso de medicina e de nutrição e metabolismo da Faculdade de Medicina de Ribeirão Preto-USP (FMRP-USP) e, também, médicos residentes do Hospital das Clínicas da FMRP-USP têm prestado assistência à saúde à população local. Alunos de graduação de outras unidades do Campus de Ribeirão Preto da USP (odontologia, enfermagem e psicologia) também atuam no CMSC “Vila Lobato”. Inúmeros projetos de pesquisa na área da saúde foram e continuam sendo desenvolvidos na unidade, beneficiando a comunidade. A experiência de meio século da USP junto ao CMSC “Vila Lobato” constitui-se em modelo bem-sucedido de extensão universitária, devendo não somente ser reconhecido de forma genuína no meio acadêmico, mas também, estimulada

Vitamina D em pediatria

Vitamin D (VD) is one of the fat-soluble vitamins. Its main sources in nature are diet and exposure to sunlight. Recent findings have shown that organs other than the kidney and liver are also able to synthesize VD metabolically active (calcitriol). Vitamin D deficiency (VDD) has been described almost 2.000 years ago and is classically related to diseases of the musculoskeletal system (especially rickets and osteomalacia). However, in recent years, VDD has been linked to disorders that affect other systems in the body, such as asthma and diabetes. In addition, an increase in the prevalence of VDD worldwide has been observed, even in countries with good insolation conditions. The most appropriate way to prevent VDD is by vitamin supplementation since there are no safe limits to sun exposure. The treatment of the VDD is mainly based on the replacement of the vitamin and it is indicated in the symptomatic forms (osteo-muscular symptoms) of its deficiency. VD intoxication is rare and observed in infants and young children who take high doses of VD in an acute way. This review article approaches these and other questions about VD, with particular emphasis on the particularities related to children and adolescents

Breastfeeding and nutritional superstitions

OBJETIVO: Conhecer a opinião de nutrizes sobre o consumo de alimentos em sua dieta durante o período de amamentação e identificar as possíveis restrições alimentares a que estão sujeitas. MÉTODOS: Estudo transversal realizado por análise de questionário aplicado às mães de crianças, inscritas em Programas de Puericultura em Unidades Básicas de Saúde, com idade variando do nascimento a seis meses completos para identificar se existe algum alimento que essas mães consideram inapropriado durante o período de lactação, quais são esses alimentos e os motivos alegados para que não sejam consumidos. RESULTADOS: Foram entrevistadas 504 mães das quais 296 (59%) responderam acreditar que existem alimentos inapropriados para o período de lactação. Os motivos referidos foram: poderia fazer mal à criança (78%); indefinidos (16%); faz mal à mãe (5%). Os principais alimentos a serem evitados, segundo as mães, seriam: refrigerantes (17%), pimenta (17%), gordura de porco (11%) e bebidas alcoólicas (10%). CONCLUSÕES: Mais da metade das lactantes entrevistadas considera que há alimentos que não devem ser consumidos durante o período de lactação, o que não encontra respaldo científico. Essas práticas restritivas podem interferir na nutrição da lactante e, conseqüentemente, na prática do aleitamento materno.OBJECTIVE: To know the opinion of lactating mothers about the consumption of food in their diet during the breastfeeding period and to identify possible alimentary restrictions. METHODS: This cross-sectional study enrolled mothers of children registered at Health Care Programs of Primary Health Care Centers, with ages varying from birth to six months. A questionnaire was applied in order to identify the foods considered by the mothers as improper during the breastfeeding period, and the reasons stated by them to justify such restriction. RESULTS: In a universe of 504 interviewed mothers, 296 (59%) stated that some foods should not be consumed during the breastfeeding period. The reasons mentioned to avoid them were: they harm the child (78%), undefined (16%) and they harm the mother (5%). The main deleterious foods mentioned were: soft drinks (17%), pepper (17%), pork fat (11%) and alcoholic drinks (10%). CONCLUSIONS: The majority of the interviewed mothers considered that there are some foods that are improper during the breastfeeding period. However, this opinion does not have scientific support. Restrictive practices can interfere in maternal nutrition and, as a consequence, interfere in breastfeeding practice.(FAEPA) Fundação de Amparo ao Ensino, Pesquisa e Assistência - Hospital das Clínicas da FMRP-US

Distorção da autopercepção de imagem corporal em adolescentes

Introduction: During adolescence, a period of acceleration of growth and body changes, there may be contending behaviors that make the individual vulnerable to concerns about his or her body and appearance. Objective: To verify the presence of body image self-perception distortion in adolescents of the city of Ribeirão Preto, SP. Methods: The present work is a cross-sectional, observational and analytical study. A total of 343 adolescents aged between 12 and 19 years old and belonging to the Professional Information Program (PIP, in the Portuguese acronym) of the University of Ribeirão Preto, state of São Paulo, Brazil, were evaluated. The adolescents responded how they considered themselves in relation to their body weight. Anthropometric measurements of the participants (weight, height, and body mass index [BMI]) were performed. The presence of body image distortion was assessed through the discrepancy between the BMI diagnosed by the professional and the BMI perceived by the adolescent. Results: There was a prevalence of 41.7% of adolescents with body image distortion, either due to overestimation or underestimation of the body size. Female adolescents had greater distortions in the perception of self-image. The overestimation of body image was higher in eutrophic adolescents, while the underestimation was greater in obese and overweight adolescents. Conclusion: The results indicate the need to implement public policies and projects within the school context for the prevention of body image and eating disorders, including in eutrophic adolescents

Características clínicas e epidemiológicas de lesões entre adolescentes atendidos em um pronto-socorro na cidade de Ribeirão Preto, São Paulo

CONTEXT AND OBJECTIVE: Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. DESIGN AND SETTING: Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirão Preto (FMRP), between January 1, 2009, and September 30, 2009. METHODS: Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. RESULTS: Among 180 adolescents attended, 106 (58.8%) were boys and 74 (41.1%) were girls. Their ages were: 10 to 12 (66/36.6%), 12 to 14 (60/33.3%) and 14 to 16 years (54/30%). The injuries had occurred in public places (47.7%) and at home (21.1%). The main types were bruises (45.1%) and falls (39.2%), involving upper limbs (46.1%), lower limbs (31%) and head/neck (13.1%). The injuries occurred in the afternoon (44.4%) and morning (30%), on Mondays (17.7%) and Thursdays (16.6%). Radiological examinations were performed on 53.8%. At the time of injury, 76.1% of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4%. CONCLUSIONS: Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents

Determination of lead concentration in breast milk and blood of lactanting women in an interior city of Brasil

Background: breast milk offers numerous advantages biological and emotional. However, in some situations, can transfer harmful elements for the health of infants. Objective: to determine lead levels in the blood and milk of mothers whose children frequent a primary mother-child health care. Methods: a cross-sectional, observational and descriptive study of 70 healthy women who were breast-feeding babies younger than six months during 01/04/2011 to 30/09/2011. Lead determination was performed by mass spectrometry with inductively coupled plasma. A linear regression model was adjusted to determine the association between lead concentrations in maternal milk and blood. The estimated values of the difference between means and their 95% confidence intervals were obtained. Results: mean lead concentration in milk was 1.462 ng/mL and blood lead concentration was 1.801 μg/dL. Conclusions: human milk is not a source of contamination for the babies in this area. However, more studies are needed in other regions of the country in view of the growing evidence of foci of lead contamination, which may represent an occult risk for the population

Epidemiological and clinical characteristics of injuries among adolescents attended at an emergency service in the city of Ribeirao Preto, Sao Paulo

CONTEXT AND OBJECTIVE: Injuries are an important cause of morbidity during adolescence, but can be avoided through learning about some of their characteristics. This study aimed to identify the most frequent injuries among adolescents attended at an emergency service. DESIGN AND SETTING: Retrospective descriptive study on adolescents attended at the emergency service of the Teaching Health Center, Faculdade de Medicina de Ribeirao Preto (FMRP), between January 1, 2009, and September 30, 2009. METHODS: Age, sex, type of injury, site, day and time of occurrence, part of body involved, care received, whether the adolescent was accompanied at the time of injury and whether any type of counseling regarding injury prevention had been given were analyzed. RESULTS: Among 180 adolescents attended, 106 (58.8%) were boys and 74 (41.1%) were girls. Their ages were: 10 to 12 (66/36.6%), 12 to 14 (60/33.3%) and 14 to 16 years (54/30%). The injuries had occurred in public places (47.7%) and at home (21.1%). The main types were bruises (45.1%) and falls (39.2%), involving upper limbs (46.1%), lower limbs (31%) and head/neck (13.1%). The injuries occurred in the afternoon (44.4%) and morning (30%), on Mondays (17.7%) and Thursdays (16.6%). Radiological examinations were performed on 53.8%. At the time of injury, 76.1% of the adolescents were accompanied. Some type of counseling about injury prevention had been received by 39.4%. CONCLUSIONS: Although the injuries were of low severity, preventive attitudes need to be incorporated in order to reduce the risks and provide greater safety for adolescents

Ingestão dietética, avaliação antropométrica e composição corporal de adolescentes atendidos em um Centro de Atenção Primária à Saúde em Ribeirão Preto, São Paulo, Brasil

Objectives: This study aimed to describe and compare the nutritional profile of three groups of adolescents of the same age and gender, diagnosed as overweight, obese and eutrophic as determined by theBody Mass Index (BMI). Materials and Methods: This is a cross-sectional, observational, comparative,and descriptive study in which adolescents were evaluated using anthropometric measurements suchas skinfolds, waist circumference, BMI and body composition assessed by bioelectric impedance. Asemi-quantitative questionnaire about eating frequency was applied to evaluate food intake. The samplewas determined by convenience. A total of 517 adolescents were attended at the CMSCVL betweenOctober 2005 and December 2006. Of these, 141 (27.3%) agreed to participate and satisfied the inclusion criteria. Results: There was no significant difference between groups regarding energy consumption or percent macronutrient contribution although the diet of all groups contained fat percentages aboverecommended levels. Median lipid consumption was 36.6%, 38.3% and 38.2% among eutrophic, overweight and obese adolescents, respectively. Also, there was no significant difference between groupsregarding micronutrient consumption. Quantitative analysis of the diet revealed in general a frequentconsumption of rice and beans, as well as bread, salty snacks, soft drinks, artificial juices, coffee withsugar, and sausages. The fruits most frequently consumed were orange, apple and banana and thelegumes most frequently consumed were lettuce and tomato. These data are important for the policy ofnutritional education adopted at the health center. Conclusion:  The food intake does not seem to havebeen the main factor triggering weight gain. The adolescents studied, regardless of their nutritionalstatus, have similar eating habits which are not compatible with the food pyramid.Objetivos: Este estudo teve como objetivo descrever e comparar o perfil nutricional de três grupos deadolescentes da mesma idade e sexo, com diagnóstico de sobrepeso, obesidade e eutrofia, determinado pelo Índice de Massa Corporal (IMC).Materiais e Métodos: Estudo transversal, observacional, comparativo, descritivo, no qual os adolescentes foram avaliados utilizando medidas antropométricas, tais como dobras cutâneas, circunferência dacintura, IMC e composição corporal avaliada pela impedância bioelétrica. Um questionário semi-quantitativo sobre a freqüência alimentar foi aplicado para avaliar a ingestão de alimentos. A amostra foideterminada por conveniência. Foram atendidos no CMSCVL, no período entre outubro de 2005 edezembro de 2006, 517 adolescentes. Desse total, 141 (27,3%) concordaram em participar e estavamdentro dos critérios de inclusão.Resultados: Não houve diferença estatisticamente significativa entre os grupos em relação ao consumo de energia e contribuição percentual dos macronutrientes, embora todos os grupos apresentaramuma dieta com percentual de gordura acima dos níveis recomendados. O consumo mediano de lipídiosentre os adolescentes eutróficos, com sobrepeso e obesos foi de 36,6%, 38,3% e 38,2% respectivamente. Além disso, não houve diferença estatisticamente significativa entre os três grupos em relaçãoao consumo de micronutrientes. Quanto à análise qualitativa da dieta, observa-se em geral consumofreqüente de arroz e feijão, assim como pães, salgados, refrigerantes, sucos artificiais, café com açúcare salsichas. As frutas mais consumidas foram: laranja, maçã e banana, enquanto os legumes maisconsumidos foram: alface e tomate. Esses dados são importantes para a política de educação nutricional adotada no centro de saúde.Conclusão: A ingestão alimentar não parece ter sido o principal fator desencadeador do ganho de peso.Os adolescentes, independente do seu estado nutricional, apresentam hábitos alimentares semelhantes e não compatíveis com o recomendado pela pirâmide alimentar

High levels of blood pressure among Brazilian overweight and obese children and adolescents

Introdução: A hipertensão arterial (AH) é um problema crescente no mundo e traz várias consequências para a saúde. Numerosos levantamentos mostram que o risco de AH é maior em indivíduos com sobrepeso e obesos do que nos eutróficos. Por isso, este estudo tem como objetivo avaliar a prevalência de hipertensão arterial em crianças e adolescentes portadores de sobrepeso e obesidade. Métodos: Estudo transversal retrospectivo com crianças e adolescentes de dois serviços de saúde em diferentes regiões do Brasil e perfis socioeconômicos distintos. Todas as crianças e adolescentes atendidos entre 1998 e 2020, com idades entre 5 e 17 anos, com escore z de índice de massa corporal superior a +1 foram incluídos no estudo. A pressão arterial foi medida uma vez com o paciente deitado e em repouso. As diretrizes da Academia Americana de Pediatria foram usadas para classificar os níveis de pressão arterial do paciente. Resultados: Foram avaliados 691 pacientes (49% do sexo masculino). As prevalências de hipertensãoarterial entre indivíduos com sobrepeso e obesidade foram de 38,8% e 51,5% (p = 0,002), respectivamente. Além disso, os indivíduos obesos tinham 1,67 vezes mais chances de ter hipertensão em comparação com os portadores de sobrepeso. Os homens apresentaram maior prevalência de hipertensão arterial (52,1% vs. 43,3%; p = 0,002) e foram 1,3 vezes mais propensos a ter valores mais elevados de pressão arterial. Conclusão: A prevalência de hipertensão arterial em dois ambulatórios pediátricos foi elevada entre crianças e adolescentes portadores de sobrepeso e obesidade. Homens e indivíduos com obesidade tiveram risco significativamente maior de hipertensão.Background: Arterial hypertension (AH) is a growing problem globally, bringing various health consequences. Numerous surveys show that the risk of AH is higher in overweight and obese individuals than in eutrophic ones. However, the number of data that investigates blood pressure in obese pediatric populations is still small. Therefore, this study aims to assess the prevalence of hypertension in overweight and obese children and adolescents. Methods:Retrospective cross-sectional study with children and adolescents from two health services in different regions of Brazil and distinct socioeconomic profiles. All children and adolescents seen between 1998-2020, aged 5-17 years, with a body mass index greater than +1 standard deviation (Z-score), were enrolled in the study. Blood pressure was measured once with the patient lying down and at rest. American Academy of Pediatrics guidelines were used to classify the patient’s blood pressure levels. Results: 691 patients were evaluated (49% male). Of these, 47.6% had hypertension. The prevalences of hypertension among overweight and obese subjects were 38.8% and 51.5% (p = 0.002), respectively. In addition, obese people were 1.67 times more likely to have hypertension than overweight people. Males had a higher prevalence of hypertension (52.1% vs. 43.3%; p = 0.002) and were 1.3 times more likely to have high blood pressure values. Conclusion: The prevalence of hypertension was high in overweightand obese children and adolescents from two pediatric outpatient clinics. Males and subjects with obesity were at significantly higher risk of having hypertension