Padrões de referência nutricionais na população de crianças com paralisia cerebral: uma revisão analítica

Growth and nutrition disorders are frequent health problems in children with cerebral palsy (CP). These nutritional disorders may lead to impaired motor and cognitive development, socialization, and increased need for health care and hospital admission. Even under adequate conditions (appropriate environment and regular medical care), children with CP grow more slowly than those without chronic health conditions and have unique growth patterns. In general, health teams use as a reference the growth curves for populations without neurological deficit, which are not suitable for children with CP, since this population has a distinct growth. In the last decades, researchers have been building specific growth curves for the PC. To date, there are five published references. Choosing the best reference for this population is a difficult task. However, the growth curves developed by Brooks et al. seem to be more reliable and are the most used in specialized centers for these children and adolescents. They are simple, methodologically safer, based on a large representative sample of all motor development groups and are related to clinical outcomes. Nevertheless, it needs further studies to prove its quality, especially in different contexts. However, because of the importance of evaluating each child/adolescent with their specific growth curve for their illness, it is suggested that it should be integrated into the anthropometric evaluation along with other nutritional parameters in clinical practice

Positron Emission Tomography With 2-[18F]-Fluoro-2-Deoxy-D-Glucose For Initial Staging Of Hodgkin Lymphoma: A Single Center Experience In Brazil

BACKGROUND: 2-[18F]-Fluoro-2-Deoxy-D-Glucose (FDG-PET) is a well established functional imaging modality for the initial staging of Hodgkin lymphoma (HL) in patients from Western Europe and North America. The reliability of FDG-PET in populations of different ethnic groups is unclear, as all investigations published to date have come from developed countries. PURPOSE: The aim of the present study was to investigate the effectiveness of FDG-PET in the initial staging of HL patients in a Brazilian population. METHODS: Eighty-two patients with newly diagnosed HL were prospectively included in the study. All patients were staged with both conventional clinical staging (CCS) methods, including computed tomography (CT) and whole-body FDG-PET methods. A standard of reference for the nodal regions and the extranodal organs was determined using all available information, including the CCS methods, FDG-PET, the diagnostic histology and the follow-up examinations. The results of the CCS were then compared to the FDG-PET results. RESULTS: The sensitivity of FDG-PET was higher for nodal staging than that of CT (87.8% vs. 61.6%, respectively). FDG-PET was also more sensitive than CT in regard to evaluating the extranodal organs for lymphomatous involvement (96.2% vs. 40.0%, respectively). FDG-PET detected all 16 patients who were characterized by a positive bone marrow biopsy and identified an additional 4 patients with bone marrow disease. The incorporation of FDG-PET coupled with CCS in the staging procedure upstaged 20% (17/82) of the patients and downstaged 11% (9/82) of the patients. As a result of these changes in staging, 15% (13/82) of the patients would have received a different therapeutic regimen. CONCLUSIONS: The FDG-PET method is superior to CT for the detection of nodal and extra-nodal HL. The observation that the FDG-PET method upstaged the disease was the most common result (20% of patients) brought about by the addition of PET to the staging algorithm, even in a population of patients with a high incidence of advanced disease. However, changes in stages based on FDG-PET results should be confirmed by biopsy

Diagnosis and treatment of polycythemia vera: Brazilian experience from a single institution

CONTEXT AND OBJECTIVE: Polycythemia vera (PV) is a chronic myeloproliferative disorder characterized by predominant proliferation of erythroid precursors. Few data are available concerning Brazilian patients with this condition. The aim of this study was to describe clinical and demographic characteristics of PV patients at diagnosis and analyze their long-term outcomes. DESIGN AND SETTING: Retrospective study at the Division of Hematology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo. METHODS: All consecutive patients with PV diagnosed according to World Health Organization criteria were eligible for this study. Clinical and demographic characteristics, thrombotic events, transformation to acute leukemia, myelofibrosis and survival were evaluated. RESULTS: Sixty-six patients were evaluated. Thirty-six (54.5%) were females, with a median age at diagnosis of 61 years. At diagnosis, the median hemoglobin concentration was 18.8 mg/dl and the median platelet count was 593,000/mm³. Fifty-eight patients (88.0%) were treated with hydroxyurea with or without phlebotomy. During a median follow-up of 77 months, 22 patients (33.3%) had new thrombotic events, mainly of arterial type. The overall incidence of leukemia and myelofibrosis was 0.42% per patient-year and 1.06% per patient-year, respectively. Median overall survival was not reached and the seven-year survival rate was 77.8%. CONCLUSION: The PV patients described here had long survival and arterial thrombotic events were the most important and common complication among this population

Diagnóstico e tratamento da policitemia vera: experiência de uma instituição brasileira

CONTEXT AND OBJECTIVE: Polycythemia vera (PV) is a chronic myeloproliferative disorder characterized by predominant proliferation of erythroid precursors. Few data are available concerning Brazilian patients with this condition. The aim of this study was to describe clinical and demographic characteristics of PV patients at diagnosis and analyze their long-term outcomes. DESIGN AND SETTING: Retrospective study at the Division of Hematology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo. METHODS: All consecutive patients with PV diagnosed according to World Health Organization criteria were eligible for this study. Clinical and demographic characteristics, thrombotic events, transformation to acute leukemia, myelofibrosis and survival were evaluated. RESULTS: Sixty-six patients were evaluated. Thirty-six (54.5%) were females, with a median age at diagnosis of 61 years. At diagnosis, the median hemoglobin concentration was 18.8 mg/dl and the median platelet count was 593,000/mm³. Fifty-eight patients (88.0%) were treated with hydroxyurea with or without phlebotomy. During a median follow-up of 77 months, 22 patients (33.3%) had new thrombotic events, mainly of arterial type. The overall incidence of leukemia and myelofibrosis was 0.42% per patient-year and 1.06% per patient-year, respectively. Median overall survival was not reached and the seven-year survival rate was 77.8%. CONCLUSION: The PV patients described here had long survival and arterial thrombotic events were the most important and common complication among this population.CONTEXTO E OBJETIVO: A policitemia vera (PV) é uma doença mieloproliferativa crônica, caracterizada pela proliferação de precursores hematopoéticos, principalmente da série eritróide. Poucos dados são disponíveis sobre pacientes brasileiros portadores desta doença. O objetivo do presente estudo é analisar as características de pacientes portadores de PV ao diagnóstico e a sua evolução clínica a longo prazo. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo unicêntrico, realizado no Serviço de Hematologia da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: Foram elegíveis para este estudo os pacientes com PV diagnosticados de acordo com os critérios estabelecidos pela Organização Mundial da Saúde. Foram avaliadas as características demográficas e clínicas ao diagnóstico, as complicações trombóticas, a transformação para leucemia aguda e mielofibrose e a sobrevida. RESULTADOS: Foram avaliados 66 pacientes; 36 (54,5%) eram do sexo feminino, com uma mediana de idade ao diagnóstico de 61 anos. As medianas da concentração de hemoglobina e da plaquetometria ao diagnóstico foram de 18,8 mg/dl e 593.000/mm³, respectivamente. 58 (88,0%) foram tratados com hidroxiuréia associada ou não à flebotomia. Em uma mediana de acompanhamento de 77 meses, 22 (33,3%) pacientes apresentaram eventos trombóticos, predominantemente arteriais. A incidência de leucemia e mielofibrose foi de 0,42/100 pacientes-ano e 1,06/100 pacientes-ano, respectivamente. A mediana de sobrevida global não foi atingida, a taxa de sobrevida em sete anos foi de 77,8%. CONCLUSÃO: Os portadores de PV em nosso serviço apresentaram longa sobrevida. Os eventos trombóticos arteriais foram a principal complicação da população estudada

Nutritional reference patterns in the population of children with cerebral palsy : an analytical review

Os distúrbios de crescimento e nutrição são problemas de saúde frequentes em crianças com paralisia cerebral (PC). Esses distúrbios nutricionais podem acarretar comprometimento no desenvolvimento motor e cognitivo, na socialização, e na maior necessidade do uso de serviços de saúde e de internação hospitalar. Mesmo sob condições aparentemente adequadas (ambiente apropriado e atendimento médico regular), as crianças com PC crescem mais lentamente do que as sem condições crônicas de saúde e possuem padrões de crescimento únicos. Emgeral, as equipes de saúde utilizam como medida de referência as curvas de crescimento para populações sem déficit neurológico, as quais não são adequadas para crianças com PC, já que essa população possui um crescimento distinto. Nas últimas décadas, pesquisadores vem construindo curvas de crescimento específicas para a PC. Até o momento, existem cinco padrões de referência publicados. A escolha do melhor padrão de referência dessa população é uma tarefa difícil. No entanto, as curvas de crescimento elaborada por Brooks et al. parece ser mais confiáveis e são as mais utilizadas nos centros especializados em cuidados dessas e adolescentes. Elas são simples, metodologicamente mais seguras, baseadas emuma amostra grande e representativa de todos os grupos de desenvolvimento motor que os indivíduos com PC possam apresentar e estão relacionadas a desfechos clínicos. Contudo, carece demais estudos que comprovema sua qualidade, principalmente em contextos diferentes. No entanto, pela importância de se avaliar cada criança/adolescente com sua curva de crescimento específica para sua enfermidade, sugere-se que ela deva ser integrada na avalição antropométrica junto com outros parâmetros nutricionais na prática clínica.Growth and nutrition disorders are frequent health problems in children with cerebral palsy (CP). These nutritional disorders may lead to impaired motor and cognitive development, socialization, and increased need for health care and hospital admission. Even under adequate conditions (appropriate environment and regular medical care), children with CP grow more slowly than those without chronic health conditions and have unique growth patterns. In general, health teams use as a reference the growth curves for populations without neurological deficit, which are not suitable for children with CP, since this population has a distinct growth. In the last decades, researchers have been building specific growth curves for the PC. To date, there are five published references. Choosing the best reference for this population is a difficult task. However, the growth curves developed by Brooks et al. seemto bemore reliable and are themost used in specialized centers for these children and adolescents. They are simple, methodologically safer, based on a large representative sample of all motor development groups and are related to clinical outcomes. Nevertheless, it needs further studies to prove its quality, especially in different contexts. However, because of the importance of evaluating each child/adolescent with their specific growth curve for their illness, it is suggested that it should be integrated into the anthropometric evaluation along with other nutritional parameters in clinical practice

Nutritional reference patterns in the population of children with cerebral palsy : an analytical review

Os distúrbios de crescimento e nutrição são problemas de saúde frequentes em crianças com paralisia cerebral (PC). Esses distúrbios nutricionais podem acarretar comprometimento no desenvolvimento motor e cognitivo, na socialização, e na maior necessidade do uso de serviços de saúde e de internação hospitalar. Mesmo sob condições aparentemente adequadas (ambiente apropriado e atendimento médico regular), as crianças com PC crescem mais lentamente do que as sem condições crônicas de saúde e possuem padrões de crescimento únicos. Emgeral, as equipes de saúde utilizam como medida de referência as curvas de crescimento para populações sem déficit neurológico, as quais não são adequadas para crianças com PC, já que essa população possui um crescimento distinto. Nas últimas décadas, pesquisadores vem construindo curvas de crescimento específicas para a PC. Até o momento, existem cinco padrões de referência publicados. A escolha do melhor padrão de referência dessa população é uma tarefa difícil. No entanto, as curvas de crescimento elaborada por Brooks et al. parece ser mais confiáveis e são as mais utilizadas nos centros especializados em cuidados dessas e adolescentes. Elas são simples, metodologicamente mais seguras, baseadas emuma amostra grande e representativa de todos os grupos de desenvolvimento motor que os indivíduos com PC possam apresentar e estão relacionadas a desfechos clínicos. Contudo, carece demais estudos que comprovema sua qualidade, principalmente em contextos diferentes. No entanto, pela importância de se avaliar cada criança/adolescente com sua curva de crescimento específica para sua enfermidade, sugere-se que ela deva ser integrada na avalição antropométrica junto com outros parâmetros nutricionais na prática clínica.Growth and nutrition disorders are frequent health problems in children with cerebral palsy (CP). These nutritional disorders may lead to impaired motor and cognitive development, socialization, and increased need for health care and hospital admission. Even under adequate conditions (appropriate environment and regular medical care), children with CP grow more slowly than those without chronic health conditions and have unique growth patterns. In general, health teams use as a reference the growth curves for populations without neurological deficit, which are not suitable for children with CP, since this population has a distinct growth. In the last decades, researchers have been building specific growth curves for the PC. To date, there are five published references. Choosing the best reference for this population is a difficult task. However, the growth curves developed by Brooks et al. seemto bemore reliable and are themost used in specialized centers for these children and adolescents. They are simple, methodologically safer, based on a large representative sample of all motor development groups and are related to clinical outcomes. Nevertheless, it needs further studies to prove its quality, especially in different contexts. However, because of the importance of evaluating each child/adolescent with their specific growth curve for their illness, it is suggested that it should be integrated into the anthropometric evaluation along with other nutritional parameters in clinical practice

Redução do estresse laboralem profissionais de enfermagem: aplicação de uma intervenção

11 páginasObjective: To compare the levels of ex-post-facto stress between nursing personnel who participated in an educational intervention with nursing personnel on work duties, within the hospital work environment. Materials and method: This was an observational and cross-sectional study. The final sample was composed of 30 nursing personnel, with 15 of them composing the group exposed to the intervention and 15 being selected by simple random sampling to compose the unexposed group. The intervention consisted of a program focused on the employees, structured in four sessions, applied in a course format twice a week, and lasted two months. The Student’s t-test for independent samples and the Mann-Whitney U-test were used to compare the groups. Results: Using the Mann-Whitney U-test, the stress levels could be compared between the groups, and a statistical difference in stress levels was observed between the control group (3.34 ± 0.71 a.u.) and the intervention group (2.52 ± 0.59 a.u.) (p = 0.002; d = 1.26). Conclusions: Comparing the general stress levels between the groups, it was found that the intervention significantly decreased the stress levels in the participants; it was also pos-sible to identify the mental stressors faced by the participants using the Scale of Stress in Professionals.Objetivo: comparar los niveles de estrés ex-post-fact entre los profesionales de enfermería en el ambiente del trabajo hospitalario participantes de intervención educativa con profesionales de enfermería en actividades laborales. Materiales y método: estudio obser-vacional y transversal. La muestra final se compuso por 30 profesionales de enfermería, de la que 15 profesionales compusieron el grupo expuesto a intervención y 15 se seleccionaron por muestreo aleatorio para componer el grupo no expuesto. La intervención consistió en un programa, con enfoque en el trabajador, estructurado en cuatro sesiones, aplicado en formato de curso, con periodicidad quincenal y duración de dos meses. En la comparación entre los grupos, se utilizaron la prueba t de Student para amuestras independientes y la prueba U de Mann-Whitney. Resultados: por medio de la prueba U de Mann-Whitney, se puede comparar el nivel de estrés entre los gru-pos, en el que se observó diferencia estadística del nivel de estrés entre el grupo control (3,34 ± 0,71 u.a.) y el grupo intervención (2,52 ± 0,59 u.a.) (p = 0,002; d = 1,26). Conclusiones: comparando el nivel de estrés general entre los grupos, se constata que la intervención disminuyó significativamente el nivel de estrés en los profesionales; se logró aun identificar los estresores mentales de los profesionales por medio de la Escala de Estrés en Profesionale