CLINICAL-EPIDEMIOLOGICAL PROFILE OF HOSPITALISED PATIENTS IN PAEDIATRIC INTENSIVE CARE UNIT

Introduction: Paediatric intensive care units have made important advances in technology and assistance since the 1980s, which have made more favourable the prognosis of critically ill children all over the world. Objective: Identify the epidemiological profile and clinical outcomes of hospitalised children and adolescents in the Paediatric Intensive Care Unit of Hospital Vitória, Espirito Santo, Brazil. Methods: A descriptive and retrospective study carried out in the Paediatric Intensive Care Unit of Hospital Infantil Nossa Senhora da Glória in the city of Vitória, Espirito Santo, Brazil. Age, sex, ospitalisation diagnosis, progression to discharge/death, and length of hospital admission were obtained from the Sector of Medical and Hospital Statistics Files between 2011 and 2012. For the descriptive analysis, categorical variables were expressed as absolute and percentage, and the continuous variables in average and standard deviation. For comparison, Pearson’s chi-squared tests, Fisher’s test, and Student’s t test were used and p values <0.05 with confidence interval of 95% were considered statistically significant. Results: Of the 609 patients analysed, 342 (56.2%) were male (mean age: 72.7 ± 71.3 months). Respiratory disease, postoperative processes, and trauma were the main causes of hospitalisation. The average duration of hospitalization was 6.9 ± 5.5 days; 514 (84.4%) patients were discharged, 95 (15.6%) died, and of those, 53 (55.7%) died in less than 72 hours of hospitalisation. Conclusion: Most of the patients were less than 2 years of age. The leading causes of hospitalisation were respiratory disease (pneumonia, bronchiolitis, and asthma), sepsis, and head injury, which was the major cause of the trauma motivated by violence. The average hospital admission in the unit was one week and the mortality rate was 15.6%, with one third of the deaths recorded in the first 72 hours of hospitalisation

ASSOCIATION BETWEEN FOOD CONSUMPTION AS PREDICTOR OF CARDIOVASCULAR RISK AND WAIST CIRCUMFERENCE INCREASE IN TEENAGERS

Introduction: the eating habits of young people have changed significantly over the last few decades. Teenagers tend to have less than desirable intake of fruits, vegetables, dairy products and wholegrain products, and higher intake of foods high in saturated and trans fats, leading to increased waist circumference and consequent increased risk of cardiovascular disease. Objective: to analyse the relationship between dietary intake as predictor of and increased abdominal circumference in teenagers. Methods: a cross-sectional study was conducted in a sample of 818 teenagers aged between 10 and 14 years, of both genders, enrolled in state public schools in the metropolitan region of Vitória, Espirito Santo, Brazil, from August 2012 to October 2013. Waist circumference (WC) measurements were carried out in duplicate and the arithmetic mean was calculated. The dietary intake was identified from a simplified food questionnaire containing foods whose consumption is high or that present excessive risk of coronary heart disease in teenagers. The statistical analysis was done through Pearson’s chi-squared test. Results: a proportion of 55.9% of the sample had an adequate food intake, 15.6% a high intake and 28.5% an excessive intake. Among teenagers who had an adequate, high and excessive dietary intake, 5.6% (N = 46), 1.1% (N = 9) and 2.6% (N = 21) had increased WC, respectively. The result of the chi-squared test indicated no association between dietary intake as predictor of cardiovascular risk and WC, p-value = 0.576. Conclusion: there was no association between dietary intake presenting cardiovascular risk and increased waist circumference

Lipid profile in schoolchildren in Vitória – Brazil

Introduction: The growing prevalence of obesity is currently considered the most important nutritional disorder. It is characterized, according to the World Health Organization (WHO) as a worldwide epidemic in developing and developed countries. In an associated form, there is an increasing prevalence of dyslipidaemia. Aiming to improve the current situation and prevent the progression of the epidemic, the American Academy of Pediatrics recently reinforced the need for cholesterol screening in overweight children older than two years. Objective: To determine overweight and lipid profi le in children aged between six and nine years. Methods: A descriptive, cross-sectional study with children from Vitoria, ES. For nutritional classifi cation the Z-score > + 1 SD body mass index-for-age (according to WHO / 2007) was used; for the lipid profi le the Atherosclerosis Prevention Guidelines in Childhood were used. Anthropometric measurements (weight, height, waist circumference and triceps skinfold thickness) followed the standard techniques described by WHO. Data were organized and analysed using SPSS, version 8.5 and calculated the absolute, relative and mean (SD) frequencies and the association between overweight, lipid profile and other variables is adopted as signifi cant when p < 0.05. Results: The sample comprised a total of 511 children of both sexes (46.7% male), with a mean age of 101.6 ± 11.1 months. Overweight was found in 197 (38.5%) children: overweight in 71 (13.9%) and obesity in 126 (24.6%). Total cholesterol was elevated in 167 (32.7%) as were high LDL-C (136–27%). High triglycerides were found in 21 participants (4.1%). Signifi cant association was found between waist circumference and high levels of triglycerides (p = 0.019) and HDL-C (p = 0.033). Conclusion: Excess weight of the sample investigated is considered high and its health effects are important, with an increased total cholesterol greater than 32%. The high levels of HDL-C are protectivefactors for coronary heart disease, although the lipid profi le had been changed

Growth and nutritional status of adolescents of public education system

Introduction: The prevalence of obesity in children and adults has increased worldwide exponentially over the past two decades, becoming an important issue of global public health. Objective: To describe the growth and nutritional status of adolescents of  public schools. Methods: Epidemiological, cross-sectional study, a representative sample of students aged 10 to 14 years of the public schools of the Metropolitan Region of Grande Vitória (MRGV), State of Espírito Santo, Brazil. Data on gender, age, skin colour/race, pubertal stage, socioeconomic class, weight and height were obtained. In the nutritional evaluation, the Height/Age (H/A) and Body Mass Index/Age (BMI/A) indexes, in z-score, of the WHO reference (2007) were considered. For statistical analysis, we used the Qui-square test and Student's t test (Mann-Whitney test for non-normal distribution), and significance level of p <0.05. Study approved by the Institutional Research Ethics Committee. Results: There were assessed 818 adolescents, with average age of 12.8 ± 1.1 years, female predominance (58.3%), mixed skin colour/race (41.7%), post-pubertal stage (53, 4%) and socioeconomic class C (59.5%). It was identified very low stature in 0.4% and low stature in 1.8% of adolescents. Overweight was diagnosed in 227 (27.7%) students, represented by overweight (18.7%), obesity (8.4%) and severe obesity (0.6%); While 0.2% presented severe thinness and 2.7% thinness.  The mean z-score of girls' height (p = 0.024) was higher than the WHO reference, as well as the BMI z-score of girls (p = 0.0001) and boys (p = 0.0002). Conclusion: Adolescents of public schools of MRGV achieve adequate growth, even higher, on average, proposed by WHO (2007). However, they also present a high prevalence of overweight, indicating that the region is at an advanced stage of nutritional transition

Acesso aos procedimentos cirúrgicos em uma unidade de saúde da família: uma iniciativa para melhorar o cuidado e o acesso a unidades básicas de saúde

It was describe the implantation of small surgical procedures performed by physicians living in a Brazilian Family Health Unit. This is an experience report carried out in the city of Vitória, Espírito Santo, Brazil, describing the introduction of small surgical procedures by the Family and Community Medicine medical residency program in a Basic Health Unit (UBS) of the municipality. The selected US did not have a room for minor surgery procedures or the necessary materials. It was evidenced that the population demanded surgical complaints without resolution of the same ones, being these patients referenced to other specialties.O estudo descreve a implantação de pequenos procedimentos cirúrgicos realizados por médicos residentes em uma Unidade de Saúde da Família. Trata-se de um relato de experiência realizado na cidade de Vitória, Espírito Santo, Brasil, descrevendo a introdução de pequenos procedimentos cirúrgicos pelo programa de residência médica em Medicina de Família e Comunidade em uma Unidade Básica de Saúde (UBS) do município. As unidades selecionadas não tinham espaço para pequenos procedimentos cirúrgicos ou os materiais  necessários. Evidenciou-se que a população demandava queixas cirúrgicas sem resolução das mesmas, sendo esses pacientes encaminhados para outras especialidades

Percepção materna do estado nutricional do filho sob a óptica da análise dos resíduos ajustados

Backgroung: The maternal perception of the nutritional status of their children has several important social factors in its composition and it can be important in determine quality of children’s food. Objective: To assess social factors influencing maternal perception of her children´s nutritional status. Methods: Cross sectional study with school children from 6 to 10 years from a public school in São Paulo, Brazil. The data was obtained through a structured questionnaire applied to mothers and through children’s body mass index. Associations between variables were analyzed by the Qui-square test andby the adjusted residues analysis, with 5% of significance. The agreement between maternal perception and nutritional status was assessed through the Kappa test.   Results: We found incorrect perception in 45.8% of cases, from which 98.2% were underestimation, with 80% of underestimation for overweight children. We found poor and slight agreement for all cases. Adjusted residuals pointed eutrophic underestimation; better maternal perception forthe obese; better perception for mothers that attained middle and high school levels; underestimation for eutrophic boys and correct perception for eutrophic girls. Single mothers andthose who do not work outside tended to underestimate their eutrophic children. Conclusion: We found poor agreement for almost all cases, with exception to mothers of girls and those that do not work outside. A correct perception was related positively with lower education levels, being worse for mothers without a partner and for those who do not work outside. Mothers of girls, compared to mothers of boys, had a more accurate perception.Introdução: A percepção materna do estado nutricional de seus filhos apresenta diversos fatores sociais importantes em sua composição e ela pode ser um importante na determinação da qualidade de alimentação das crianças. Objetivo: Avaliar os fatores sociais que influenciam a percepção materna sobre o estado nutricional de seus filhos. Método: Estudo transversal com escolares de 6 a 10 anos de uma escola pública de São Paulo, Brasil. Os dados foram obtidos por meio de um questionário estruturado aplicado às mães e a partir de antropometria das crianças. As associações entre as variáveis foram analisadas pelo teste do Quiquadrado e pela análise dos resíduos ajustados, com 5% de significância. A concordância entre a percepção materna e o estado nutricional foi avaliada por meio do teste Kappa.   Resultados: Encontramos percepção incorreta em 45,8% dos casos, dos quais 98,2% foram de subestimação, com 80% de subestimação para crianças com sobrepeso. Encontramos concordância pobre e leve para todos os casos. Os resíduos ajustados apontaram para subestimação eutrófica; melhorpercepção materna para o obeso; melhor percepção para mães que atingiram o ensino fundamental e médio; subestimação para meninos eutróficos e percepção correta para meninas eutróficas. As mães solteiras e as que não trabalham fora tendem a subestimar seus filhos eutróficos. Conclusão: Encontramos baixa concordância para quase todos os casos, com exceção das mães de meninas e das que não trabalham fora. A percepção correta relacionou-se positivamente com a menor escolaridade, sendo pior para as mães sem companheiro e que não trabalham fora. As mães demeninas, em comparação com as mães de meninos, tiveram uma percepção mais precisa. &nbsp

Um modelo de aprendizagem de máquina interpretável para triagem de COVID-19

Introduction: the Coronavirus Disease 2019 (COVID-19) is a viral disease which has been declared a pandemic by the WHO. Diagnostic tests are expensive and are not always available. Researches using machine learning (ML) approach for diagnosing SARS-CoV-2 infection have been proposed in the literature to reduce cost and allow better control of the pandemic. Objective: we aim to develop a machine learning model to predict if a patient has COVID-19 with epidemiological data and clinical features. Methods: we used six ML algorithms for COVID-19 screening through diagnostic prediction and did an interpretative analysis using SHAP models and feature importances. Results: our best model was XGBoost (XGB) which obtained an area under the ROC curve of 0.752, a sensitivity of 90%, a specificity of 40%, a positive predictive value (PPV) of 42.16%, and a negative predictive value (NPV) of 91.0%. The best predictors were fever, cough, history of international travel less than 14 days ago, male gender, and nasal congestion, respectively. Conclusion: We conclude that ML is an important tool for screening with high sensitivity, compared to rapid tests, and can be used to empower clinical precision in COVID-19, a disease in which symptoms are very unspecific.  Introdução: a Doença do Coronavírus 2019 (COVID-19) é uma doença viral que foi declarada uma pandemia pela OMS. Testes diagnósticos são caros e nem sempre estão disponíveis. Pesquisas utilizando a abordagem de aprendizado de máquina (ML) para o diagnóstico de infecção por SARS-CoV-2 têm sido propostas na literatura para reduzir custos e permitir melhor controle da pandemia. Objetivo: nosso objetivo é desenvolver um modelo de aprendizado de máquina para prever se um paciente tem COVID-19 com dados epidemiológicos e características clínicas. Método: usamos seis algoritmos de ML para triagem de COVID-19 por meio de predição diagnóstica e fizemos uma análise interpretativa usando modelos SHAP e importâncias de recursos. Resultados: nosso melhor modelo foi o XGBoost (XGB) que obteve área sob a curva ROC de 0,752, sensibilidade de 90%, especificidade de 40%, valor preditivo positivo (VPP) de 42,16% e valor preditivo negativo ( VPL) de 91,0%. Os melhores preditores foram febre, tosse, história de viagem internacional há menos de 14 dias, sexo masculino e congestão nasal, respectivamente. Conclusão: Concluímos que o ML é uma importante ferramenta de triagem com alta sensibilidade, em comparação aos testes rápidos, e pode ser usado para potencializar a precisão clínica na COVID-19, doença em que os sintomas são muito inespecíficos