Acompanhamento antropométrico de uma coorte de crianças e adolescentes infectados pelo vírus da imunodeficiência humana atendidos em centro de referência

Exportado OPUSMade available in DSpace on 2019-08-14T03:13:58Z (GMT). No. of bitstreams: 1 marcelle_marie_martins_maia_ultimaversao_tese__1_.pdf: 1146126 bytes, checksum: 23f0a5fe06d68bd4aa9276eeeaace4aa (MD5) Previous issue date: 9Como o acesso ao tratamento antirretroviral e a sobrevida das crianças e adolescentes infectadas com HIV aumentaram, surge a necessidade do conhecimento das possíveis alterações no crescimento e no perfil lipídico neste grupo de pacientes. O estudo em questão longitudinal foi realizado em Belo Horizonte, Minas Gerais com crianças e adolescentes infectadas verticalmente pelo HIV-1 atendidos no Ambulatório de AIDS Pediátrica da Universidade Federal de Minas Gerais. Essa coorte aberta foi iniciada em fevereiro de 1989 e as análises foram realizadas com os dados de crianças e adolescentes virgens de tratamento que iniciaram o primeiro esquema de terapia antirretroviral combinado (TARVc) a partir de 1998 até 2008. O objetivo geral do presente estudo foi avaliar longitudinalmente o crescimento e os níveis séricos de triglicérides e colesterol de crianças e adolescentes infectados com HIV. Os dados foram analisados utilizando modelo de regressão linear de efeitos mistos e ajustados por máxima verossimilhança restrita. A avaliação longitudinal do crescimento foi realizada com 172 (cento e setenta e duas) crianças e adolescentes. E a avaliação longitudinal dos níveis séricos de triglicérides e colesterol, com vinte e sete. Foi observado no final das análises em questão que: ao longo do período de exposição à TARVc, as meninas eram mais pesadas e altas do que os meninos; as crianças que foram expostas à TARVc com inibidores de protease (IP) apresentaram escore-z peso-idade significativamente maior do que aquelas expostas aos inibidores de transcriptase reversa não análogo de nucleosídeos (ITRNN); as crianças expostas aos IPs eram mais altas do que aquelas expostas aos ITRNNs; as crianças que iniciaram TARVc com carga viral 5 log eram mais leves do que as crianças que iniciaram com carga viral < 5 log, até um ano de exposição; ao longo do período de exposição as crianças apresentaram aumento significativo do escore-z peso-idade e alturaidade; o aumento de triglicérides e colesterol sérico foram observados em quinze (55,5%) e sete (29,2%) antes de iniciar terapia antirretroviral e em onze (40,7%) e 15 (62,5%) após 41,9 meses (mediana) sob uso de TARVc, respectivamente; crianças que iniciaram TARVc com ITRNN mostrou que a exposição aos antiretrovirais está associada com níveis séricos menores de triglicérides e maiores de colesterol quando comparadas com crianças não expostas aos antiretrovirais; crianças que iniciaram TARVc baseado em IP apresentaram níveis séricos maiores de triglicérides e colesterol; crianças expostas aos ITRNN e aos IP apresentavam aumento de 23,4 mg/dL e 52,5 mg/dL respectivamente, nos níveis séricos de colesterol com associação com a contagem de CD4. O presente trabalho mostra o efeito positivo da introdução da terapia antirretroviral no crescimento. O estudo do perfil lipídico mostra que o tratamento antirretroviral pode estar associado com alterações dos níveis séricos de triglicérides e colesterol.Access to antiretroviral treatment and survival of HIV-infected children and adolescents increased, so it has been necessary to describe the growth and lipid profile alterations in these patients. A cohort study on Belo Horizonte, Minas Gerais. Following vertically HIV-infected children and adolescents at the Pediatrics AIDS Outpatient Center, Federal University of Minas Gerais. This open cohort started in February 1989 and the analyses were carried out using information of HIV infected children and adolescents who started highly active antiretroviral therapy (HAART) from 1998 until 2008. The purpose of this study was to longitudinally assess the growth, triglycerides and cholesterol profile of HIV-infected children and adolescents. Data were analyzed using mixed-effects linear regression models fitted by restricted maximum likelihood. The longitudinal evaluation of growth was carried with one hundred and seventy two HIV infected children and adolescents, whereas the longitudinal evaluation of triglycerides and cholesterol profile, with twentyseven. At the end of the analysis it was observed that: during the period of exposure HAART girls were heavier and taller than the boys; children who were exposure to PI had significant increase in weight-for-age z-score, and were taller than those used NNRTI; those who had viral load 5 log at baseline were weightiness compared with those who started HAART with viral load < 5 log, until one year of exposure; during the period of exposure the children showed significant increase in the z-score weigh-for-age and heightfor- age; increased levels of triglycerides and cholesterol were observed in fifteen (55.5%) and seven (29.2%) at baseline and in eleven (40.7%) and fifteen (62.5%) after median f 41.9 months using HAART; children exposed to NNRTI had decrease on triglycerides and increased of cholesterol levels compared to baseline with longitudinal effect measured monthly with exposure to antiretroviral; children exposed to PI had increment on triglycerides and cholesterol levels; an increment in cholesterol levels of 23.4 mg/dL and 52.5 mg/dL were observed in exposed both to NNRTI and PI, respectively and it was associated to CD4 count. The present work shows the positive effect of the introduction of antiretroviral therapy on growth. The study of lipid profile shows that antiretroviral therapy may be associated with changes in serum triglycerides and cholesterol

Impacto da terapia antirretroviral combinada no crescimento e nas taxas de hospitalização de crianças infectadas pelo HIV

OBJETIVO: Avaliar mudanças em parâmetros de crescimento e hospitalização em crianças infectadas pelo vírus da imunodeficiência humana (human immunodeficiency virus, HIV) em uso de terapia antirretroviral combinada. MÉTODOS: As crianças foram avaliadas durante os primeiros 3 anos de terapia. A resposta clínica foi avaliada a cada 24 semanas com base em escores z de peso/idade e altura/idade. Modelos de regressão linear foram utilizados para identificar preditores de resposta clínica. Dados relevantes relativos à hospitalização dos pacientes foram obtidos retrospectivamente mediante revisão dos prontuários clínicos. RESULTADOS: Um total de 196 crianças foram avaliadas. A média do escore z aumentou de -1,62 (±1,32) no início do estudo para -1,14 (±1,12) na semana 24. A média do escore z de altura/idade aumentou de -1,88 (±1,45) para -1,66 (±1,18). Foi observada associação entre maiores escores z no início do estudo e maiores aumentos nos escores z de peso/idade ao longo do tempo. Cargas virais mais baixas e escores de altura/idade mais altos também estiveram associados com maior recuperação do crescimento. Oitenta e cinco crianças (43,3%) foram hospitalizadas. A maioria das internações esteve associada a causas infecciosas, sendo apenas dois casos de infecções oportunistas. CONCLUSÃO: A terapia combinada resultou em aumentos significativos nos escores z de peso/idade e altura/idade. A menor idade, o uso de inibidores de protease e a classificação clínica em estágios avançados estiveram associados a uma maior efetividade do tratamento. Além disso, o estudo demonstrou a eficácia da terapia para a redução das taxas de hospitalização, morte e incidência de infecções oportunistas entre crianças portadoras do HIV

The prevalence of malnutrition and its risk factors in children attending outpatient clinics in the city of Manaus, Amazonas, Brazil.

O objetivo do estudo foi determinar a preval?ncia de desnutri??o e fatores de risco em crian?as de 0-10 anos, atendidas em ambulat?rios em Manaus, Amazonas, Brasil. Foi conduzido um estudo epidemiol?gico transversal em uma amostra de 347 crian?as. As entrevistas foram realizadas com os pais ou respons?veis, foram coletados dados socioecon?mico e de consumo alimentar de cada crian?a. Para avalia??o diet?tica utilizou-se um question?rio semiquantitativo de freq??ncia alimentar. Amostras de fezes foram examinas por microsc?pio ?tico. Medidas antropom?tricas foram transformadas em percentis e z-escore e o estado nutricional foi avaliado pelos indicadores do National Center for Health Statistics (NCHS) e do Centers for Disease Control (CDC). Fatores de risco associados ? desnutri??o foram analisados usando modelo de regress?o log?stica com efeito aleat?rio. As preval?ncias de baixo peso, d?ficit de estatura e d?ficit de peso foram 18,1, 15,5 e 10,7% pela refer?ncia do CDC e 14,3, 17,3 e 4,4% do NCHS. A preval?ncia de d?ficit de peso foi maior quando estimada pelo CDC em compara??o ao NCHS (p=0,02). A preval?ncia de parasitoses intestinais foi de 58,8%. Os fatores de risco associados a desnutri??o foram: baixo n?vel educacional dos respondentes (OR=4.55), ingest?o cal?rica <54.5 kcal/kg (OR=4.55), crian?as na faixa et?ria de 6-10 anos (OR=3.54), e consulta pedi?trica como motivo de visita ao ambulat?rio (OR=2.71). Na popula??o estudada, desnutri??o (baixo peso, d?ficit de estatura e d?ficit de peso) e infec??o parasit?ria ainda representam um problema de sa?de p?blica. Os fatores de risco confirmam a influ?ncia dos fatores s?cio econ?micos no estado nutricional das crian?as.The objective of this study was to determine the prevalence of malnutrition and its risk factors in children aged 0-10 years attending outpatient clinics in Manaus, Amazonas, Brazil. A cross-sectional epidemiological study of a population of 347 children was conducted. Data concerning socio-economic levels and food consumption were obtained by interviewing the accompanying guardian of each child. Dietetic evaluation was conducted using a semi-quantitative food frequency questionnaire, and faecal samples were examined by optical microscopy. Anthropometric measurements were transformed into percentiles and z-scores, and nutritional status was evaluated by reference to National Center for Health Statistics (NCHS) and Centers for Disease Control (CDC) indicators. Factors associated with undernutrition were analysed using a random-effects logistic regression model. The overall prevalences of underweight, stunting and wasting were 18.1, 15.5 and 10.7%, respectively, with reference to CDC growth curves, and 14.3, 17.3 and 4.4%, respectively, with reference to NCHS growth curves. The overall prevalence of wasting was statistical higher according to the CDC reference than that estimated using the NCHS reference (P=0.02). The prevalence rate of intestinal parasites was 58.8%. Risk factors associated with malnutrition were: low educational level of guardian respondent (OR=4.55), energy intake <54.5 kcal/kg (OR=4.55), children in age group 6-10 years (OR=3.54), and attendance at outpatient clinic for paediatric visit (OR=2.71). In the studied population, malnutrition (stunting, underweight and wasting) and parasite infection still represent serious public health problems. The risk factors identified in the present study confirm the influence of socio-economic factors on the nutritional status of children

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally